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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 ___________________________________________ Amount Charged __________________________________________ Signature/Date ____________________________________________ 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!!!! --Audio MP3 files are $10 for each Workshop listing (listen in your computer or transfer to an iPod or Your Phone) FULL SET – CONFERENCE SPECIALS 1730-00____ 2013 Renfrew Conference Full Set of Audio CDs for only $299 1730-99____ 2013 Renfrew Conference Full Set of MP3 Audio files for only $99 **audio files can be listened to in any computer or transferred to your Phone, iPod or MP3 player** 1630-99 ____ 2012 Renfrew Conference Full Set of MP3 Audio files for only $49 ITEM QTY MP3 File CD TOTAL Individual Sessions on Audio _______ $10.00 $12.00 $ __________ 10-Session Special _______ $49.00 $120.00 $ __________ 2013 Renfrew Conference Full Set _______ $99.00 $299.00 $ __________ 2013 Renfrew Conf Full Set on USB drive _______ $125.00 $ __________ 2012 Renfrew Conf Set MP3s _______ $49.00 $ __________ Shipping and Handling $1 each item with a Maximum of $15, $5 for set mp3 files TOTAL $ __________ $ __________ $ __________ Name _______________________________________________________________________________________________________ Address_____________________________________________________________________________________________________ City _________________________________________________________State ________________ Zip ____________________ Phone _______________________________________________ Email _________________________________________________ q Cash q Check* q Visa q MC q AMEX *(Please Make Checks Payable to All Star Media) Card # ____________________________________________________________________ Exp. ________________ Signature ________________________________________________________________________________________ Have a question related to the 2013 Renfrew Conference MP3 audio files? Contact: David Lee Joy, CEO, All Star Media at 619-723-8893 (call or text) or [email protected] Thank you for your Order!!!! ALL STAR MEDIA 9740 Campo Road PMB #118 Spring Valley CA 91977 Telephone: 619-723-8893 WWW.ALLSTARTAPES.COM [email protected] 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 Emails to the Editor Join the discussion by emailing your thoughts on this issue to [email protected] 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. 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