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Acceptance and Commitment Therapy

12/26/2015

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Acceptance and Commitment Therapy Bootcamp Overview
By:
​Blanche Stokley LMHC, CEDS
Address: 225 S Swoope Ave #205, Maitland, FL 32751
Phone:(407) 691-0477 

Hi folks. Just returned from a ACT bootcamp in Raleigh, NC. ACT stands for Acceptance and Commitment Therapy, a behavioral based therapy within a relational frame. This training was intense starting at 9am to 6:45pm for four days. Basically it is a a blend of behaviorism and rogerian therapies.

The primary object in ACT is to help others achieve “psychological flexibility” as opposed to ‘psychological rigidity”. Flexibility is often a sign of health in our bodies, minds, emotions and spirit. Asking a eating disorder client to consider psychological flexibility in their selected food choices challenges them. We know this includes eating with others and eating in restaurants. Asking for such flexibility in decreasing exercise, reconsidering a sport and reducing time in the gym is difficult for a client to accept and commit to recovery.

Emotionally we are asking a client to accept feeling emotions when the eating disorder has been successfully rendering the client numb. The client is often surprised by the extent of their repressed feelings. Flexibility often means accepting that feelings have their own time table. I use the metaphor of being pregnant. Your body has its own process which you can’t control. It might be nausea, fatigue or food cravings. And when the baby is ready, then it’s delivery time. Waiting and patience takes on new meaning!

We are also asking the family to be flexible. The family’s expectations whether realistic or not play a role in recovery. The supportive family will struggle and succeed in accepting the client’s eating disorder and the perhaps the client’s new or reemerging identity. But sometimes the most challenging idea for a client is the acceptance of a parent who may never elect to change. No amount of family therapy can convince this parent to become accepting and flexible.
Rigidity is risk avoidant and it makes an eating disorder client’s life small. The longer the disorder is un-arrested the smaller the life. Slowly encouraging the client to move out into the world helps them face maturity and rejections fears.

We as clinicians are challenged to be flexible as well. It is hard when insurance companies cut off necessary treatment payment. We see clients who cling to their disorder out of fear. Progress often is slow. However the rewards can be amazing! So consider bringing in the theme of psychological flexibility as a goal in treatment. Thanks for taking the time with me.



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Validation and Eating Disorder Treatment

9/26/2015

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By Melissa McCormick, MA, LMHC
Licensed Mental Health Counselor
Blue Horizon Eating Disorder Services, LLC
1155 Louisiana Ave., Suite 216
​
Winter Park, FL 32789

In therapy, an essential technique for virtually all emotional distress is validation. Validating that the patient’s experience and emotions are real is one of the most powerful ways to convey empathy. Expressing this to an eating disorder patient may even mean that they are hearing, for one of the first times ever, that their emotions are okay. 

Many people with anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, and other specified or unspecified eating disorders have lived most of their lives in invalidating environments. They may have been raised in a home with an alcoholic parent, where the unspoken rules of the home were to not speak about the clear problems occurring, not talk about emotions at all, and to not let outsiders in. They may have had a coach tell them repeatedly to “suck it up” and even possibly to ignore their physical needs as well as their emotional needs to get the desired results. They may have had a bully in school tell them to “stop being a baby” or “get over it”. If they are so used to being told to “leave their emotions at the door”, then they are surely used to being emotionally invalidated. This can be a recipe for an eating disorder or other addiction. 

If someone is told they should “get over it” and “stop being dramatic” when they show sadness, anger, fear, or even joy, then they will eventually have a conditioned response to their emotions in a similar way. This also means they may start relating having emotions with being “bad”, which can create a shame response every time an emotion is felt. Shame can manifest in “should statements” like “I shouldn’t feel this way, it’s no big deal”, or “I should be over this by now”. An eating disorder can develop as a perceived solution to these thoughts and emotions. The thought process may look like this: If I have a feeling, that’s bad. I need to get rid of it. I can use this behavior to numb the feeling. 

Naturally, the treatment for this is to work on self validation. While we as treatment providers can empathize and validate while they are in session, patients need to build an internal system of validation that they can use within themselves. Patients may find it difficult to give themselves permission to have emotions. They may have many negative core beliefs about themselves having emotions, such as believing that having emotions is weak. Patients can practice self validation by telling themselves it is okay to have any emotion at any time. They can practice reframing and thought replacement for times that they invalidate themselves. They can also use affirmations to confirm that their experience is real and makes sense. Using self validation can create shame resiliency, increased self compassion, and self efficacy. It may seem basic or general, but it can be the foundation for which they create their complex and profound recovery. 

About the Author:
Melissa McCormick, MA, LMHC is a Licensed Mental Health Counselor and received a Masters of Arts degree in Mental Health Counseling from the University of Central Florida. She has previous experience working with eating disorders at the residential level of care, as well as various other clinical disorders including substance use, mood disorders, and trauma related disorders. Melissa is a board member for two nonprofit eating disorder organizations in Central Florida, including the Central Florida IAEDP Chapter, which focuses on advocacy and education of eating disorders and eating disorder treatment.

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