Download A Word from the Editor

A Professional Journal of The Renfrew Center Foundation • Winter 2014
The 23rd Annual
Conference Update &
CALL FOR PROPOSALS
for 2014 are included
in this issue.
See page 12 for details
CONTRIBUTORS
S. Roy Erlichman,
PhD, CAP, CEDS, F.iaedp
3
Abigail H. Natenshon,
MA, LCSW, GCFP
5
Mark Warren,
MD, MPH, FAED
7
Page Love,
MS, RDN, LD, CSSD
9
A Word from the Editor
I
t is a great pleasure and privilege to be the new editor of Renfrew’s cuttingedge journal, Perspectives. The journal’s tradition of highlighting emerging and
noteworthy issues has been a valuable contribution to practitioners in the field
and one that I intend to pursue.
You may notice that this particular issue of Perspectives has a different format,
one which may be a catalyst for a broader discussion concerning how we
conceptualize and confront the complicated issues presented by our clients.
To initiate the discussion, a case study of a complex patient treated at Renfrew is
presented. Rather than focusing on treatment strategies,
four eating disorder professionals have been invited
to share their personal struggles and dilemmas about
treating complex patients, their feelings about recovery
and their concerns regarding the possibility of failure.
Four diverse and sometimes conflicting perspectives
are presented by experts from different schools of
thought. They are Roy Erlichman, a psychoanalyst with
training in family systems, Abigail Natenshon, a
psychotherapist and Feldenkrais practitioner; Mark
Warren, a psychiatrist with DBT background; and Page Love, a nutrition
therapist and sports dietician. I am most grateful to Roy, Abbie, Mark,
and Page for their contributions regarding an issue not frequently addressed
and hope their commentaries inform and resonate with your own
clinical experiences.
I encourage you to join the discussion by sharing your insights through
“e-mails to the editor”, a new section that will appear in the next issue
of Perspectives.
Warmest wishes,
Editor:
Marjorie Feinson, PhD
Assistant Editors:
Alecia Connlain
Jenna McCormick
Marjorie Feinson, PhD
editor
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
PAGE 2
CASE STUDY
JK is a 40-year-old divorced Caucasian female with a 24-year history of anorexia
nervosa (AN), binge purge type, and an extensive treatment history.
Her first admission to inpatient treatment was as a
substance abuse. JK has severe depression with
young adolescent and she has been re-admitted many
suicidal ideation and para-suicidal behaviors,
times since then. JK began restricting her food intake
attempting suicide via overdose approximately 10
and purging via exercise after a sexual assault at
times; her most recent attempt was about
age 13. Around age 16, she began binge eating
8 years ago. Engaging in self-injurious behaviors
and
and
including burning her skin with cigarettes,
by age 17, was drinking alcohol and abusing
scratching and cutting her skin with knives
prescription medication.
was also reported. JK experiences anxiety and
At admission, JK had severe muscle wasting and
panic attacks related to “anything,” especially being
was unable to walk without assistance. A regular
separated from her mother. Her history includes
visitor to the emergency room (at least 15 times in the
severe childhood sexual abuse by a close family
past year), she was diagnosed with digestive
friend. She also was verbally and emotionally
issues and headaches and had secondary amenorrhea,
abused by her ex-husband. Although JK has a
hypokalemia metabolic alkalosis, gastritis, gastro-
significant history of substance abuse (alcohol
poresis, parititis, constipation and visible enamel
and prescription drugs), at the time of her
erosion. JK has been prescribed dozens of different
assessment she had been sober from alcohol for
psychiatric medications, including multiple anti-
approximately 8 years.
depressants, anti-anxiety medication, and typical and
JK’s family history is positive for substance
atypical anti-psychotic medications.
abuse, alcoholism on both sides of the family,
At the time of her assessment, JK weighed less
and mood disorders. Her 34-year old sister has
than 70 pounds and was restricting her food intake
been diagnosed with schizoaffective disorder and
during the day to an apple. In the evenings, she
currently resides in her parents’ home. JK reports
would binge approximately 3 times and purge (vomit)
a familial history of suicide, stating, “just lots
approximately 60-70 times. In order to support her
of people have killed themselves in my family.”
binges, JK would steal food; she had been arrested
While JK has an estranged relationship with
6-7 times for shoplifting. In her late teen years, she
her father, an accountant who suffers from health
ran away from an inpatient treatment center and while
problems, she has an “enmeshed” relationships
living on the streets, engaged in prostitution to
with her mother who, out of desperation, hand-
support her substance use.
feeds her baby food each night and places
In addition to AN, JK suffers from major recurrent
receptacles around the home for self-induced
depression,
vomiting. Although JK received her GED, she has
purging
via
self-induced
generalized
anxiety
vomiting
disorder,
post-
traumatic stress disorder (PTSD) and a history of
never been gainfully employed.
PERSPECTIVES • WINTER 2014
PAGE 3
S. Roy Erlichman, PhD, CAP, CEDS, F.iaedp
My first reaction to reading the case presentation
was to mumble a silent “oh my” and second, to offer welldeserved congratulations to the therapist who courageously
undertook the care of JK. Clearly the patient presents an
enormous challenge, both to the clinical team and the
patient herself in her journey, hopefully, toward health.
In order to understand my responses to JK, I’ll briefly
describe my orientation. My training was in “modern
psychoanalysis,” a theoretical system developed many
years ago by Hyman Spotnitz, M.D., who emphasized the
importance of addressing the patient’s aggression, understanding a patient’s emotional language, communicating
affectively as well as cognitively, resolving resistances that
may both protect and limit a patient’s life and growth, and
understanding the therapist’s conscious and unconscious
countertransference experiences in the process.
My education was further
enriched with training in family
systems theory and practice,
which may seem anathema to
the singularity of analysis; but
was not true for me. The family
system counts. It is a common
context we all share. All in all,
the blend of analytic training
and family systems therapy has
guided my work and helped me
understand the value of integrative care.
Those of us who are analytically trained and treat eating
disorders well know that a patient can perish while we
are exploring resistances rather than acting to preserve life.
Patients such as JK do not have the time or endurance to
wait for the symptom to be analyzed. The use of long periods of silence or weighty interpretations, well-established
analytic tools, are often unmanageable or damaging to a
starving woman who may be “fed” by the therapist’s words
and connectivity or “starved” by the coolness of silence.
Consequently, I believe that conceptualization of this
case begins with my very first questions, thoughts and
feelings that arise from my countertransference responses
to the original case presentation.Two elements are clear at
the start. The first is the set of life-threatening behaviors that
have brought JK to the very edge of disaster. The second
is that these behaviors do not exist in a vacuum. They
are nestled in a context that is as yet unknown to me.
Characteristic of so many, JK has a language that is uniquely
hers. She speaks through a voice of starvation, purging,
shoplifting, substance abuse, trauma, prostitution, self-harm.
And the list continues, tragically long.
JK’s history is a tragic saga. I began to ask myself how
I would feel if I were treating her. Where would we
begin? How would I deal with her seemingly endless
needs? Could I possibly feel hope? Could she? And then
I asked myself, “How is it that she is alive, still seemingly
amenable to treatment and perhaps amenable to living?
How could I understand and help this woman who has
experienced such horrors? These and other questions
resonated strongly within me. I felt lost. “Lost,” however
seems very appropriate. After all, isn’t she lost too?
Another question that came to mind related to my
gender. JK was sexually abused by a close family friend,
emotionally abused by her ex-husband, and estranged from
her father. I wondered whether engaging in prostitution
was strictly to raise money, or was it also a statement about
her feelings towards men? Was this a way to render them
impotent by giving them a false sense of satisfaction when
she, in fact, was controlling their pleasure? Would I be
rendered impotent too, and, if so, how might that happen?
When I begin working with a new patient or family,
unlike many practitioners, I do the entire intake by myself.
I do not give forms to patients to fill out and return to me. I
do not communicate with patients by email or text message.
In my opinion, an eating disorder is not a disorder
of the stomach. It is a “disorder of the larynx.” My wish
is to communicate with patients in words. Even the
simplest questions, answers, grunts and shrugs can have
meaning, especially with someone who does not use
words for emotional expression. While this process takes
more work, I have found it extremely helpful in eliciting
information that I otherwise might have missed.
After I have asked basic intake questions, I then ask a
different, and what I believe to be my most important
single question: “How can I be helpful?” And then I am
quiet. I wait and hope for the patient to answer this openended question, telling me what she knows to the extent
that she feels secure in doing so. Experience has taught
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
me that many patients know what they want and need, but
may not tell me. After all, I am no more than a stranger.
What could possibly make me trustworthy?
JK and her environment must be safe. The process of
physical restoration, and nourishing her tired brain, would
no doubt take many months. The therapist must be patient.
Once she has been stabilized physically, I would hope to
learn what might be helpful to JK in the work we would
do together. What does she envision for herself?
When a patient comes to see me for the first time, I
explain that our sessions are like a canvas that she creates in
my office. Her words are the paints. Her thoughts, feelings
and memories are the colors. My hope is that as months
go by, the painting assumes shape, character and meaning.
The best news is that the canvas can be changed as time
goes along. Hopefully this will be a meaningful metaphor
for the patient, that her canvas of life can be redesigned.
When I conceptualize the care of JK or any patient,
my countertransference reactions are crucial elements of
the process. They raise personal questions. Do I truly
want to work with JK? Can I tolerate her wasted state,
her extreme needs, the possibility of death or suicide, her
troubled family, the years needed to bring her to a state of
good health? How rageful may she be? Do I have the time
and emotional energy to do the work? How do I make a
truly informed and acceptable decision?
Some years ago, when I felt depleted by a caseload
overflowing with exhausting, egocentric, complaining
patients, I asked a friend, a skilled and experienced
therapist, how he determines which complex cases to
accept and which to decline. He told me that he needs to
find something in the patient, no matter how difficult he
or she may be, that he can like. If he cannot find that, he
declines working with that person.
I found my friend’s idea very useful but insufficient.
I also need to feel hopeful. I do not demand that the
patient feel hopeful, for she may surely not. She must be
free to feel what she feels. However, I need to believe that
the patient, at some level, harbors a wish to be well.
Accepting the challenge of treating JK brings with it
the risk of failure. In my experience, therapists generally
talk about case successes. Seldom do we go to professional
conferences or read journal articles that focus on failures
in treatment. Yet treatment failures occur and frequently
and how we conceptualize our failed cases is critical to our
ability to succeed.
PAGE 4
I remember well a patient who died some years ago. I
had seen her only 4 times. She ended her life as violently
as her mother had, with the same shotgun. I felt horrified,
incompetent, confused, sad and angry. I was enraged with
her for dying and furious with the patient’s siblings and
father who knew the truth, but withheld facts about the
patient’s profound despair. They feared I would not take
her case and, with the same tortured logic, instructed
the patient to withhold the vital, life-threatening facts of
her history. She complied. After she died, my friends and
colleagues tried hard to help me accept that her death was
certainly not my fault. The patient was going to die anyway,
I was told repeatedly. Still, I felt that I had failed.
These feelings were induced in me by a patient I scarcely
knew. In short, nothing provided relief for the feelings that
I had failed. I decided to call a former supervisor for an
hour of supervision. After I explained what happened, he
said simply and directly, “You must feel very guilty. You
failed to cure her!” And then he was quiet. The brilliance
of his intervention was the use of the word “cure.” Once
I heard that word the experience became clear. There was
no way I could cure her in 4 sessions or 40 or more.
With this experience came a more mature understanding
of treatment success and treatment failure. This was a
doorway to understanding that working with complex
cases, where life and death can be a moment to moment
issue, demands that I be prepared to fail, that I work hard
to distinguish failing in my work from being a failure as a
person. To paraphrase Donald Winnicott, “One can only
be a good enough therapist.”
In conclusion, can the therapist manage the complexities
of JK’s life and needs and retain and infuse a thread of
hope in her wounded soul? Can he or she metabolize
the intensity of working with the narcissistically wounded
patient? I have asked myself these questions many times.
Never is this work easy. But it is what we do and it is clear
why we do it. To have the opportunity to help and save
a single life is a gift. The totality of this experience gives
me hope that not only the patient, but I too, will survive.
As Martin Luther King said so famously, “I have a dream.”
Hopefully JK will too.
S. Roy Erlichman, PhD, CAP, CEDS, F.iaedp
is in private practice in Palm Beach Gardens, Florida, and a partner in
ERE Associates. He is a past president of the International Association
of Eating Disorders Professionals. His special interests include complex
diagnostic issues and the roles of countertransference and resistance in
the treatment of eating disorders.
PERSPECTIVES • WINTER 2014
PAGE 5
Abigail H. Natenshon MA, LCSW, GCFP
Moving Beyond Transference and
Countertransference to Connection
Despite my 45 years as a psychotherapist specializing in
the treatment of eating disorders, reading JK’s case history
evoked in me a visceral sense of defeat and hopelessness
about her potential to heal. What, in fact, would define
“healing” for a patient with such extensive and complex
family and treatment history? Multi-faceted treatment
challenges would require constant vigilance of JK’s highrisk physical and emotional status. In the face of her
merging, and ever-emerging issues, treatment goals would
need to remain fluid, shifting between crisis intervention
and intrapersonal growth and stabilization.
It is critical that the seeds of
a healthy connection be sown
from the very start of JK’s care.
I would extend my first invitation for her to join with me
emotionally by recognizing and
acknowledging her strengths,
and engaging with them directly and immediately. To minimize her fears and defensiveness
and evoke a sense of safety and
readiness to engage, I might comment on the strength and
courage she demonstrates in simply showing up for her
first session. As an example, “You know, it takes a lot of
courage and spunk to re-engage now in the hard work of
therapy, with me, a total stranger. I know it’s not easy for
you to be here today, but I see your perseverance and your
determination to heal as a very real predictor of successful
outcomes.” JK’s responses might shed light on her own
self-perceptions and feelings about therapy, as well as on
any transference issues that she might be harboring.
The potency of damaging transference responses might
be further mitigated by attention to the here-and-now…
to the immediate and pressing needs of the patient and
the unique requirements of the ever-changing therapeutic
moment. Even while collecting didactic diagnostic
information, I would actively and intentionally investigate
JK’s expectations, fears, hopes, wishes and agendas for this
initial session, a strategy designed to stimulate the budding
of an emotional connection. Any lack of congruency
between her expectations about treatment and my own
would provide fodder for immediate and future attention.
In greasing the path to a mutually trusting connection,
I would attempt to establish a collaborative treatment
partnership, empowering her to become a contributing
member of her own treatment team. In so doing, I might
inquire as to her perceptions of what worked in past therapies,
and what did not; what she liked best and least about prior
treatment experiences, in an effort to mobilize a sense
of self-trust, self-determination and self-regulation…
all benchmarks of eating disorder recovery.
Offering the safety of ground rules, easily attainable
goals, [such as the recommendation to make specific, small
and gradual changes in what and how she eats] and realistic
expectations in an otherwise unpredictable and elusive
recovery process would help to minimize unknowns for
JK, thereby maximizing her confidence in the process.
Particularly in light of her suicidality, a prerequisite for
care from the very onset of treatment would be to require
a commitment to medical and psychiatric monitoring,
scheduled regularly and as needed. Making myself
personally and professionally transparent by demonstrating
my own value system, personality, treatment and attachment
style often helps to break down defensive barriers. I would
describe my own unique perspective of what eating
disorder recovery is about, what it means, and what it
entails. Beyond the ability to feed and care for herself, the
recovery process would mark the return and re-integration
of her core self, temporarily exiled by her disorder.
Over the years, I have discovered that genuinely liking
and enjoying my patients energizes them, the treatment
process, and me. It is a widely held misconception among
professionals that genuine affection between therapist and
patient connotes inappropriate “friendship,” boundary
breeches, and lack of professionalism. I do not see it
this way. In my practice, I make myself readily available
at unscheduled times, welcoming, and responsive to
occasional ‘crisis’ emails seeking a word of encouragement,
etc. I believe that the more deeply and authentically I care
about the patient, the more palatable become my ‘tough
love’ demands and limit setting, so necessary in moving
the healing process forward. In my work, I take fearless
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
PAGE 6
stands behind the demands of reality and healthy life
values, encouraging the patient’s engagement in emotional,
behavioral and relational challenges for the sake of
learning, even if these might result in what she might
perceive to be ‘failures’ and discomfort.
tasks would provide a platform for learning, self-reflection
and accountability to herself and the treatment process.
Once she becomes physically and emotionally stable,
appropriate treatment tasks might focus on a job search and
her productive functioning within an employment setting.
Motivating treatment engagement and change
Adjunctive care; accessing the embodied self
through somatic education
I envision psychotherapy as a process of change and
growth. “This time around, things will be different” is a
powerful message that I would convey to JK through my
request for, and insistence upon, her commitment to
making changes consistently throughout the process. The
nature, choice and pacing of change belongs to the patient;
it is for me, as her therapist to be by her side and on
her side, throughout that process. As a discussion about
making changes is likely to trigger resistance, I would
actively invite and welcome her thoughts about her
own ambivalence to heal, setting the stage for her
honest self-appraisal and feeling ‘heard.’ As an example,
“I wonder what it might be like for you to consider
making changes when we know how tough it can be to let
go of a disorder that has been a reliable crutch and source
of comfort for you through the years.”
When the diagnostic process is used to assess not only
pathology, but also the patient’s evolving recovery progress, it
can become a powerful motivational device. In tracking
recovery growth through treatment, I create the sense
that ‘recovery’ is a verb, rather than a noun… an ongoing,
action-based, and rewarding dynamic that happens
throughout care, rather than as a ‘slam dunk’ finale at the
end of care. If JK finds it difficult to acknowledge personal
progress and growth, I would encourage her self-reflection:
“I notice that it seems so easy for you to be self-critical,
but that you find it far more difficult to acknowledge your
strengths. When I speak of your strengths, I wonder if
you think that I have allowed myself to be fooled by you,
or that I am not being truthful with you. If so, can we
talk about that?”
The patient’s surges of emotional arousal, traumatic life
experiences and evidence of relational dysfunction might
respond well to therapeutic interventions based in CBT
and DBT, which speak directly to the needs of malnourished patients like JK.These techniques create structure by
providing education, options for healthy problem solving,
and a mindful presence in the moment. Collaborating with
JK to create, execute and monitor achievable behavioral
The dysfunctions of attachment that sabotage JK’s
relationship with others also sabotage her connection
with herself, fostering an inaccurate perception of body
and self-image. Dr. Moshe Feldenkrais developed a means
to reintegrate a fragmented sense of body, self, and mind,
creating neurological reintegration through movement
with attention and intention. A resulting ‘felt’ sense
of self and self-awareness moves the patient beyond
dysfunctional thinking patterns that limit and distort
self-image and inhibit authentic self-expression.
Feldenkrais’Awareness through Movement© groups stand
apart from yoga or other forms of somatic education by
providing highly specialized movement patterns designed
to clarify self-image. This is accomplished through a
focus on the experience of each part of the movement
and its effect on total body image. The work decreases
compulsive behaviors while fostering improved body image.
Because JK’s history includes many years of traditional
treatments, the Feldenkrais Method might provide her
with a dynamic and pleasurable alternative form of bodybased learning, unburdened by the constraints of language.
The experiential, non-verbal quality of the learning
offers a sense of universality, novelty and joy, potentially
stimulating changes within her neurological function.
Empowering and self-informative, this work would
negate any obsolete notions she might carry about
the intractability of her condition, and defy a belief
system based in hopelessness and incurability. [For more
information about the Feldenkrais Method and
eating disorders, see http://www.aedweb.org/source/newsletter/index.cfm?fuseaction=Newsletter.showThisIssue&Issue_
ID=19&Article_ID=343.]
In conclusion, my hope and vision for JK is to create
and infuse energy into a treatment relationship through
which she can learn to value and trust herself and her
body, ultimately learning to care for them both. Over
time, small behavioral changes accrue to become larger
developmental achievements, and within the context of
PERSPECTIVES • WINTER 2014
a healthfully dependent treatment relationship, would
evolve into JK’s autonomous functioning… first within,
then outside of, the treatment venue. The treatment process
would provide a practice ground for JK to learn to manage
herself, and to prosper, in the face of uncertainty, which
is not only an intrinsic part of recovery, but of life itself.
Termination of treatment would be contingent upon JK’s
learned readiness to recognize her need for support and
willingness to ask for help.
PAGE 7
Abigail H. Natenshon MA, LCSW, GCFP has been a psychotherapist specializing in eating disorder treatment for four decades.
Author of WhenYour Child Has an Eating Disorder: a Step-byStep Workbook for Parents and Caregivers as well as Doing What
Works:An Integrative System for the Treatment of Eating Disorders
from Diagnosis to Recovery, she hosts an educational web site for
patients, parents and professionals: www.treatingeatingdisorders.com.
She is a Guild Certified Feldenkrais Practitioner.
Mark Warren, MD, MPH, FAED
It is extraordinarily difficult to read about a woman
who is in so much pain, is suffering, and teetering on the
edge of death. Her situation feels so sad, so overwhelming,
and appears so hopeless at first pass that it is hard to feel
anything but tremendous fear that this patient will die,
coupled with amazement that she is not already dead. I am
also struck by how her mother has stood by her all these
years, and continues to care for her sick child.
Yet it is not unusual for me to work with patients who
present in this way. At the Cleveland Center for Eating
Disorders we have developed a focus on just this type of
patient, using an adherent DBT model, originally
developed for BPD, now being studied, researched
and utilized at our center with
clients for whom traditional
treatment has not worked. It is
crucial for me that treatment
be adherent—which in DBT
means providing individual
therapy, skills groups, availability
for outside of session telephone
coaching and a consultation
team to provide therapy for
therapists—a need when working with patients such as JK who
have such pain in their lives. We need an adherent system
both to increase the likelihood it will work and so we can
study our outcomes. We have worked to have adherent
treatment at multiple levels of system from outpatient to
partial hospitalization and have seen many patients thought
hopeless find a life worth living. Which helps me refocus
from solely the emotional impact of this case.
Now I remember that JK has been sick for 24 years,
which means that she likely received many years of care
that were not grounded in scientific evidence, as EBT
was not widely available when she first presented for
treatment for her multiple diagnoses. Although there are
not solid evidence-based therapies for AN, there are some
things supported by the literature for other eating disorders
or other psychological disorders. I would start with these.
In my experience this includes, at a minimum, weight
restoration, stopping behaviors, CBT, DBT, other third
wave CBT treatments, and supportive specialist clinical
practice. Additionally, JK was likely told she was a failure,
was hopeless, lacked motivation, was told her parents
caused her illness and that she had to take charge of
her own life. She was likely told the many myths and
half-truths that have characterized the historical reality of
eating disorders, including the list above, and that she was
weak, that she just had to eat, that that she wasn’t trying
hard enough, or even that she had caused her own illness.
JK also was unlikely to get adequate medical care, as so
much was unknown. She has probably had ineffective
care for her co-morbid symptoms—the PTSD, self-harm
and myriad of other conditions—for which there is now
better EBT. I am curious how much care she
received at a healthy weight, or if she ever has been at a
healthy weight, and if she had psychological treatment
that might have worked if she was refed. Furthermore,
the likelihood she received treatment that was able to
address multiple illnesses at the same time is pretty low,
based on where we are as a field and how long she
has been ill.
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
For me, when using the DBT framework (as others may
use their own framework), I find that I am much better
at conceptualizing complex situations and see that more
effective treatment for this client, while not widely
available, does exist. I find myself moving away from
hopelessness. I start to focus on her 8 sober years. I think
about her mother, who may be misguided in how she
provides care, but still cares and still tries. And I see a
patient who has persevered and, by all accounts, has not
given up -- she is still living, still breathing, and continues
to seek help. For this patient I see hope. A glimmer now,
and maybe more to come. I think she wants to change and
I think she probably can, as she has already made changes
in her life. DBT says that we assume that the life she is
currently living is unbearable and that she wants this to be
different. She wants to make enormous changes. I think
that there is hope for this patient. But it is still just a
glimmer and it is my job now, and our job together, to
make that change happen. From all the literature I know,
behavioral change must come first. We need to have a
relationship with shared goals, but I need to remember not
to accept relationship as the only goal.
When I approach treatment with JK my focus would
be on how find a path to health, how to help her behave in
a healthier way and how to move forward. At 70 pounds
I would harbor no illusions that I can convince her of
anything. I am sure that others with great skills have tried
this and it did not work. Otherwise, why am I sitting with
this woman right now?
I would stress with JK that we are at a beginning, not
the end, and that treatment will have many stages. I would
be clear with both myself and with her that treatment will
involve many different professionals, family and treatment
sites before feeling that recovery is taking place. I would
be clear that each stage of recovery—medical, behavioral,
relational, and resolution of co-morbid condition—will
need to be reached for recovery to truly happen. Some
co-morbid issues will not be treated until life-threatening
aspects of her illness are resolved. I would remind
myself over and over that JK is malnourished and cannot
understand or remember much of what I say, while hoping
that 1% of what I say is retained.
I would practice acceptance and compassion with
myself and seek out support every step of the way,
knowing that I will likely be pulled into hopelessness,
feelings of ineffectiveness and burnout many times before
PAGE 8
treatment has ended. I will always want to practice in
the context of a team so that I can make good decisions
and avoid burnout. In our treatment system no one ever
practices alone. There are two primary reasons for this.
It is very difficult to stay with adherent care and not
drift away into non-adherent treatment, which is less
likely to be effective. A consultation team keeps treatment
at its most effective. Additionally, most patients, and
particularly this patient, require a therapist, psychiatrist,
primary care doctor, dietitian, groups, and multiple levels
of care to achieve health. Only by staying within a true
team that talks and works together in a seamless way can
the best care be provided. My burnout will be so much
lower if I have colleagues to support me and guide me, and
a multidisciplinary team to resolve those issues I am not
expert in.
I will not expect JK to hear me, believe me, trust in
me or think I am expert. I will expect that refeeding can
occur, that behavioral change can occur, and that my
commitment to this process is as important as hers.
I would think of commitment as something that exists
forever, knowing that there will be ebbs and flows that may
make it seem distant and sometimes impossible. I would
need to remind myself over and over that she has a horrid
version of a horrid illness with many complicating factors.
And I would need to remember that none of this might
matter very much of the early phases of care, as our focus
will be on food, behaviors, and medical stability for a long
time. When she is refed and her behaviors can be managed,
I would be clear that I think her job is to survive, commit,
find motivation, and stay with a healing process. I would
be clear that I have a job as well - to help her create a
system of care that is intensive, immersive, open to change
and constantly aware of possibilities.
We are fortunate that today we have more science to
fall back on.We understand levels of care better. We know
better when to seek outside help and when to persevere.
We understand that these illnesses are not caused by
families, but that families can help cure [cure or treat]
them. We begin to understand the biological basis of AN.
We have a growing range of treatments, that, while clearly
less than we want, have real science behind them. We also
are aware that while therapeutic relationship matters long
term, that short term it may need to take a back seat to
weight restoration and behavioral change. These things
will continue to orient me as a provider and to help me
explain to JK why I do what I do.
PERSPECTIVES • WINTER 2014
I think of JK’s recovery as I would think of someone
with terrible cancer, but one which is treatable. With
cancer I would do radiation, chemotherapy and surgery,
according to accepted literature, staging our work
according to the patient’s status. I would base JK’s
treatment on her stage of illness as well. I would make
sure that she knows that our goals are the same, and that
the quality of her life matters and is our ultimate goal.
Yet, I would get results first, anyway I can, from hospital,
to refeeding, and involving family and community if
possible. I would use myself strategically long before
I consider using myself relationally. I would ask her to judge
me by results, not kindness. I would try always to tell the
PAGE 9
truth, to not be distracted away from the life threatening
part of her illness into things that seem more treatable or
more interesting. Together we can make a journey
towards recovery. I would never let go of hope. I think
JK can have a life worth living.
Mark Warren, MD, MPH, FAED is the co-founder and medical
director of The Cleveland Center for Eating Disorders. He is a faculty
member at Case Medical School and teaches at University Hospitals
of Cleveland and The Cleveland Clinic Foundation. Dr.Warren is a
Distinguished Fellow of the American Psychiatric Association, a twotime recipient of the Exemplary Psychiatrist Award of the National
Alliance for the Mentally Ill and a winner of the Woodruff Award.
Page Love, MS, RDN, LD, CSSD
As an outpatient dietitian for over 20 years, I have
worked with many acute eating disorder clients. This
case study encompasses the extreme complexities of all
eating disorders. At every level, JK exemplifies the
most complicated eating disorder issues—long-standing
lifetime history of the disease, family dysfunction history,
dynamics of substance abuse and sexual abuse, medical
acuity, dual diagnosis issues,
and multiple treatment history.
With each of these issues
there are considerations for
nutrition therapy treatment,
but even more crucial is
assembling a team. When
there are numerous clinical
issues present, it is imperative
to realize the importance of
being part of the treatment
team. While each issue is treatable, a team of professionals
is required. As a member of the team, I can contribute
my professional insights concerning what treatment approaches may help this client take the next step in recovery.
Often the dietitian is the first place a chronic eating
disorder client or “lifer” may go to try to do things
differently after multiple failed treatment attempts. The
client may be trying to fix these surface issues… such as
weight restoration, gastrointestinal side effects of purg-
ing behaviors, and other physiological imbalances. As an
initial professional insight I would require a patient of JK’s
complexity to seek immediate medical attention to make
sure she is medically stable and that her medical symptoms
are being managed. She may need to see a cardiologist,
gynecologist, gastroenterologist, and dentist to best address
all of these symptoms. As the dietitian on the team, I am
often the one who can take the lead to connect the client
with specialists who are experienced in the treatment of
eating disorders. With a client of this level, the very best
treatment is without question intensive medical inpatient
hospitalization until she is medically stable. There also
must be intensive medical follow-up on a weekly basis
In addition to medical stability issues, I have multiple
concerns regarding family systems issues, and JK’s long
term suffering from the disease without any long term
recovery under her belt. Does she know how to be in
recovery? Her life is mental illness on many levels. Over
the years, as I have worked with similar patients, I have
learned that the longer the person has struggled with the
disease, the longer the treatment must be in order help the
client to shift into recovery mode. I have had to learn and
accept that I cannot heal my clients. They have to want a
certain level of recovery and a different life for themselves.
This may mean separating from their current lives. I have to
accept that there may only be a certain level of recovery,
and unfortunately, it may not be full recovery.
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
This case of JK evokes sadness for me because she has
struggled for so long at this level of acuity. However, it
also evokes a challenge to me as a professional, and at a
gut level, it makes me want to reach down and help her
approach this a different way…to get to a better level
of life functioning…to help her improve her quality of
life, both physically and emotionally. Given her age and
family background, I am saddened she is still living with her
family, a place of illness and enmeshment that is not allowing
her to move forward and develop an independent life.
Mom feeds her like an infant, feeding into her belief that
she cannot survive on her own. Purging is normalized,
with the placement of receptacles around the house for
self-induced vomiting. Instead, the family needs to learn
how to help, to reduce the triggers and make the family
environment safe. There is so much guilt and so much
shame, but they are stuck!
I have seen many clients over the years who, taken out
of their unhealthy environments for intensive residential
treatment, physically improve, but do not have long
term success on a physical or emotional level. They have
returned to the environment where triggers exist—
triggers that lead to the same old coping mechanisms
and to relapse of eating disorder behaviors, and often
times full relapse. These patients continue to keep the
disease as their identity, rather than shifting to a healthier
place. A therapeutic consideration right from the get-go,
therefore, is to get JK’s family into therapy in order to
learn how to do things differently. The family needs
to learn how to break enmeshment patterns and refrain
from supporting ongoing behaviors. They need to learn
how to use their voices as opposed to their unhealthy
coping mechanisms. An intensive family therapy
weekend, in which life skills work were presented,
could be beneficial. Within this treatment approach,
the dietitian could help with family meals, from being
in the kitchen with the family and client to helping
with portioning and communications at the table in
a guided meal support fashion. I call this “family
nutrition therapy.” Another approach I find to be helpful
for clients and their families is an experiential
approach. Experiential nutrition therapies can guide a
client and her family through the refeeding process
and teach real life skills to help them actually execute
treatment successfully and gain the confidence to move
out of a stuck place. I have my doubts about whether JK’s
family would or could engage in this type of approach.
PAGE 10
With such a complex client as JK and, based on her
long time history with the disease, I see large shifts in
recovery less possible, and slight shifts more realistic. But,
then again, given that, she is 8 years sober from alcoholism,
a 12-step approach with her bulimia may be a successful
direction to undertake. Another realization is the
importance of being open to a variety of treatment
approaches in view of the issues presented. A more
extreme black and white avoidance of triggers (like her
family’s home) while being inpatient may help her shift.
Long term success with JK will be largely dependent
on her ability to separate from her family of origin and
avoid the same environment that will trigger old coping
mechanisms.
I can only be hopeful for partial or full recovery for a
client like JK if there is long term residential treatment
followed by real life residence, including living away from
the current family. There must be a chance for JK to take
a different path. With a long term, medically supervised
recovery process, she may be able to get to a slightly better
place of functioning, especially if she is able to cease
purging and restabilize her weight.
JK’s history reminds me of a client I worked with for
a year. She was in fact, adopted from an abusive situation
into a home for children, dad an alcoholic and adopted
mother who had passed away… abandonment on so many
levels. She benefitted from several intensive therapeutic
approaches, but seemed stuck in binge/purge cycles
and over-exercise. She was a marathoner to boot! This
case ended sadly with a suicide, unexpected and sudden.
This was one of my first experiences of a client dying while
I was working with her. I grieved her loss, our approach,
and realized my approach needed to be different with
such acute patients, taking more care to keep the treatment
team close-knit and not waiting so long to change
a treatment approach that was not working. This,
unfortunately, was not my first client to pass away.
So, another skill I have had to learn is how to deal with
loss and to expect that there will be loss. I never give up
on a client… but I have learned how to accept there may
be failure when clients have this level of acuity.
Recently, I treated a client who was struggling with
over-exercise and extreme OCD and anxiety; his mother
had an active, untreated eating disorder. After several
years of treating this patient, the team was able to get this
client into a treatment center that adressed the exercise
addiction more experientially. This approach gave both
PERSPECTIVES • WINTER 2014
the client and his treatment team more hope! Aligning this
client with more sports-trained eating disorder specialists
and discharging him to a therapist with a background in
sports, and to me, a sports dietitian, helped this client
become “unstuck.” It is refreshing for me to do this work
at a different level by being more sports specific, the focus
is no longer on the eating disorder or the disease. Now
it is on health and performance. Clients such as this one
help me stay motivated to hang in there and trouble-shoot
ways to help acute clients take new approaches to recovery
and life!
PAGE 11
Page Love, MS, RDN, LD, CSSD is a nutrition therapist and
sports dietitian who runs NutriFit Sport Therapy, Inc., a consulting
dietetic practice in Atlanta, GA. She specializes in individual and
group nutrition counseling for the full spectrum of eating disorders and
offers sports nutrition counseling for high school, collegiate and professional athletes.
Emails to the Editor
Join the discussion by emailing your thoughts on this issue
to [email protected]
Your Donation Makes a Difference
A
s a professional and educator working with individuals
affected by eating disorders, you are undoubtedly aware of the devastation these illnesses cause to families and communities.
The Renfrew Center Foundation continues to fulfill our mission of
advancing the education, prevention, research and treatment of eating
disorders; however, we cannot do this without your support.
Please designate below where you would like
to allocate your donation:
q Treatment Scholarships q Training & Education
q Area of Greatest Need q Research
q Barbara M. Greenspan Memorial Lecture at The Conference
Your Donation Makes A Difference…
Name ___________________________________________________
• To many women who cannot afford adequate treatment.
• To thousands of professionals who take part in our
annual Conference, national seminars and trainings.
• To the multitude of people who learn about the signs and
symptoms of eating disorders, while learning healthy ways
to view their bodies and food.
• To the field of eating disorders through researching best
practices to help people recover and sustain recovery.
Address __________________________________________________
An important source of our funding comes from professionals like
you. Please consider a contribution that makes a difference!
Tax-deductible contributions can be sent to:
The Renfrew Center Foundation
Attn: Debbie Lucker
475 Spring Lane, Philadelphia, PA 19128
City/State/ZIP ____________________________________________
Phone/Email ______________________________________________
Below is my credit card information authorizing payment to
be charged to my account.
Credit Card # _____________________________________________
Security Code ___________________ Exp. Date _________________
Credit Card Type ___________________________________________
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A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
23rd
The
Twenty-Third
Annual
Conference Update
PAGE 12
On behalf of the Conference Committee,
I would like to extend my thanks to all of the speakers
and attendees who made this year’s event exceptional.
The evaluations were among the highest we have
received in our 23 year history!
The important elements we work with from clinical
practice, research and the culture came together on stage
and in workshops throughout the weekend and created
an extraordinary energy that infused the Conference.
Highlighting the program were the three Keynote
presentations. On opening day, four master clinicians and
researchers- Judith Banker, the panel moderator and
Drs. Kathleen Pike, Margo Maine and Howard
Steiger, addressed the integration of empirically
supported treatment with clinical wisdom and the
impact of cultural issues on our clients. Jennifer Weiner,
our Saturday Keynote, enlivened the audience with a
wonderful presentation on her journey as she evolved
from a “large” girl who did not fit in, to a successful
author who empowers young women to be true to
themselves and speak out. Her book signing had long
lines of attendees wanting to share their own stories and
express their admiration for her writing and her messages.
Amy Banks, MD delivered the closing keynote
bringing together neuroscience and psychotherapy
in an elegant and user-friendly way.
Workshops featured throughout the weekend presented
topics on the integration of various therapeutic
approaches, the use of evidence based guidelines with
an emphasis on clinical wisdom and the therapeutic
relationship. Attendees were given ample opportunities
to not only learn new ways of helping complex
patients but to extensively network with colleagues as well.
Planning is underway for the 24th Annual Renfrew
Center Foundation Conference, Feminist Perspectives
and Beyond: The “Practice” of Practice which will be
held in Philadelphia from November 14-16, 2014.
A Call for Proposals may be found on Page 14.
This update includes photos from the Conference
as well as a form to order CDs if you were unable to
attend or missed some workshops.
Many thanks, once again, for making the Conference
a great success.We hope to see you next year!
Judi Goldstein, MSS, LSW
Conference Chair
PERSPECTIVES • WINTER 2014
PAGE 13
“Thank you for
another rejuvenating,
regenerative 3 days.
I leave nourished.”
“I really loved the
conference – great speakers
and very well organized.
It was one of the most
clinically useful conferences
I’ve ever attended.”
“Absolutely fabulous
conference. Only wish
I could have attended
more workshops.
Hard to decide.”
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
The 24th Annual
Renfrew Center Foundation Conference
Feminist Relational Perspectives and Beyond:
The “Practice” of Practice
November 14-16, 2014
Philadelphia Airport Marriott
Effective treatment of eating disorders is both an
art and a science.Yet there remains a daunting gap
between what research offers and what clients require.
Clinicians are caught in a murky middle – treating
these most deadly psychiatric diagnoses, making one
critical decision after another – while continually
managing their innermost feelings and fears.They
must integrate their acquired wisdom and lived
experience with the best evidence based care,
knowing that neither alone is likely to be sufficient.
The “Practice” of Practice offers an opportunity to
explore how eating disorder clinicians actually “mind
the gap,” incorporating new approaches and research
findings – all as they respond in real times, with real
lives, in their offices each day
Accepted Proposals will address
topics such as the following:
• Elements which influence the rationale for using
one treatment approach in favor of another in any
given situation
• How clinicians can sensitively respond to diversity
within their client population
• Integrating new and/or evidence based treatment
into current clinical approaches
• How to effectively manage internal reactions to
clients who are challenging, difficult, hopeless,
suicidal and/or sometimes unlikeable
• Treatment approaches which have resulted in the
greatest improvements in your clients’ eating disorder
symptomology and/or quality of life
• Translating and applying the qualitative and
quantitative literature findings to facilitate both the
physical and psychological elements in recovery
• If and how clinicians’ personal lives influence
treatment
• How clinicians can best integrate their own clinical
wisdom and lived experience with research and
evidence based treatment
• Establishing and maintaining a good therapeutic
alliance – what are the active ingredients?
• How does one prioritize the core elements
underlying complexity and co-occurring
conditions – specifically trauma, substance abuse
and personality disorders?
Conference Format:
• Keynotes
• Two-Hour and Three-Hour Presentations
• Networking Receptions
• Poster Presentations*
PAGE 14
Call for Proposals
Presentations which document new research findings on eating disorders and
approaches to treatment may include research studies (exploratory studies, single subject or group
case studies, or randomized controlled studies), reviews of current research and/or discussions of
theoretical issues in the field.The Poster Session will take place on Saturday, Nov. 15th and will
feature the work of both senior and junior investigators. Graduate students are encouraged to
submit proposals. Questions regarding the poster format should be addressed to Debbie Lucker at
[email protected].
*Poster
DEADLINE FOR SUBMISSION: MARCH 14, 2014
Please submit (A) Cover Letter, (B) Abstract, (C) Biographical Sketch, and
(D) Presentation Experience, as indicated below:
Only ONE proposal per person
A. Cover Letter: Attach a cover letter that includes the following:
1. TITLE of proposal presentation
2. TYPE of proposed presentation: Three-hour workshop, Two-hour workshop, Poster
3. PRESENTER(S): Maximum of two presenters
i. Lead presenter: name, address, degree, phone number, fax number, and email address
ii. Additional presenter: same information as lead presenter.
4. FORMAT: primarily didactic, interactive or experiential
5. CONTENT: primarily theoretical, clinical/case examples or research/experimental
6. SUGGESTED AUDIENCE LEVEL for the presentation: (Beginner, Intermediate,
Advanced, or All Levels.) Beginner - Presentations that all participants will be able to fully
comprehend and/or appreciate. Presentations will discuss concepts that are considered basic
skills/knowledge for those working in the field of eating disorders. Intermediate Presentations are appropriate for participants with an advanced graduate degree in behavioral/
nutritional health since they may address concepts that require additional knowledge,
workplace/internship experience or a special skill. Advanced - Presentations require the
knowledge level of professionals with advanced degrees in behavioral/nutritional health and
with both general and specialized work experience in the particular area/topic to be discussed.
The Conference Committee encourages Advanced workshop proposals that are Interactive.
B. Abstract: Attach a description of the presentation that includes the following:
1. An extended abstract that describes major ideas, themes and aims of the presentation
(150 words maximum)
2. A brief summary abstract for inclusion in the Conference brochure (50 words)
3. Three behaviorally measurable learning objectives that are achieved by the presentation
4. Description of handout(s) to be provided. A handout may be a bibliography, power point
presentation, outline of presentation summary, additional resources, a case study, etc.
C. Biographical Sketch: Attach a description of your professional experience
in the following order: current title and affiliation; relevant publications; relevant
organizations; private practice location and area of expertise (100 words maximum).
D. Resume/CV
E. Presentation Experience: Provide a list of professional presentations you have done within the past two years.
PRESENTATION
GUIDELINES:
1. Presentations must relate to the Conference theme and meet stated learning objectives.
2. Handouts must be provided to attendees.
3. Whenever possible, integrate relevant clinical examples and case material.
4. Plan to be interactive with attendees; time must be allotted for questions and answers
at the end of the presentation.
5. Do not plan to read your lecture or power point presentation.
SUBMIT a proposal by electronic mail, on two pages only, and within the body of the
email. The SUBJECT line should read: 2014 Conference followed by the LAST name
of the LEAD presenter. Attachments will NOT be accepted or opened.
SEND THE PROPOSAL TO THE FOLLOWING MEMBERS OF THE
CONFERENCE COMMITTEE:
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
CONFERENCE COMMITTEE DECISIONS WILL BE MADE BY MAY 7, 2014.
PERSPECTIVES • WINTER 2014
PAGE 15
AUDIO CD & MP3 ORDER FORM
THE 23RD ANNUAL RENFREW CENTER FOUNDATION
EATING DISORDERS CONFERENCE FOR PROFESSIONALS
November 8-10, 2013 in Philadelphia, Pennsylvania
KEYNOTE PRESENTATIONS
q KEY 1 Good Old Fashioned Know How:The Essential Role of Clinical Wisdom and Expertise in Evidence-Based Practice
- Margo Maine, PhD, FAED, CEDS; Kathleen Pike, PhD, FAED; Howard Steiger, PhD, FAED
q KEY 2 The F Word: On Growing Up Big, Speaking Out Loud & Raising Betty Friedan Girls in a Brittany Spears World
- Jennifer Weiner
q KEY 3 Bridging the Great Divide: How the C.A.R.E. Program May Integrate the Art and Science
of Psychotherapy in Eating Disorders
- Amy Banks, MD
WORKSHOPS
Friday, November 8, 2013
q FR 1 Utilizing Integrated Care to Address the Hidden Health Crisis on Campus
- Carolyn Hodges Chaffee, MS, RD; AJ Rubineau, MD, MPH
q FR 3 The Eating Disordered, Self-Injuring,Trauma Client: How Do We Know When Treatment is Going Away?
- John L. Levitt, PhD
q FR 4 The Barbara M. Greenspan Memorial Lecture: Closed Doors Reopened: Expanding the
Therapeutic Relationship—The Use of Self & Other Unmentionables
- Beth Hartman McGilley, PhD, FAED; Jacqueline Szablewski, MTS, MAC
q FR 5 Medical Issues in EDs—For Physicians and Non-Physicians Alike…Really
- Edward P.Tyson, MD
q FR 6 The Art of Integrating Diversity: How to Appreciate and Address Issues of Difference in Psychotherapy
- Cynthia Whitehead-Laboo, PhD
q FR 7 The Emaciated Imagination: Disordered Eating and Symbollic Expression
- Michelle L. Dean, MA, ATR-BC, LPC
q FR 8 Advances in the Treatment of Binge Eating Disorder
- Ann Kearney-Cooke, PhD
q FR 9 Bringing Men to the Table: Supporting and Utilizing Male Loved Ones as Allies in Treatment and Recovery
- Joe Kelly, BS
q FR 10 Clinical Applications of Current Research on Eating Disorders & Trauma: Connecting Sensation, Perception & Emotion
- Norman H. Kim, PhD
q FR 11 From Meal Plans to Weighing Patients: Knowing When and How to Change Direction Based Patient Readiness
- Lori Lieberman, RD, MDH, CDE, LDN
q FR 12 Neuroscience for the Non-Neuroscientist Eating Disorder Therapist: How to Offer Neuroscientifically Sound Psychotherapy
- Howard Steiger, PhD, FAED
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
PAGE 16
Saturday, November 9, 2013
q SA 1 Integrating Spirituality, Embodiment & Neuro-Repatterning for Transforming ED Behaviors:
Expanding the Therapeutic Relationship
- Barbara Birsinger, PhD, MPH, CEDRD
q SA 2 Emotion-Focused Therapy in the Treatment of Eating Disorders
- Gwenn Kudler Gelfand, LCSW, ACSW
q SA 3 Writing for Self-Reflection, Self-Regulation and as a Stepping Stone to Recovery
- Judith Ruskay Rabinor, PhD; Martha Peaslee Levine, MD
q SA 4 Customizing Mindfulness: Fitting the Practice to the Person
– Ronald D. Siegel, PsyD
q SA 5 How to Utilize the Eating Disorder Inventory to Direct Treatment for Eating Disorders
- Rebecca Wagner, PhD; Chelsea MacCaughelty, LCSW, CGP
q SA 6 Dialectical Behavior Therapy (DBT) & Treatment of Complex Eating Disorder Patients
- Lucene Wisniewski, PhD, FAED; Mark Warren, MD, MPH, FAED
q SA 7 Internal Family Systems Therapy: Healing the Wounds of Trauma with Eating Disorders
- Frank Guastella Anderson, MD
q SA 8 The Yoga of Body and Mind: Using Yoga to Empower the Body and Heal the Mind in Eating Disorder Treatment
– Genevieve S. Camp, MA, ATR-BC; Jamie E. Silverstein, BA, E-RYT-500
q SA 9 A Universal Model for Promoting Health at Every Size (HAES) in Adults and Children
- Kathy Kater, LICSW
q SA 10 Promoting Mutuality and Motivation: How Relational-Cultural Therapy Helps Adult Women
with Eating Disorders Reclaim Self, Relationships and Recovery
- Anita Sinicrope, MSW; Lisa Maccarelli, PhD
q SA 11 Wisdom & Compassion in Psychotherapy: Deepening Mindfulness in Clinical Practice
- Ronald D. Siegel, PsyD
q SA 12 ACT Based Family Skills Intervention for Eating Disorders
- Nancy Zucker, PhD; Rhonda M. Merwin, PhD; C. Alix Timko, PhD
Sunday, November 10, 2013
q SU 1 What Resists Persists: Helping to Overcome the Persistent Voice of “ED” by Utilizing Humor in Group Psychotherapy
- Danielle Doucette, PsyD; Jennifer Bradtke, PsyD
q SU 2 When to Push,When to Pull and When to Walk Along Beside Eating Disorder Clients
- Laura Hill, PhD
q SU 4 Weight,Weight History and Weight Suppression:Their Role in the Etiology and Maintenance of Anorexia and Bulimia Nervosa
- Michael R. Lowe, PhD; Staci Berkowitz, BA
q SU 5 Recovery Defined: Perspectives from Different Ends of the Couch
- Lara CC Pence, MBA, PsyD; Johanna Kandel, BA
q SU 6 Treatment in Fluidity: A Relational Approach to the Choice and Timing of Therapeutic Interventions for BED Patients
- Marissa Sappho, LCSW; Melanie Rogers, MS, RD
Share the Knowledge with Family, Friends and Clients Who Could Not Attend
Listen to the Sessions You Did Not Attend
Become Inspired by the Sessions You Did Attend
PERSPECTIVES • WINTER 2014
PAGE 17
PRICING INFO AND ORDERING INFORMATION
--Audio CDs are $12 for each Workshop listing (listen to audio cds in your car or computer)—Buy 10 Get 2 FREE!!!!
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We’re Bringing Our Expertise to You...
The Nation’s Leader in Eating Disorders Training presents the
2014 Spring Seminar Series for Professionals
We will be visiting the following cities
between March and June:
• Cincinnati, OH
• Lehigh Valley, PA
• Poughkeepsie, NY
Featured speakers include:
• Long Island, NY
• Macon, GA
All seminars will be held from 9:00am - 4:00pm
Offering 6 CE Credits
For more information visit www.renfrewcenter.com
or contact Debbie Lucker at 1-877-367-3383.
Adrienne Ressler, LMSW, CEDS, Fiaedp
Gayle Brooks, PhD
A PROFESSIONAL JOURNAL OF THE RENFREW CENTER FOUNDATION
PAGE 18
We’re Expanding!
The Renfrew Center is pleased to announce
the opening of its 13th facility in Baltimore,
MD and the upcoming opening of its 14th
facility in Boston, MA.
Programming at both locations will consist
of a comprehensive range of services
including:
• Day Treatment
• Intensive Outpatient
• Individual, Family
and Couples Therapy
• Group Therapy
• Nutrition Therapy
• Psychiatric Consultation
The Renfrew Center of Baltimore
NOW OPEN
Located at: 1122 Kenilworth Drive, Towson, MD 21204
For more information
please call 1-800-RENFREW.
The Renfrew Center of Boston
OPENING EARLY 2014
Located at: 870R Commonwealth Avenue, Boston, MA 02215
The Renfrew Center Announces New Facility in New York City
The Renfrew Center is pleased to announce the New York site will be relocating this Spring.
The larger, state-of-the-art facility will provide more space for patients and allow Renfrew to serve
a greater number of those in need.
The Renfrew Center of New York will be located at:
38 East 32nd Street, 10th Floor, New York, NY, 10016
For more information about the site and its programming,
please call 1-800-RENFREW or visit www.renfrewcenter.com.
PERSPECTIVES • WINTER 2014
PAGE 19
2014 Spring Webinar Series for Professionals
The Renfrew Center Foundation is proud to offer online training seminars for healthcare
professionals. Our clinical experts have developed cutting-edge presentations, which explore
the many issues surrounding the treatment of eating disorders. They will provide a variety of
perspectives, tools and tactics to more effectively treat this complex illness.
February March April May June Understanding Eating Disorders in Jewish Women
Presented by: Sarah Bateman, LCSW & Alissa Baum, PsyD
Maximizing Wellness for the Clinician
Presented by: Laurie Reid, LMFT, CAP
When Winning is Everything: Eating Disorders in Athletes
Presented by: Ryann Smith, RD, LDN
Social Media, Technology and Eating Disorders: When Tweeting, Posting,
Pinning and Tumbling Become a Barrier to Recovery
Presented by: Lara Pence, MBA, PsyD
The Renfrew Difference
Presented by: Gayle Brooks, PhD & Adrienne Ressler, LMSW, CEDS, Fiaedp
All webinars are FREE and run from noon to 1 PM EST.
To register, please visit www.renfrewcenter.com.
The Renfrew Center Foundation Presents:
Feast and Fasting: The Ups and Downs of
Eating Issues in the Jewish Community
We are pleased to present a seminar for health and mental health
professionals, educators and clergy addressing women’s body image
issues and eating disorders within the Jewish community.
Featured Speakers:
Marjorie C. Feinson, PhD
Professional Development Specialist for
The Renfrew Center Foundation
Sarah Bateman, LCSW
Jewish Community Liaison for
The Renfrew Center
When: Spring 2014
Where: Baltimore
For more information: visit www.renfrewcenter.com
or call Debbie Lucker at 1-877-367-3383.
NON-PROFIT ORG
U.S. POSTAGE
PAID
THE RENFREW
CENTER FOUNDATION
The Renfrew Center Foundation
475 Spring Lane
Philadelphia, PA 19128
1-877-367-3383
www.renfrewcenter.com
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The opinions published in Perspectives do not necessarily reflect those of The Renfrew Center. Each author is entitled to his or
her own opinion, and the purpose of Perspectives is to give him/her a forum in which to voice it.
L O C A T I O N S
Northeast Sites
Mid-Atlantic Sites
Southeast Sites
Philadelphia, Pennsylvania
475 Spring Lane
Philadelphia, PA 19128
Baltimore, Maryland
1122 Kenilworth Drive
Towson, MD 21204
Coconut Creek, Florida
7700 Renfrew Lane
Coconut Creek, FL 33073
Boston, Massachusetts
870R Commonwealth Avenue
Boston, MA 02215
Bethesda, Maryland
4719 Hampden Lane
Suite 100
Bethesda, MD 20814
Atlanta, Georgia
50 Glenlake Parkway
Suite 120
Atlanta, GA 30328
New York, New York
11 East 36th Street
2nd Floor
New York, NY 10016
Old Greenwich, Connecticut
1445 E. Putnam Avenue
Old Greenwich, CT 06870
Ridgewood, New Jersey
174 Union Street
Ridgewood, NJ 07450
Mt. Laurel, New Jersey
15000 Midlantic Drive
Suite 101
Mount Laurel, NJ 08054
Radnor, Pennsylvania
320 King of Prussia Road
2nd Floor
Radnor, PA 19087
Charlotte, North Carolina
6633 Fairview Road
Charlotte, NC 28210
Dallas, Texas
9400 North Central Expressway
Suite 150
Dallas,TX 75231
Nashville, Tennessee
1624 Westgate Circle
Suite 100
Brentwood,TN 37027