Anorexia and bulimia

[Adam Blatner]

This illustrates what I said about depression. I think the problem with treating any of these is that possibly six to thirty different therapeutic elements need to be woven together and individualized. The condition cannot be treated, but the person... 
        For example: Patient A has three strengths that she likes but 2 of them haven't been socially or educationally recognized... 
              She has a co-morbid condition of some sort, a mild or sub-clinical something, an addiction, some trauma, some other stuff
                Plus past experiences with therapists that need to be addressed, overall nutrition and health status
             Peer groups and reference groups are big, and these may be more important than family therapy
                   Where is she in relation to goal, overal morale in life, spirituality, forms of artistic or other kinds of expression?
                Education and career goals if any?  Allies who don't enable? Friends who do? 
                     Sexual history is big,  how much it's been oppressive, threatening, tumultuous, etc. Man-woman relations can be really weird nowadays.. 
                   Cultural reference groups, etc.
                           
     So I'm not sure that any single approach is sufficient, and trying to stick with even only two or three may be eliminating the potential value of twenty others... skill building, education, assertion training, sociometric status, etc. 

          That's why I'm trying to shift the identity of the Morenian movement from psychodrama or group psychotherapy to the more general category of tools, tools for psycho-social development, that can and should be applied preventively as well as in treatment, and that are open to integration with other approaches. 

 -  improv theatre, theatre games, spontaneity training of all sorts

 -  sociometry, attention to tele, cultivation of sensitivity to preferences (when that may have been repressed)

 - group, not just therapy, but for social action, encounter groups, group dynamics for education, interactive groups rather than mere aggregates listening to a lecture, really using the group dynamics, with group leader more out of control, 
        (Interestingly, Moreno's first use of what he called group treatment in 1931 at Sing Sing just involved administrative placement of certain prisoners with those others with whom it seemed there may be a benificient influence.)

 -  role theory, using a user-friendly language that clients and colleagues can more readily understand
             -- less pathological, frame things in terms of developing roles, more skill- and educational-- 
  
-  experiential learning, role training, 

-  nonverbal communications (internal cueing as well as interpersonal and group)
          exploring not only what was said, but how it was expressed,   using mirror, role reversal, group feedback, opportunities to see how others might do it, practice, etc.

- creativity as a goal, identifying inhibitions to spontaneity and creativity and countering them (cultural, too)

- externalization, through diagrams, enacted diagrams (e.g., spectrogram), art, family sculpture, etc.

-  exploring role repertoire, exaggeration, minimization, finding balance

-  role playing to explore best approach, integrate with role training

-  sociodrama to explore social roles and expectations (and axiodrama to explore cultural assumptions, especially those in flux)
         extensions into fictional roles, bibliodrama, drama therapy, allowing clients to have more distanced roles when they're not ready to own the enactments as their own lives (and many clients are not ready in this way)

 - Social conflicts enacted mixing sociodrama and role playing (e.g., here's the situation, members of the group or audience might show how they would play it to cope.) Use in Theatre of the Oppressed's Forum Theatre, but also role playing in business & industry (as written about by Corsini), in Education (Shaftel), etc.
  
 -  Extensions of drama into art, ritual, and other arenas
 
-   Replay, rehearsal, role practice, role development, taking it over

-  Role Reversal, empathy practice   (I suspect that few other approaches teach this or insist that it be included in later stages of therapy)

- Asides, Soliloquy, Doubling, techniques for increasing levels of disclosure

- Evocative techniques, such as having the auxiliary play it the worst possible way, concretization, 

- Reformed auxiliary--- play the scene showing how it could have been most healing, supportive

- Future projection, to explore not only worries, but also most extravagant goals

- Dream interpretation
              etc.    All these tools and many others can be used integrated with other approaches, as discussed by Corey at the St. Louis conference. They need not be kept in a single package. 

    Thoughts?    Warmly, Adam
  ----- Original Message ----- 
  From: Bud Weiss 
  To: Adam Blatner 
  Cc: list at grouptalkweb.org 
  Sent: Thursday, November 26, 2009 9:50 AM
  Subject: Anorexia and bulimia


  Has anyone here a fair amount of experience in treating persons with Anorexia or bulimia successfully. I have used several other modalities in doing so as they have demonstrated effectiveness including at one time Minuchin's approach, Palazzolli's approach and Milton Erickson's hypnotherapy approach. However, my experience is limited to only a few clients in this area. 


  So anyone out there hungry? You have to keep a sense of humor or as Professor Sol Gordon of Syracues University once said to me at his keynote address at a conference on sexuality and the handicapped which I organized back in the 70s on Long Island, " If you are going to work in this field, you have to develop a real sense of humor; if not, then become an administrator," which is what I was at the time. 
  Be well, Bud


  -- 
  "The perfect man breathes as if he is not breathing" - Lao-Tzu (circa 4th century BC)
  Breathing is the foundation of life, and good breathing is the foundation of good health. Improve your health by improving your breathing with the BIBH Buteyko Method. 
  Call or write me for details or appointments.
  Barnett J. Weiss, MA, LCSW , (Bud)
  E-mail: ButeykoNYC at gmail.com 
  Voice mail (951) 262-3004
  Web site : www.ButeykoNYC.com
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