Hi there,

I would love to share some of my experiences. I´ll start with the
things that work...for me....or at least that´s what I think.

Yes, motivation is an issue. To move the clients a bit toward "my"
perspective I use a time-line as a starting point where we write up
all important life events that affect(s)ed them. And if they did some
thing as a reaction to that, and how it worked. Then I´ll go on
asking about the eating problem when it started, how it changed, up /
down in weight, exercising, purging, laxatives, bingeing, asking
about things as did it make you feel special (often yes with AN),
loosing weight in the beginning often gives a "high", self-esteem....
and so on. In the meantime while thesse events are reported I also
ask them to talk about the function of these behaviors (educating
them about how we often/always seem to behave in order to get
conesquences). What we often end up in is a sort of "something
happened - I felt bad - to take away the bad I did X- and it worked
in short term - looking at the whole process of doing X; it ruins my
life - but I dont know what else to do.
This I think gives a very nice collaborative look at the processes,
You did what you could do given your history and it seemed as it
worked. looking at it now gives another perspective.
Then write up, in columns, all the things they wanted to get rid of
(anxiety,depression, wothlessness etc) / what they did to get rid of
it / how it worked in short time / how it worke in long time /
creates creative hopelessness.

sorry if I´m being too obvious. And this part I am quite pleased with
as the majority of patients seem to be with me up to here, they
havent done any thing up to this point so I really dont know about
their motivation for change in this stage...and this they get.
Returning to this what I have tried list, over and over again is
essential - I always let the big time-line sketch be in the wall to
point at it whenever they fall back in same old behaviors or talk
about these behaviors as solutions to their "problem".

we start every session w a mindfulness exercise, very short in the
beginning, slowly let them learn the new behavior of looking at
internal events and gradually slip over to letting them do short
mindfulness exercises at home. I really find the physicalising
exercise helpful - for some patients its an eye-opener and a place
from where they can really choose other behaviors.

ok, all for now -its friday and I gotta go. Hopefully this thread can
grow with others joining in.

humbly / Thomas

6 feb 2009 kl. 16.00 skrev Matt Boone:

>
> Hello Thomas, Carla, & Alix,
>
> I'm thrilled to hear this research is going on. About 1/3 of the
> work I do is with eating disorders and disordered eating generally.
> I find implementing "full-ACT" particularly difficult with this
> group. What I mean is this: with anxiety clients, it's easy to jump
> right into all of the processes. It makes a lot of intuitive sense
> to the clients and gains appear almost immediately, usually in the
> areas of diminished control, hope, and a willingness to have some
> anxiety. But with eating disorder clients, I have to start very
> slow. The motivation for change is low. Any sort of mindfulness
> needs to be done very tentatively. It's very difficult to lead
> someone through any kind of mindfulness exercise. Usually I just
> start with short periods of physicalizing. Values conversations
> bring up tons of fusion and a lack of willingness.
>
> I'm curious to hear how it goes for you all. I also would love to
> see some of your materials if you're willing to offer them. More
> than anything, I like to start a conversation on this list about
> working with eating disorders and ACT.
>
> Best,
>
> Matt
>
> Matt Boone, LCSW
> Counselor Therapist
> Counseling and Psychological Services (CAPS)
> Gannett Health Services phone: 607 255-5208
> Cornell University fax: 607 254-5244
> Ithaca, NY 14853-3101 e-mail: mb352@...
> For more information about Gannett: 607 255-5155;
> www.gannett.cornell.edu
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>

Thomas Parling, leg.Psykolog, doktorand
Institutionen för Psykologi
Box 1225, 751 42 Uppsala
Trädgårdsgatan 20
018-471 6221
070-205 8007
thomas.parling@...