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Values in Recovery

10/12/2013

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To get better you need a reason.  I think you need to know what life do you want to have, and how do you want to live that life.

To wade through the mud of recovery you need to be able to set a course towards a destination where life without the eating disorder will be more rewarding than with the eating disorder.
One way that I try to help patients find a reason to get better is to help them tap into their "values", to what is important to them.  This can be hard to do, especially if you are wired to focus on the details in life rather than the big picture.  Looking at values is a very big picture question.  That is why some people have trouble holding their values in mind.


To help people explore their values I find a number of things helpful.  You may like to consider some of these questions.  When considering them however, don't feel a need to jump to a conclusion.  Feel free to "sit inside the question" for a while - ponder it for a bit.

A simple question may be "What kind of person do you want to be?"  When these questions are asked the ED mind will probably try to jump in with 'thin' or maybe 'but I don't deserve to be that kind of person".  Practice defusing from these thoughts, see them for the words they are. Let them pass and come back to the question.

"What kind of person do I want to be?".  Maybe, "if the eating disorder went away, as if by magic, what person would I like to be?"

What sort of son? What sort of daughter? What sort of mother or father? What sort of team member, student, employer ….? Think about all the roles you play in life.

I try to get people to think about seeing their values in action.  



How would you like to behave as a son/daughter etc.  How would you like to treat people?  This includes how would you like to treat yourself?  If the eating disorder was not strong how would you treat your body?


Often people may say, "I want to be a good mother".  Ask yourself, What are the qualities of "a good mother" that you would like to embody.  Try to see your values in a behavioural light. 


Clarifying our values can give recovery purpose and meaning.  They are a crucial part of the choice point to eat regularly to a meal plan.  


See if you can sit inside these questions to help you make the decisions that will move you towards recovery.


Best
Chris.
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United we stand, divided we drop out.

4/12/2013

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In my recent talk for ANZAED, I spoke about the need for clinicians to study what they do.  To measure our clinical outcomes to see if what we do, whatever that is, is helpful.

A recent paper published in IJED did a little bit of that and more.  The paper by The Redleaf Practice's Director of Family Therapy, Dr Stuart Murray, and The Redleaf Practice's Research Fellow, Scott Griffiths (and some other guy named le Grange) looked at the importance of collegial alliance when working in FBT.  This is something that we have written about before in a somewhat provocative way.
In looking at the article a few things jump out at me.  One of the most important things to me is that 
1) patients gained weight significantly in the 15 sessions the study covered
2) patients achieved significant thinking change in 15 sessions.
As Director of The Redleaf Practice, I am really pleased of these results (that were not really the point of the study).
3) Most change was achieved early. Those early sessions need to focus on behaviour change.
4) Neither Body Weight or EDE-Q score (which measures the thinking component of the eating disorder) predicted drop out.  To me this indicates that "severity" of the eating disorder should not be a factor in offering FBT or not.
5) The alliance between clinicians was pretty stable.  Either the team members were collaborating at the beginning or they never did.  FBT still polarises.
6)Collegial alliance was correlated with drop out.  If you want families to stay in a treatment program you need a unified team from the get go.
7)Collegial alliance was correlated with cognitive change (but not weight change). That is an interesting finding. The paper hypothesises that having a united therapy team, as well as united parenting team may help the patient feel more secure and this is helpful in changing cognitions. The teams, parenting and clinical need to be seen to be bigger than the eating disorder.  

Why is alliance not correlated to weight change.  Maybe because parents are not distracted by ideology that can divides teams (my way is the right way etc) because they simply focus on getting their child well.  Maybe clinicians should just focus on that.
CT
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    Author

    Chris Thornton is a Clinical Psychologist and the Clinical Director of The Redleaf Practice, a specialist outpatient clinic for the treatment of eating disorders.  He is interested in bringing elements of positive psychology, Cognitive Behavioural Therapy and Acceptance and Mindfulness approaches to the treatment of eating disorders.   

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