Exploring Competence for Outpaent Psychotherapists Treang … · 2018-04-04 · • ED-speciﬁc...

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ExploringCompetenceforOutpa9entPsychotherapistsTrea9ngEa9ngDisorders

Presentedby:AlliSpoCs-DeLazzer,M.A.,LMFT,LPCC,CEDS

LaurenMuhlheim,Psy.D.,CEDS

AlliSpoCs-DeLazzer,M.A.,LMFT,LPCC,CEDS,and

LaurenMuhlheim,Psy.D.,CEDS,

havenocommercialintereststodisclose.

©2016AlliSpoCs-DeLazzer&LaurenMuhlheim

Welcome!•  Inspira9onfor“Ea9ngDisordersandScopeofCompetencefor

Outpa9entPsychotherapists”(SpoCs-DeLazzer&Muhlheim,2016)inPrac9ceInnova9ons,ajournaloftheAmericanPsychologicalAssocia9on

•  Goalsforpresenta9on:wecan’tprovidecompetencein60or90minutes,butthegoalistocollec9velycreateahelpfultoolboxtoday


Whatiscompetence?Whycompetence?


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•  Ethicscodes•  Whycompetencesoimportantwithea9ngdisorder(ED)

popula9on

•  Elevateddeathrates•  Myths

•  Psychologicalillnesso^enwithphysicalconsequences•  ED-specifictrainingisnotautoma9callyprovidedforeither

medicalormentalhealthprac99oners


ConsensusdomainsforEDtreatment

•  AssessmentandDiagnosis

•  MedicalFactors

•  Nutri9onandMalnutri9on

•  TreatmentStrategies

•  Mul9disciplinaryCollabora9on/LevelsofCare


THESETUP

Therapist’sknowledge•  Diagnoses•  TOOLBOX:•  Diagnos1candsta1s1calmanualofmentaldisorders(5th

ed.)(AmericanPsychiatricAssocia9on,2013)


Therapist’sknowledge•  Goalsoftreatment(AED,2016)

•  MEDICALSTABILIZATION•  Includesresump9onofmenses(whereappropriate)•  Managementofacuteandchronicmedicalcondi9ons

•  NUTRITIONALREHABILITATION•  Weightrestora9on•  RestoremealpaCernsthatpromotehealthandsocialconnec9ons

•  NORMALIZATIONOFEATINGBEHAVIOR•  Cessa9onofrestric9veorbingeea9ngand/orpurgingbehaviors•  Elimina9onofdisorderedorritualis9cea9ngbehaviors

•  PSYCHOSOCIALSTABILIZATION•  Evalua9onandtreatmentofanycomorbidpsychologicaldiagnoses•  Re-establishmentofappropriatesocialengagement•  ImprovementinpsychologicalsymptomsassociatedwithED•  Improvedbodyimage


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•  TOOLBOX(nextslide):•  NineTruthsAboutEa9ngDisorders(Bulik,2015)


Therapist’sknowledge(conCnued)•  Therapistquali9es•  language•  myths

•  psychoeduca9on•  andmore

NINETRUTHSABOUTEATINGDISORDERSTruth#1:Manypeoplewithea9ngdisorderslookhealthy,yetmaybeextremelyill.Truth#2:Familiesarenottoblame,andcanbethepa9ents’andproviders’bestalliesintreatment.Truth#3:Anea9ngdisorderdiagnosisisahealthcrisisthatdisruptspersonalandfamilyfunc9oning.

Truth#4:Ea9ngdisordersarenotchoices,butseriousbiologicallyinfluencedillnesses.Truth#5:Ea9ngdisordersaffectpeopleofallgenders,ages,races,ethnici9es,bodyshapesandweights,sexualorienta9ons,andsocioeconomicstatuses.Truth#6:Ea9ngdisorderscarryanincreasedriskforbothsuicideandmedicalcomplica9ons.

Truth#7:Genesandenvironmentplayimportantrolesinthedevelopmentofea9ngdisorders.Truth#8:Genesalonedonotpredictwhowilldevelopea9ngdisorders.Truth#9:Fullrecoveryfromanea9ngdisorderispossible.Earlydetec9onandinterven9onareimportant.~~

Producedincollabora9onwithDr.CynthiaBulik,PhD,FAED,whoservesasdis9nguishedProfessorofEa9ngDisordersintheSchoolofMedicineattheUniversityofNorthCarolinaatChapelHill,“NineTruths”isbasedonDr.Bulik’s2014“9Ea9ngDisordersMythsBusted”talkattheNa9onalIns9tuteofMentalHealth.

Leadingassocia9onsinthefieldofea9ngdisordersalsocontributedtheirvaluableinput.

TheAcademyforEa9ngDisordersalongwithothermajorea9ngdisorderorganiza9ons(FamiliesEmpoweredandSuppor9ngTreatmentofEa9ngDisorders,Na9onalAssocia9onofAnorexiaNervosaandAssociatedDisorders,Na9onalEa9ngDisordersAssocia9on,TheInterna9onalAssocia9onofEa9ngDisordersProfessionalsFounda9on,Residen9alEa9ngDisordersConsor9um,Ea9ngDisordersCoali9onforResearch,Policy&Ac9on,Mul9-ServiceEa9ngDisordersAssocia9on,BingeEa9ngDisorderAssocia9on,Ea9ngDisorderParentSupportGroup,Interna9onalEa9ngDisorderAc9on,ProjectHEAL,andTransFolxFigh9ngEa9ngDisorders)willbedissemina9ngthisdocument.


EmpiricallySupportedEDPracCceGuidelines•  TOOLBOX:•  Ea1ngdisorders:Coreinterven1onsinthetreatmentand

managementofanorexianervosa,bulimianervosa,andrelatedea1ngdisorders.(NICE,2004)

•  Treatmentofpa9entswithea9ngdisorders(3rded.)(APA,2006)&Guidelinewatch(APA,2012)

•  RoyalAustralianandNewZealandCollegeofPsychiatristsclinicalprac9ceguidelinesforthetreatmentofea9ngdisorders(Hay,etal.,2014)


TOOLBOXHELPERS•  TOOLBOX:

•  NEDAtoolkitforparents(Na9onalEa9ngDisordersAssocia9on,n.d.)

•  EDJournals•  Interna1onalJournalofEa1ngDisorders•  Ea1ngDisorders:TheJournalofTreatmentand

Preven1on•  TheEa1ngDisordersReview•  JournalofEa1ngDisorders


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AssessmentandDiagnosis


AssessmentandDiagnosis

AccordingtotheAmericanPsychiatricAssocia9onGuidelines(2006)anEDassessmenttypicallyincludesa:•  thoroughreviewofthepa9ent’sheightandweight

history•  restric9veandbingeea9ngandexercisepaCernsand

theirchanges•  purgingandothercompensatorybehaviors•  coreaptudesregardingweight,shape,andea9ng•  andassociatedpsychiatriccondi9ons


AssessmentandDiagnosis(conCnued)

SomeEDMeasuresyoumightconsiderusing:

•  SCOFF•  EDE-Q6•  EDDS•  EAT-26•  Others?•  TOOLBOX:Transi9oningfromDSM-IVtoDSM-5:A

systema9creviewofea9ngdisorderprevalenceassessment(Dahlgren&Wis9ng,2016)


MedicalFactors


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MedicalFactors•  Therapist’srole,psychoeduca9onalaspects,teamingwithMD,

knowingwhentorefertoMDand/orER

•  TOOLBOX:•  Ea1ngdisorders,aguidetomedicalcare:Cri1calpointsfor

earlyrecogni1on&medicalriskmanagementinthecareofindividualswithea1ngdisorders(AED,2016).

•  Ea1ngdisordersintheemergencydepartmentcri1calpointsfortherecogni1onandmedicalmanagementofindividualswithea1ngdisordersintheacutecareseFng(AED,2012).

•  Poten9alneedforpsychotropicmedica9onevalua9on


NutriConandMalnutriCon


NutriConandMalnutriCon•  Thephysiologicandpsychologicalconsequencesofstarva9on

andbinge/purgethatcanbeconfusedwithEDpathology

•  TOOLBOX:•  TheAncelKeysstudyknownastheMinnesotaStarva9on

Experiment(Keysetal.,1950)

•  Observa9onsonhumanbehaviorinexperimentalsemi-starva9onandrehabilita9on(Franklinetal.,1948)

•  Meallogs/teamingwithanRD

•  Refeedingsyndrome


TreatmentStrategies


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TreatmentStrategies•  Currentstateofevidence-basedtreatmentsforanorexia,

bulimia,andbinge-ea9ngdisorder

•  Obesityvs.BED

•  Primacyofweightrestora9onforAN

•  Includingfamily,spousesandothersintreatment

•  Groupwork

•  Thinbias/weights9gma


TreatmentStrategies(conCnued)•  Cogni9ve-behavioraltherapy(CBT)•  Family-basedtreatment(FBT)•  Interpersonaltherapy(IPT)•  Dialec9calbehaviortherapy(DBT)•  Self-helpandguidedself-help•  Specialsuppor9veclinicalmanagement(SSCM)•  Acceptanceandcommitmenttherapy(ACT)•  Mindfulness-basedea9ngawarenesstraining(MB-EAT)•  Integra9veCogni9ve-Affec9veTherapy(ICAT)•  TOOLBOX:CCIInforma9onPacks-OvercomingDisordered

Ea9ng


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MulCdisciplinaryCollaboraConandLevelsofCare


MulCdisciplinaryCollaboraConandLevelsofCare

TeamMembers

•  Psychotherapist•  RegisteredDie99an•  MedicalDoctor•  Psychiatrist

•  Idealversusreality•  Alliance


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LevelsofCareAPA(2006)providesachart,Table8,detailingsuggestedcriteriaforeachsteppedlevelofcare:•  medicalstatus•  suicidality•  weight(asapercentageofhealthybodyweight)•  mo9va9ontorecover,includingcoopera9veness,insight,and

abilitytocontrolobsessivethoughts•  co-occurringdisorders,includingsubstanceuse,depression,

andanxiety•  structureneededforea9ngandgainingweight•  abilitytocontrolcompulsiveexercising


MulCdisciplinaryCollaboraConandLevelsofCareStroberandJohnson(2012)specifiedthefollowingcondi9onsthatcanwarrantatransi9ontoahigherlevelofcareforpa9entswithAN:

•  steadyweightdeclineoverthefirst3weeksoftreatment

•  ini9alstabiliza9onofweightwithoutmeaningfulgainbytheendofmonth2,or

•  ini9alweightgainwithaplateaubelowfullweightrestora9onlas9ngforatleast6con9nuousweeks


MulCdisciplinaryCollaboraConandLevelsofCare(conCnued)•  TOOLBOX:•  Table8,LevelofCareGuidelinesforPa9entswithEa9ng

Disorders(APA,2006)

•  SCANAdvancePrac1ceGuideline:Transi9oningcareeffec9vely:Aguidefortheexpertlevelregistereddie99annutri9onist(RDN)workingwithclientswithea9ngdisorders(Alphinetal.,2014)

•  StroberandJohnson(2012)


TOOLBOX:SpoCs-DeLazzer,A.,&Muhlheim,L.(2016).Ea9ngdisordersandscopeofcompetenceforoutpa9entpsychotherapists.Prac1ceInnova1ons,1(2),89-104.


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Conclusion1)  Whatmightyoubetakingawayregardingtoolsforyour

toolboxesand/orareasofexplora9on?

2)  Whatcanormightbeaddedtothiscollec9vetoolboxfromyourownEDtreatmenttoolboxes?

Forbestprac1ces,itisaprac11oner’sresponsibilitytoconsultappropriateprofessionals,ethicalcodes,stateandlocallaws,applicableresources,con1nuingeduca1oncourses,and/orper1nentliteraturesothataclinicianmayworkatanappropriatecompetencelevelandwithinthelegalparametersdesignatedbystateandlocalauthori1esand/orthelicensingboard.


CONTACT

[email protected]

(818)388-2355

[email protected]

(323)743-1122


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Exploring Competence for Outpaent Psychotherapists Treang … · 2018-04-04 · • ED-speciﬁc...

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