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Doing What Works
An Integrative System for the Treatment of Eating Disorders from Diagnosis to Recovery
Abigail Horvitz Natenshon
ISBN: 978-0-87101-390-3. 2009. Item #3903. 380 pages.
ISBN: 978-0-87101-390-3. 2009. Item #3903. 380 pages.
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Eating disorders at times leave practitioners feeling as emotionally challenged and out of control as the patients they treat. This is the first book of its kind to provide support, direction, clarity, and optimism to clinicians treating these disorders. In describing what to do and how to do ‘what works,’ reader-friendly strategies and holistic guidelines bring together science and human personality, protocols and art, skill and instinct, evidence-based research and practicable clinical applications to provide a fully integrative approach to eating disorders care.
In Doing What Works, Ms. Natenshon fills the gaps that currently exist in professional education and practice and in the general understanding of what sets eating disorder diagnosis and treatment apart from other disorders. The author, a psychotherapist with 40 years of experience treating eating disorders in patients of all ages with a specialty in working with children and families, speaks to health professionals and parents as pivotal advocates for the child in treatment and recovery.
In Doing What Works, Ms. Natenshon fills the gaps that currently exist in professional education and practice and in the general understanding of what sets eating disorder diagnosis and treatment apart from other disorders. The author, a psychotherapist with 40 years of experience treating eating disorders in patients of all ages with a specialty in working with children and families, speaks to health professionals and parents as pivotal advocates for the child in treatment and recovery.
Foreword
Acknowledgments
Chapter 1: A Treatment Field in Transition: Where We’ve Been and Where We’re Going
Chapter 2: Eating Disorders 101: Knowledge Is Power
Chapter 3: Soul Searching: Assessing the Personal Side of Professional Challenges
Chapter 4: Eating Disorders and the Diagnostic and Statistical Manual of Mental Disorders
Chapter 5: Diagnosis and Eating Disorders: Seeing the Whole Picture
Chapter 6: Getting Started: Structuring the Diagnostic Process
Chapter 7: Diagnosing and Managing Eating Disorders, Feeding Disorders, and Picky Eating Syndrome in Young Children
Chapter 8: The Therapist’s Unique Use of Self in Treatment
Chapter 9: Partnering for Success: Multidisciplinary Treatment Teamwork
Chapter 10: Treatment Modalities and Milieus: Integrating Diverse Resources
Chapter 11: As the Brain Learns, People Change: Innovative Treatment Approaches That Work
Chapter 12: Structuring Eating Disorder Treatment: Laying the Foundation of Care
Chapter 13: Eating Disorder Treatment Methods and Approaches: Differentiating and Integrating Methodological Techniques
Chapter 14: Practical Building Blocks of Strategic Interviewing: Borrowing Freely From Diverse Treatment Approaches
Chapter 15: Recovery, Aftercare, and Relapse: Sustaining the Integrity of the Healing Process Through the Long Haul
References
Index
About the Author
Acknowledgments
Section 1: Preparing Yourself to Treat Eating Disorders
Chapter 1: A Treatment Field in Transition: Where We’ve Been and Where We’re Going
Chapter 2: Eating Disorders 101: Knowledge Is Power
Chapter 3: Soul Searching: Assessing the Personal Side of Professional Challenges
Section 2: Diagnostic Nuts and Bolts
Chapter 4: Eating Disorders and the Diagnostic and Statistical Manual of Mental Disorders
Chapter 5: Diagnosis and Eating Disorders: Seeing the Whole Picture
Chapter 6: Getting Started: Structuring the Diagnostic Process
Chapter 7: Diagnosing and Managing Eating Disorders, Feeding Disorders, and Picky Eating Syndrome in Young Children
Section 3: Tapping Treatment Resources
Chapter 8: The Therapist’s Unique Use of Self in Treatment
Chapter 9: Partnering for Success: Multidisciplinary Treatment Teamwork
Chapter 10: Treatment Modalities and Milieus: Integrating Diverse Resources
Section 4: The Eating Disorders Treatment Toolbox
Chapter 11: As the Brain Learns, People Change: Innovative Treatment Approaches That Work
Chapter 12: Structuring Eating Disorder Treatment: Laying the Foundation of Care
Chapter 13: Eating Disorder Treatment Methods and Approaches: Differentiating and Integrating Methodological Techniques
Chapter 14: Practical Building Blocks of Strategic Interviewing: Borrowing Freely From Diverse Treatment Approaches
Section 5: The Reality of Recovery
Chapter 15: Recovery, Aftercare, and Relapse: Sustaining the Integrity of the Healing Process Through the Long Haul
References
Index
About the Author
I can remember the moment.
I had been told all too many times that I needed to make the decision between listening to the eating disorder and listening to my own voice, yet for seven long years it was difficult to distinguish between the two. Through multiple hospitalizations, months at intensive day hospital programs, and years of therapy, weigh-ins, doctors’ appointments, and nutritionist visits, I never lost the hope that one day the decision to recover would seem easier and that living a full and healthy life would be within my reach. I was on a path to complete self-destruction; without the enduring support of my family, friends, and treatment teams along the way, I would have succeeded. My journey was filled with many losses – the loss of a true college experience, the loss of many friends, the loss of a fully functioning heart (working now, thanks to a pacemaker), and the loss of the innocence that I was invincible, as in fact I learned that I was not.
Thankfully, I managed to make it to that magical point in time when my own voice prevailed. It was the summer between my first and second year of graduate school. I hit my own personal rock bottom and finally accepted the help that had been right before my eyes all along my journey – including embracing the recommendations made so frequently to accept the support of medication. Eight weeks after my first true medication trial, I woke up and made the decision no longer to listen to the voice of the eating disorder. I remember the moment vividly.
After that point in time, my mind and my body finally began healing together. It took years of adopting new patterns, taking on new challenges (including a move across the country), making new friendships, establishing myself in a new career, and using adjunctive healing supports before I could feel confident in my recovery. But it did happen. I did recover. The journey was long and the pathway at times painful, but the results have been both rewarding and long lasting. Over 10 years have passed since that special moment, and with a wonderful, loving husband, two healthy children (born without fertility assistance), and a fulfilling career, I can say that I am stronger and more present as a result of my struggles through my eating disordered years.
My success story is not isolated. Long-lasting recovery from an eating disorder is possible, although not simple or easy. Fighting through an eating disorder is as complicated as the treatment it requires. One must have tenacity, patience, endurance, and continual hope to sustain the momentum for change. Recovery involves taking risks, being humble, asking for help when needed, and remaining connected with others who are committed to helping one grow each day. Support and connections to others are critical. Being open to using adjunctive approaches, thinking outside the box, and problem solving are all at the core of success throughout treatment and recovery.
What is required of clients for recovery from an eating disorder is essential for those providing the treatment as well. It is therefore no surprise that the field of eating disorder treatment is filled with clinicians who have completed their own recovery journeys and have been blessed to feel the beauty and joy of life without battling eating disordered thoughts or behaviors. We become involved in this difficult work because we have been able to experience firsthand the power of the therapeutic connection, the challenges and possibilities of recovery, and most of all the real belief that recovery is possible. This has been my motivation to enter the field of clinical social work and to mentor novice clinicians in becoming more present, caring clinicians.
I met Abbie Natenshon 18 years ago, when I was first diagnosed with anorexia nervosa and had to return home from my first semester in college. At 18 years of age, I had just been released from my first hospitalization and had just begun the grueling task of recovery. For almost six years, through four years of college and my first years of work as a teacher, Abbie listened, supported, and cared for me unconditionally. I never once doubted her commitment to my full and enduring recovery. Through her kindness, wisdom, and encouragement, and mostly through her continual presence in the moments of our sessions, I learned that there was too much to lose from the eating disorder and too much possibility for losing hope in myself.
A quick Internet search 10 years after I finished treatment led me back to the therapist who not only built my endurance for the long recovery tasks ahead, but also first exposed me to the field of clinical social work, a field that is at the core of who I am today. I e-mailed her to thank her for her unconditional support during a difficult time in my life and to let her know about her impact on me through the years.
What happened after I pressed the send button was in itself magical. Abbie responded. Not only did she remember who I was after all of those years apart, but she also remembered the details of my experiences as if they had happened yesterday. She continued to show the same interest and enthusiasm in my recovery as she did in my years of treatment. And since the time of our reconnection, she has continued to be a source of support and guidance, but this time in the role of professional and personal mentor as I continue to grow as a therapist, a wife, and a mother.
On behalf of your clients over the past 40 years, Abbie, I thank you. And on behalf of the clinicians who can now also hear your compassionate, honest, patient, and present voice through the pages of Doing What Works, I thank you as well. I know clinicians around the world will be better prepared for working with clients with eating disorders as a result of reading this book, and I know hundreds and thousands of individuals like me will recover and lead healthy and fulfilling lives as a result.
This book gets to the heart of the healing process – what it means and what it takes. It describes a uniquely human process, spoken through the voice of a uniquely experienced and committed practitioner. Within this book, you will discover and learn how it all works in becoming best prepared to do what works for your clients, their families, your team, and yourself, in life as well as in your professional encounters.
Kimberly Israel, LCSW, MPH, PPSC
I had been told all too many times that I needed to make the decision between listening to the eating disorder and listening to my own voice, yet for seven long years it was difficult to distinguish between the two. Through multiple hospitalizations, months at intensive day hospital programs, and years of therapy, weigh-ins, doctors’ appointments, and nutritionist visits, I never lost the hope that one day the decision to recover would seem easier and that living a full and healthy life would be within my reach. I was on a path to complete self-destruction; without the enduring support of my family, friends, and treatment teams along the way, I would have succeeded. My journey was filled with many losses – the loss of a true college experience, the loss of many friends, the loss of a fully functioning heart (working now, thanks to a pacemaker), and the loss of the innocence that I was invincible, as in fact I learned that I was not.
Thankfully, I managed to make it to that magical point in time when my own voice prevailed. It was the summer between my first and second year of graduate school. I hit my own personal rock bottom and finally accepted the help that had been right before my eyes all along my journey – including embracing the recommendations made so frequently to accept the support of medication. Eight weeks after my first true medication trial, I woke up and made the decision no longer to listen to the voice of the eating disorder. I remember the moment vividly.
After that point in time, my mind and my body finally began healing together. It took years of adopting new patterns, taking on new challenges (including a move across the country), making new friendships, establishing myself in a new career, and using adjunctive healing supports before I could feel confident in my recovery. But it did happen. I did recover. The journey was long and the pathway at times painful, but the results have been both rewarding and long lasting. Over 10 years have passed since that special moment, and with a wonderful, loving husband, two healthy children (born without fertility assistance), and a fulfilling career, I can say that I am stronger and more present as a result of my struggles through my eating disordered years.
My success story is not isolated. Long-lasting recovery from an eating disorder is possible, although not simple or easy. Fighting through an eating disorder is as complicated as the treatment it requires. One must have tenacity, patience, endurance, and continual hope to sustain the momentum for change. Recovery involves taking risks, being humble, asking for help when needed, and remaining connected with others who are committed to helping one grow each day. Support and connections to others are critical. Being open to using adjunctive approaches, thinking outside the box, and problem solving are all at the core of success throughout treatment and recovery.
What is required of clients for recovery from an eating disorder is essential for those providing the treatment as well. It is therefore no surprise that the field of eating disorder treatment is filled with clinicians who have completed their own recovery journeys and have been blessed to feel the beauty and joy of life without battling eating disordered thoughts or behaviors. We become involved in this difficult work because we have been able to experience firsthand the power of the therapeutic connection, the challenges and possibilities of recovery, and most of all the real belief that recovery is possible. This has been my motivation to enter the field of clinical social work and to mentor novice clinicians in becoming more present, caring clinicians.
I met Abbie Natenshon 18 years ago, when I was first diagnosed with anorexia nervosa and had to return home from my first semester in college. At 18 years of age, I had just been released from my first hospitalization and had just begun the grueling task of recovery. For almost six years, through four years of college and my first years of work as a teacher, Abbie listened, supported, and cared for me unconditionally. I never once doubted her commitment to my full and enduring recovery. Through her kindness, wisdom, and encouragement, and mostly through her continual presence in the moments of our sessions, I learned that there was too much to lose from the eating disorder and too much possibility for losing hope in myself.
A quick Internet search 10 years after I finished treatment led me back to the therapist who not only built my endurance for the long recovery tasks ahead, but also first exposed me to the field of clinical social work, a field that is at the core of who I am today. I e-mailed her to thank her for her unconditional support during a difficult time in my life and to let her know about her impact on me through the years.
What happened after I pressed the send button was in itself magical. Abbie responded. Not only did she remember who I was after all of those years apart, but she also remembered the details of my experiences as if they had happened yesterday. She continued to show the same interest and enthusiasm in my recovery as she did in my years of treatment. And since the time of our reconnection, she has continued to be a source of support and guidance, but this time in the role of professional and personal mentor as I continue to grow as a therapist, a wife, and a mother.
On behalf of your clients over the past 40 years, Abbie, I thank you. And on behalf of the clinicians who can now also hear your compassionate, honest, patient, and present voice through the pages of Doing What Works, I thank you as well. I know clinicians around the world will be better prepared for working with clients with eating disorders as a result of reading this book, and I know hundreds and thousands of individuals like me will recover and lead healthy and fulfilling lives as a result.
This book gets to the heart of the healing process – what it means and what it takes. It describes a uniquely human process, spoken through the voice of a uniquely experienced and committed practitioner. Within this book, you will discover and learn how it all works in becoming best prepared to do what works for your clients, their families, your team, and yourself, in life as well as in your professional encounters.
Kimberly Israel, LCSW, MPH, PPSC
Abigail H. Natenshon, MA, LCSW, GCFP, is an expert in the treatment of eating disorders who has treated children, adults, couples, families, and groups for the past 35 years. The author of When Your Child Has an Eating Disorder: A Step-by-Step Workbook for Parents and Other Caregivers (Jossey-Bass, 1999) and the e-book Doing What Works: A Professional's Guide for Treating Eating Disorders, Abigail is the founder and director of Eating Disorder Specialists of Illinois: A Clinic without Walls.
Abigail is also a Guild Certified Feldenkrais Practitioner. She is a leader in the use of this neurophysiologic approach to augment more traditional approaches to treating patients with eating disorders and body image disturbances. The Feldenkrais Method, based on the work of Dr. Moshe Feldenkrais, uses gentle, pleasurable movements and directed attention, to create a novel and remediated experience of the body and the self, offering patients enhanced self-awareness, stress-relief, and new options for personal growth and change.
Abigail has appeared on national television as an eating disorder expert on The Oprah Winfrey Show, The John Walsh Show, Starting Over (NBC), as well as on MSNBC and National Public Radio. She was featured in the fall of 2009 as an expert in a documentary about eating disorders produced by Fox TV.
Abigail is also a Guild Certified Feldenkrais Practitioner. She is a leader in the use of this neurophysiologic approach to augment more traditional approaches to treating patients with eating disorders and body image disturbances. The Feldenkrais Method, based on the work of Dr. Moshe Feldenkrais, uses gentle, pleasurable movements and directed attention, to create a novel and remediated experience of the body and the self, offering patients enhanced self-awareness, stress-relief, and new options for personal growth and change.
Abigail has appeared on national television as an eating disorder expert on The Oprah Winfrey Show, The John Walsh Show, Starting Over (NBC), as well as on MSNBC and National Public Radio. She was featured in the fall of 2009 as an expert in a documentary about eating disorders produced by Fox TV.
I’m a nutritionist who specializes in treating people with eating disorders. I’ve just finished reading Abigail Natenshon’s book, Doing What Works, and I feel compelled to tell you what a truly wonderful resource it is. It’s the most thorough and intelligent treatment of the subject that I’ve ever read and yet it’s written in a warm and accessible manner.
Eating disorders are often misunderstood and treatment remains a mystery for many professionals treating them. Every professional working with the eating disorder population needs to read this book. I can easily imagine this book becoming part of the curriculum in colleges, graduate schools and medical schools and then serving as the main resource for the entire professional treatment team... it’s that good. On behalf of my fellow eating disorder nutritionists, thank you for making it available.
Lynn Freedman M.Ed, RD, LD
Highland Park, IL
Eating disorders are often misunderstood and treatment remains a mystery for many professionals treating them. Every professional working with the eating disorder population needs to read this book. I can easily imagine this book becoming part of the curriculum in colleges, graduate schools and medical schools and then serving as the main resource for the entire professional treatment team... it’s that good. On behalf of my fellow eating disorder nutritionists, thank you for making it available.
Lynn Freedman M.Ed, RD, LD
Highland Park, IL
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