Hi Tyler,

Thanks so much for expanding on your email and being as transparent as possible.
As you say, working in an outpatient setting is a whole different ball game to
working with clients in residential care with a deadline hanging over your head.
No wonder you want to switch to distress tolerance strategies, so you can feel
like you're giving them something. I have always worked in outpatient settings
and never in inpatient settings and I take my hat off to you, because you see
these clients at their most severe and most distressed.

One of the things that struck me about the residential setting is the amazing
opportunity to work with people in-vivo when they are experiencing such intense
emotions. I work in a DBT program and the phone is our equivalent for people to
call when they're in the crisis situations to work with them at that moment. As
therapists, it's so much more challenging that when people come in all regulated
and we can just talk about what to do when the crap hits the fan, but also so
much more powerful.

I'm very much a fan of Kelly's idea of 'sitting inside the question' without the
pull of the need to answer it.... and yet, I don't really know how to do that on
a listserve. If others also value the idea of sitting inside the question to
give space for something fresh to emerge maybe we can work out how to do that
together?

My main suggestion would be to lean in when the emotions are intense and notice
with the patient. What is this thing that they believe is impossible to have.
Where do they notice the emotion, what does it look like, if it had a colour,
what colour would it be, or a shape, can they just breathe into it and have a
look at it and be curious about it.... even whilst it's threatening to overwhelm
them. At that time the emotions seem like they could destroy them and I've been
playing around with your metaphor of the classroom being on fire in my head.
Maybe there's so much smoke that it seems like there must be a fire and that
everyone will die, but if they could stay and look at the smoke and see through
it, they could see that there's no fire (kind of like the passengers on the bus
claim that they could really hurt you, and yet, experience shows that they never
have). The smoke makes it seem like there is a fire and they probably can't
listen to your words and what you're teaching because the smoke is demanding
their attention, so go to where they are and look at the smoke with them and
they will have an urge to run out of the room, but they've done that before and
being in that room is where they need to be for life to be lived. Does this fit
for you? I think your metaphor is a really useful one and it'd be good to play
around a bit with it. It also reminded me of a client with Bulimia who talked
about having urges to binge that felt like she was on fire and the only way to
put the fire out was to binge. Not sure how that fits in here, but it was so
evocative for me and helped me to see how could she possibly feel like not
bingeing was an option when that actually meant feeling like she was burning
alive. i can't even remember how we addressed that in therapy,  but I do
remember that over time she talked about the sense of burning alive reducing.

Also, I wonder if the more the emotional intensity the client presents with, the
more driven you feel to talk and help and coach (that's what happens for me).

Are you on the main listserve? Someone posted a question last week about working
with a young person with anorexia who is losing weight fast and their were a
couple of really lovely responses about the therapist working on acceptance and
being where the client is at.

I also discussed this with some of my colleagues who had some different ideas,
so I will leave it to them to respond as I think they'll do a better job of
explaining what they mean than I will.

I might leave it there for now. I had a few more half-baked thoughts but I have
a client downstairs waiting for me and if I wait to have time to write a longer
response it won't happen and I wanted to send something off in response to your
email.

Thanks again for your honesty and willingness to be vulnerable and to put your
questions out there.

Carla.

>>> "jtbeach78" <jtbeach78@...> 06-Feb-08 2:30:30 pm >>>
Hi Carla,

Thanks for your response!  I find myself using the very same
strategies you describe.  In my opinion, I think this works well in
longer term psychotherapy situations when we can circle over and over
until they're ready to approach.

Where I'm having a hard time applying it is with my clients in
residential care, where my they come in for 45-90 days. The situation
is quite different in that all of a sudden these clients are faced
with eating large food portions and tolerating changes to their BMI
in very quick progression.

In the interest of getting some focused feedback, I'm going to be as
transparent as possible.  The first few days are sort of a honeymoon
where the food portions are typically small and patient anxiety,
although still high, hasn't reached phobic intensity.  At this stage,
orienting someone to an ACT framework is relatively easy.  In fact
they really see how avoidance has caused so much trouble.  Other
treatments haven't been fully effective so maybe this is worth a try.
But treatment changes quick from this point, and as we know many of
these clients really have a hard time with change.  Food portions and
body changes start happening and emotional intensity and suffering
spike to high levels.  I try to prime my patients for this change as
much as I can.  When the petal hits the metal is when I feel the most
unskilled at guiding my client.  I validate, use metaphors, remind
them of their values, remind them we've anticipated this reaction,
etc.  All of this helps some but in the middle of such intensity
doesn't seem to sink in the same as it did before.  Patients who were
very eager several days before want to run for the hills.  Sometimes
my clients look at me like I'm crazy or they just repeat that they
don't want to feel this way no matter what the cost. I validate their
reactions and invite them to look at them.  I talk about the nature
of avoidance and how it can limit our ability to get free.

I love the theory but many times with clients, this is the time that
just feels weird to me.  Sometimes I feel like I am trying to teach a
class and requesting that my students please pay attention when the
classroom is on fire!  I start to worry and my brain starts producing
worry thoughts:

    "Am I being presumptuous in thinking I can open them to this
approach and then help them to see some benefit in a reasonable time
period?  Is there something else I could be providing them? Is this
work appropriate for where they are?  Am I reasonably confident they
have the skills to tolerate this sort of intervention?  Will they
leave treatment with some concrete skills they can take with them in
their continued recovery?  Should I go back to my old DBT approach
and validate the distressing nature of the current intensity,
encourage distress tolerance (distraction) techniques, thought
stopping and distortion challenges?  Or should I focus exclusively on
the validation strategy by empathizing as hard as I can, and put all
of my focus on creating a corrective emotional experience?"

So that is where I find myself sometimes.  I sometimes get
discouraged because I feel unskilled at assisting in reducing intense
suffering in the moment without using distracting skills.  Also, in
spending more time coaching them towards their values, and analyzing
language. I feel a bit pushy and invalidating of their current
suffering. I remain patient and continue forward but its hard at
times!  Part of the journey for me seems to be able to integrate this
in a way that allows me to tolerate my uncertainty.

--Tyler


--- In eatingconcernsandcontextualpsychology@yahoogroups.com, "Carla
Walton" <Carla.Walton@...> wrote:
>
> Hi Tyler,
>
> I'm not sure if I've got any big ideas for that issue, I'm really
wanting to write back to support your wonderings and keep the
conversation alive.
>
> WIth eating disorders, I find myself continually returning to
Creative Hopelessness and particularly the idea of workability, i.e.,
in your experience, has that worked and what's the cost been. I find
with Eating Disorders more than any other client group I work with, I
need to keep revisiting that, cause often just as soon as someone has
opened up to other possibilities, the Eating Disorder comes in and
takes over again. In fact, I guess I find with Eating Disorders, that
I'm often circling back over lots of ACT aspects. My take on it is
that when the lack of food intake affects people's cognitive
abilities, it makes it harder to take stuff in and that the affect
phobicness and fusion with thoughts is really strong with EDs.
>
> In the situation of ambivalence, I'd be likely to move into values,
so that it makes it more meaningful. E.g., "would it be worth having
(describe painful feeling) if it meant that (describe value)?"
>
> Not knowing each other in these situations, I always wonder when I
write things whether these are the things people are doing anyway.
>
> Carla.
>
> Dr Carla Walton
> Clinical Psychologist
> Centre for Psychotherapy
> James Fletcher Hospital
> PO Box 833
> Newcastle NSW 2300
>
> Ph:      (02) 4924 6820
> Fax:    (02) 4924 6801
> E-Mail: Carla.Walton@...
>
> >>> "Tyler Beach" <jtbeach78@...> 01/11/08 10:02 AM >>>
> Hi group,
>
>
>
> I work as a psychotherapist at a residential eating disorders
facility.  I'm
> new to ACT work.  I'd done some reading on it and recently went to a
> training offered by an ACT psychologist at Duke.  I was originally
trained
> in DBT and mindfulness based psychotherapy, but after going to this
recent
> training, I realized I was doing a bit of ACT work (sans
terminology or
> framework) without even knowing it!  For about a year I have been
slowly
> moving away from some of the distraction and blocking strategies
taught by
> DBT (which IMO certainly have their place for certain populations)
and
> leaned more heavily into the defusion strategies and mindfulness
> experiencing skills.  I find the work very rewarding and intense.
It is
> always an adventure during the intro stage, especially when I am
engaging a
> client in a conversation where I am actually asking them to stop
fighting
> their thoughts of being "fat" and corresponding feelings.  My
experience is
> that most clients are quite intrigued and like the theory, but tend
to
> become more ambivalent in the presence of actual affect or intense
thoughts.
> I wonder if others are coming up against that and what strategies
they use
> to keep a client engaged in the approach vs. avoidance.
>
>
>
> --Tyler Beach, LCSW
>





Yahoo! Groups Links

You know, I think of every moment in therapy as an opportunity to practice the
skills the
ACT model suggests are useful in helping people to move towards things that are
important to them (defusion, acceptance, being present, selfing, valuing, and
committed
action).  I think of my job as creating a context where these skills can emerge
in tiny little
steps.  Generally, when I'm creating a context where tolerance is what works,
then I'm
pushing too hard.


emily


Emily K. Sandoz
University of Mississippi

>    "Am I being presumptuous in thinking I can open them to this
> approach and then help them to see some benefit in a reasonable time
> period?  Is there something else I could be providing them? Is this
> work appropriate for where they are?  Am I reasonably confident they
> have the skills to tolerate this sort of intervention?  Will they
> leave treatment with some concrete skills they can take with them in
> their continued recovery?  Should I go back to my old DBT approach
> and validate the distressing nature of the current intensity,
> encourage distress tolerance (distraction) techniques, thought
> stopping and distortion challenges?  Or should I focus exclusively on
> the validation strategy by empathizing as hard as I can, and put all
> of my focus on creating a corrective emotional experience?"
>

Hi Carla,

Thanks for your response!  I find myself using the very same
strategies you describe.  In my opinion, I think this works well in
longer term psychotherapy situations when we can circle over and over
until they're ready to approach.

Where I'm having a hard time applying it is with my clients in
residential care, where my they come in for 45-90 days. The situation
is quite different in that all of a sudden these clients are faced
with eating large food portions and tolerating changes to their BMI
in very quick progression.

In the interest of getting some focused feedback, I'm going to be as
transparent as possible.  The first few days are sort of a honeymoon
where the food portions are typically small and patient anxiety,
although still high, hasn't reached phobic intensity.  At this stage,
orienting someone to an ACT framework is relatively easy.  In fact
they really see how avoidance has caused so much trouble.  Other
treatments haven't been fully effective so maybe this is worth a try.
But treatment changes quick from this point, and as we know many of
these clients really have a hard time with change.  Food portions and
body changes start happening and emotional intensity and suffering
spike to high levels.  I try to prime my patients for this change as
much as I can.  When the petal hits the metal is when I feel the most
unskilled at guiding my client.  I validate, use metaphors, remind
them of their values, remind them we've anticipated this reaction,
etc.  All of this helps some but in the middle of such intensity
doesn't seem to sink in the same as it did before.  Patients who were
very eager several days before want to run for the hills.  Sometimes
my clients look at me like I'm crazy or they just repeat that they
don't want to feel this way no matter what the cost. I validate their
reactions and invite them to look at them.  I talk about the nature
of avoidance and how it can limit our ability to get free.

I love the theory but many times with clients, this is the time that
just feels weird to me.  Sometimes I feel like I am trying to teach a
class and requesting that my students please pay attention when the
classroom is on fire!  I start to worry and my brain starts producing
worry thoughts:

    "Am I being presumptuous in thinking I can open them to this
approach and then help them to see some benefit in a reasonable time
period?  Is there something else I could be providing them? Is this
work appropriate for where they are?  Am I reasonably confident they
have the skills to tolerate this sort of intervention?  Will they
leave treatment with some concrete skills they can take with them in
their continued recovery?  Should I go back to my old DBT approach
and validate the distressing nature of the current intensity,
encourage distress tolerance (distraction) techniques, thought
stopping and distortion challenges?  Or should I focus exclusively on
the validation strategy by empathizing as hard as I can, and put all
of my focus on creating a corrective emotional experience?"

So that is where I find myself sometimes.  I sometimes get
discouraged because I feel unskilled at assisting in reducing intense
suffering in the moment without using distracting skills.  Also, in
spending more time coaching them towards their values, and analyzing
language. I feel a bit pushy and invalidating of their current
suffering. I remain patient and continue forward but its hard at
times!  Part of the journey for me seems to be able to integrate this
in a way that allows me to tolerate my uncertainty.

--Tyler


--- In eatingconcernsandcontextualpsychology@yahoogroups.com, "Carla
Walton" <Carla.Walton@...> wrote:
>
> Hi Tyler,
>
> I'm not sure if I've got any big ideas for that issue, I'm really
wanting to write back to support your wonderings and keep the
conversation alive.
>
> WIth eating disorders, I find myself continually returning to
Creative Hopelessness and particularly the idea of workability, i.e.,
in your experience, has that worked and what's the cost been. I find
with Eating Disorders more than any other client group I work with, I
need to keep revisiting that, cause often just as soon as someone has
opened up to other possibilities, the Eating Disorder comes in and
takes over again. In fact, I guess I find with Eating Disorders, that
I'm often circling back over lots of ACT aspects. My take on it is
that when the lack of food intake affects people's cognitive
abilities, it makes it harder to take stuff in and that the affect
phobicness and fusion with thoughts is really strong with EDs.
>
> In the situation of ambivalence, I'd be likely to move into values,
so that it makes it more meaningful. E.g., "would it be worth having
(describe painful feeling) if it meant that (describe value)?"
>
> Not knowing each other in these situations, I always wonder when I
write things whether these are the things people are doing anyway.
>
> Carla.
>
> Dr Carla Walton
> Clinical Psychologist
> Centre for Psychotherapy
> James Fletcher Hospital
> PO Box 833
> Newcastle NSW 2300
>
> Ph:      (02) 4924 6820
> Fax:    (02) 4924 6801
> E-Mail: Carla.Walton@...
>
> >>> "Tyler Beach" <jtbeach78@...> 01/11/08 10:02 AM >>>
> Hi group,
>
>
>
> I work as a psychotherapist at a residential eating disorders
facility.  I'm
> new to ACT work.  I'd done some reading on it and recently went to a
> training offered by an ACT psychologist at Duke.  I was originally
trained
> in DBT and mindfulness based psychotherapy, but after going to this
recent
> training, I realized I was doing a bit of ACT work (sans
terminology or
> framework) without even knowing it!  For about a year I have been
slowly
> moving away from some of the distraction and blocking strategies
taught by
> DBT (which IMO certainly have their place for certain populations)
and
> leaned more heavily into the defusion strategies and mindfulness
> experiencing skills.  I find the work very rewarding and intense.
It is
> always an adventure during the intro stage, especially when I am
engaging a
> client in a conversation where I am actually asking them to stop
fighting
> their thoughts of being "fat" and corresponding feelings.  My
experience is
> that most clients are quite intrigued and like the theory, but tend
to
> become more ambivalent in the presence of actual affect or intense
thoughts.
> I wonder if others are coming up against that and what strategies
they use
> to keep a client engaged in the approach vs. avoidance.
>
>
>
> --Tyler Beach, LCSW
>

Hi Carla

Thanks for your answer.
I think you have seen trought in all the issues!

I completely agree with you about having a greater
sense of doing something constructive when we do
experiencial work. And I’m willing to do it more and
to talk less. It will not be easy. In my experience I
talk very few but I often reinforce patient talking,
also (and maybe especially) when talking bring us far
from our passengers.

I apologize on bahalf of my mind that sometimes buys
the thought, the prejudice “American people are more
simple, more persuadable and more spontaneous”... I
have great and serious respect for American people and
I read mainly American psychological literature (and I
know more terrible prejudices about Italian people
pass through the Americans minds!). I agree with you
about the “fine line” and I’m grateful to you because
you remind me I might be not prepared because of my
own passengers! You have not been bossy!

About real cultural differences, may be there are very
few... In my opinion we are less pragmatic and more
speculative (or lazy). We don’t have the axact
transation of some terms (willingness, workability,
and many others). And I have to work hard and do more
experience..


Many thanks

Giovanni

--- Carla Walton <Carla.Walton@...>
ha scritto:

> Hi Giovanni,
>
> A few things came to mind as I read your email.
> Would it be different to ask the patients to show
> the passengers to you? This would get around the
> issues of it being too early or not being sure if
> they are their passengers or not. In time, if we
> stop to look at them long enough, most of us have
> some passengers that have been around a very long
> time and are probably quite familiar to us. We
> probably all know our own passengers better than
> anyone else does.
>
> You mention that often you have the sensation that
> you and the patient are not working. I don't know if
> this is relevant for you, but the biggest way that I
> stuff it up is to get too much into talking and not
> enough into experiential, and if I go back to the
> experiential, I generally have a greater sense of us
> doing something constructive.
>
> I'm curious about your comment that the practice of
> ACT doesn't fit with Italian culture. Tell me more?
>
> I think in Australia, often times we feel ridiculous
> too doing some of the ACT exercises. I think there
> are cultural differences - in my experience, most
> ACT practitioners in Australia have made
> modifications from the way we've learnt it from
> American trainers, because in Australia, we're
> generally less expressive and other differences that
> I haven't quite got sorted out yet. It's a bit of a
> fine line between adjusting to what works for the
> culture and noticing what we're not prepared to do
> because of our own passengers that show up that we
> don't want there. Would you be willing to play
> around with it?
>
> Hmmm, I have a passenger showing up saying that I'm
> sounding very bossy on here!
>
> Carla.
>
> Dr Carla Walton
> Clinical Psychologist
> Centre for Psychotherapy
> James Fletcher Hospital
> PO Box 833
> Newcastle NSW 2300
>
> Ph:      (02) 4924 6820
> Fax:    (02) 4924 6801
> E-Mail: Carla.Walton@...
>
> >>> "giovazucchi" <giovazucchi@...> 01/18/08
> 9:11 AM >>>
> I read this Emily message few days ago and I was
> encouraged to talk
> a little of my work. I hope not to bore and my
> english be
> understandable.
>
> I work prevantely with addiction (mainly alcohol)
> and I love group
> work with inpatients. I think I do a quite ACT
> consistent work in
> groups, and, more in general, with inpatients
> (hospitalizaed for a
> month). But I find my work in private practice is
> less ACT
> consistent.
> I work with only two people with eating disorders
> (in extremely, too
> few words, 1 bulimia and 1 anorexia) in this moment
> but I'm not sure
> how ACT is my work... This are my main difficulties:
>
>
> -I feel often the sensation we are not working.
> -I feel like on the bus of the `passengers on the
> bus' metaphor. The
> patient is the driver and I'm next to the driver...
> I belive I see
> the passengers and I think my work is to show the
> passengers to the
> driver.. but then I think `may be is too early...
> may be she is not
> ready... may be this passengers are a delusion of
> mine...' and I
> feel worry. And than we find again each other from
> passengers..
> -Sometimes I think ACT theory is great but the
> practice fit not well
> with Italian culture. Sometimes I feel ridiculous...
> and I prefer
> not to expose me.
> -I think they guide me were they want more than how
> I guide them.
>
> This are the main, but I have more... AND I value
> ACT work!
>
> May someone send me this article mentioned by Emily?
> Ruiz, M. R., and Roche, B. (2007, Spring). Values
> and the Scientific
> Culture of Behavior Analysis. The Behavior Analyst,
> 30(1), 1-16.
>
> Thanks for your attention
>
> Ciao
> Giovanni
>
>
>
> --- In
>
eatingconcernsandcontextualpsychology@yahoogroups.com,
> "Emily
> Sandoz" <emilykennison@...> wrote:
> >
> > Hi all...
> >
> > We've been getting a little bit of a rush in
> membership activity,
> only to find that the
> > conversation very very quiet here recently.
> >
> > So I'm sitting here wondering...  What are we all
> doing?
> >
> > For those of us who are doing therapy - how are we
> applying
> contextual approaches in
> > the room?  What are we doing?  What are we seeing?
>  What are we
> wondering about?
> >
> > And those doing research-  What questions are we
> asking?  How are
> we getting them
> > answered?
> >
> > And for everyone - Is there a way that this
> community might
> support your work in these
> > areas?
> >
> > Hope you are all well,
> >
> > em
> >
> > Emily Sandoz, M.S.
> > Graduate Student
> > University of Mississippi
> > eksandoz@...
> >
>
>
>
>
>
> Yahoo! Groups Links
>
http://groups.yahoo.com/group/eatingconcernsandcontextualpsychology/
>
http://groups.yahoo.com/group/eatingconcernsandcontextualpsychology/join
>     (Yahoo! ID required)
>
mailto:eatingconcernsandcontextualpsychology-digest@yahoogroups.com
>
>
>
mailto:eatingconcernsandcontextualpsychology-fullfeatured@yahoogroups.com
>
>
eatingconcernsandcontextualpsychology-unsubscribe@yahoogroups.com
>
>
>



       ___________________________________
L'email della prossima generazione? Puoi averla con la nuova Yahoo! Mail:
http://it.docs.yahoo.com/nowyoucan.html

Hi Giovanni,

A few things came to mind as I read your email. Would it be different to ask the
patients to show the passengers to you? This would get around the issues of it
being too early or not being sure if they are their passengers or not. In time,
if we stop to look at them long enough, most of us have some passengers that
have been around a very long time and are probably quite familiar to us. We
probably all know our own passengers better than anyone else does.

You mention that often you have the sensation that you and the patient are not
working. I don't know if this is relevant for you, but the biggest way that I
stuff it up is to get too much into talking and not enough into experiential,
and if I go back to the experiential, I generally have a greater sense of us
doing something constructive.

I'm curious about your comment that the practice of ACT doesn't fit with Italian
culture. Tell me more?

I think in Australia, often times we feel ridiculous too doing some of the ACT
exercises. I think there are cultural differences - in my experience, most ACT
practitioners in Australia have made modifications from the way we've learnt it
from American trainers, because in Australia, we're generally less expressive
and other differences that I haven't quite got sorted out yet. It's a bit of a
fine line between adjusting to what works for the culture and noticing what
we're not prepared to do because of our own passengers that show up that we
don't want there. Would you be willing to play around with it?

Hmmm, I have a passenger showing up saying that I'm sounding very bossy on here!

Carla.

Dr Carla Walton
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
PO Box 833
Newcastle NSW 2300

Ph:      (02) 4924 6820
Fax:    (02) 4924 6801
E-Mail: Carla.Walton@...

>>> "giovazucchi" <giovazucchi@...> 01/18/08 9:11 AM >>>
I read this Emily message few days ago and I was encouraged to talk
a little of my work. I hope not to bore and my english be
understandable.

I work prevantely with addiction (mainly alcohol) and I love group
work with inpatients. I think I do a quite ACT consistent work in
groups, and, more in general, with inpatients (hospitalizaed for a
month). But I find my work in private practice is less ACT
consistent.
I work with only two people with eating disorders (in extremely, too
few words, 1 bulimia and 1 anorexia) in this moment but I'm not sure
how ACT is my work... This are my main difficulties:

-I feel often the sensation we are not working.
-I feel like on the bus of the `passengers on the bus' metaphor. The
patient is the driver and I'm next to the driver... I belive I see
the passengers and I think my work is to show the passengers to the
driver.. but then I think `may be is too early... may be she is not
ready... may be this passengers are a delusion of mine...' and I
feel worry. And than we find again each other from passengers..
-Sometimes I think ACT theory is great but the practice fit not well
with Italian culture. Sometimes I feel ridiculous... and I prefer
not to expose me.
-I think they guide me were they want more than how I guide them.

This are the main, but I have more... AND I value ACT work!

May someone send me this article mentioned by Emily?
Ruiz, M. R., and Roche, B. (2007, Spring). Values and the Scientific
Culture of Behavior Analysis. The Behavior Analyst, 30(1), 1-16.

Thanks for your attention

Ciao
Giovanni



--- In eatingconcernsandcontextualpsychology@yahoogroups.com, "Emily
Sandoz" <emilykennison@...> wrote:
>
> Hi all...
>
> We've been getting a little bit of a rush in membership activity,
only to find that the
> conversation very very quiet here recently.
>
> So I'm sitting here wondering...  What are we all doing?
>
> For those of us who are doing therapy - how are we applying
contextual approaches in
> the room?  What are we doing?  What are we seeing?  What are we
wondering about?
>
> And those doing research-  What questions are we asking?  How are
we getting them
> answered?
>
> And for everyone - Is there a way that this community might
support your work in these
> areas?
>
> Hope you are all well,
>
> em
>
> Emily Sandoz, M.S.
> Graduate Student
> University of Mississippi
> eksandoz@...
>





Yahoo! Groups Links

Hi Tyler,

I'm not sure if I've got any big ideas for that issue, I'm really wanting to
write back to support your wonderings and keep the conversation alive.

WIth eating disorders, I find myself continually returning to Creative
Hopelessness and particularly the idea of workability, i.e., in your experience,
has that worked and what's the cost been. I find with Eating Disorders more than
any other client group I work with, I need to keep revisiting that, cause often
just as soon as someone has opened up to other possibilities, the Eating
Disorder comes in and takes over again. In fact, I guess I find with Eating
Disorders, that I'm often circling back over lots of ACT aspects. My take on it
is that when the lack of food intake affects people's cognitive abilities, it
makes it harder to take stuff in and that the affect phobicness and fusion with
thoughts is really strong with EDs.

In the situation of ambivalence, I'd be likely to move into values, so that it
makes it more meaningful. E.g., "would it be worth having (describe painful
feeling) if it meant that (describe value)?"

Not knowing each other in these situations, I always wonder when I write things
whether these are the things people are doing anyway.

Carla.

Dr Carla Walton
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
PO Box 833
Newcastle NSW 2300

Ph:      (02) 4924 6820
Fax:    (02) 4924 6801
E-Mail: Carla.Walton@...

>>> "Tyler Beach" <jtbeach78@...> 01/11/08 10:02 AM >>>
Hi group,



I work as a psychotherapist at a residential eating disorders facility.  I'm
new to ACT work.  I'd done some reading on it and recently went to a
training offered by an ACT psychologist at Duke.  I was originally trained
in DBT and mindfulness based psychotherapy, but after going to this recent
training, I realized I was doing a bit of ACT work (sans terminology or
framework) without even knowing it!  For about a year I have been slowly
moving away from some of the distraction and blocking strategies taught by
DBT (which IMO certainly have their place for certain populations) and
leaned more heavily into the defusion strategies and mindfulness
experiencing skills.  I find the work very rewarding and intense.  It is
always an adventure during the intro stage, especially when I am engaging a
client in a conversation where I am actually asking them to stop fighting
their thoughts of being "fat" and corresponding feelings.  My experience is
that most clients are quite intrigued and like the theory, but tend to
become more ambivalent in the presence of actual affect or intense thoughts.
I wonder if others are coming up against that and what strategies they use
to keep a client engaged in the approach vs. avoidance.



--Tyler Beach, LCSW

Hi All,

Emily - thanks for the invitation to us to participate more in this group. I
really appreciate the idea that there are other ACT clinicians out there working
in the area of Eating Disorders and that we could support each other. And yet,
as you say, it's been very quiet. I hope we can develop this into an active and
inclusive conversation. I'd find it really valuable if people could come with
upfront, uncensored questions or reflections and we could just bounce stuff
around here.

My colleague, Stella and I wrote to the list last year about putting an ACT for
Bulimia group together, well, things have been moving slowly slowly, but we are
going to consolidate our plans for the group in the next month and give it  a
trial go in the next few months. We'll likely be popping up a bit on here at
that time, seeking others' inputs.

Several colleagues and myself also use ACT with Anorexia and find this a useful
framework, although, I still find treatment really slow going. Our dietitians
are using ACT as well, so it's great for the clients to be getting the same
message on all fronts.

Personally, I've been backpacking around Central America for the past 5 weeks so
my brain has quietened down on it's usual wonderings, but I'll pipe up when the
cogs get turning again.

What are others wondering about? This community could be a great place to 'sit
inside' some of those questions.

Carla.

Dr Carla Walton
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
PO Box 833
Newcastle NSW 2300

Ph:      (02) 4924 6820
Fax:    (02) 4924 6801
E-Mail: Carla.Walton@...

>>> "Emily Sandoz" <emilykennison@...> 01/10/08 3:02 PM >>>
Hi all...

We've been getting a little bit of a rush in membership activity, only to find
that the
conversation very very quiet here recently.

So I'm sitting here wondering...  What are we all doing?

For those of us who are doing therapy - how are we applying contextual
approaches in
the room?  What are we doing?  What are we seeing?  What are we wondering about?

And those doing research-  What questions are we asking?  How are we getting
them
answered?

And for everyone - Is there a way that this community might support your work in
these
areas?

Hope you are all well,

em

Emily Sandoz, M.S.
Graduate Student
University of Mississippi
eksandoz@...





Yahoo! Groups Links

I read this Emily message few days ago and I was encouraged to talk
a little of my work. I hope not to bore and my english be
understandable.

I work prevantely with addiction (mainly alcohol) and I love group
work with inpatients. I think I do a quite ACT consistent work in
groups, and, more in general, with inpatients (hospitalizaed for a
month). But I find my work in private practice is less ACT
consistent.
I work with only two people with eating disorders (in extremely, too
few words, 1 bulimia and 1 anorexia) in this moment but I'm not sure
how ACT is my work... This are my main difficulties:

-I feel often the sensation we are not working.
-I feel like on the bus of the `passengers on the bus' metaphor. The
patient is the driver and I'm next to the driver... I belive I see
the passengers and I think my work is to show the passengers to the
driver.. but then I think `may be is too early... may be she is not
ready... may be this passengers are a delusion of mine...' and I
feel worry. And than we find again each other from passengers..
-Sometimes I think ACT theory is great but the practice fit not well
with Italian culture. Sometimes I feel ridiculous... and I prefer
not to expose me.
-I think they guide me were they want more than how I guide them.

This are the main, but I have more... AND I value ACT work!

May someone send me this article mentioned by Emily?
Ruiz, M. R., and Roche, B. (2007, Spring). Values and the Scientific
Culture of Behavior Analysis. The Behavior Analyst, 30(1), 1-16.

Thanks for your attention

Ciao
Giovanni



--- In eatingconcernsandcontextualpsychology@yahoogroups.com, "Emily
Sandoz" <emilykennison@...> wrote:
>
> Hi all...
>
> We've been getting a little bit of a rush in membership activity,
only to find that the
> conversation very very quiet here recently.
>
> So I'm sitting here wondering...  What are we all doing?
>
> For those of us who are doing therapy - how are we applying
contextual approaches in
> the room?  What are we doing?  What are we seeing?  What are we
wondering about?
>
> And those doing research-  What questions are we asking?  How are
we getting them
> answered?
>
> And for everyone - Is there a way that this community might
support your work in these
> areas?
>
> Hope you are all well,
>
> em
>
> Emily Sandoz, M.S.
> Graduate Student
> University of Mississippi
> eksandoz@...
>

Rikke,

Not sure if you're on the main ACT listserv, but there are two review articles
of the "thrid
wave" or mindfulness/acceptance movement that were recently discussed that are
fairly
critical of ACT.  The citations are below.  It might be worth looking over the
discussion
that was/is happening on the listserv, as well.  Several big-brains responded in
detail to
many of the critiques in the articles.

Ost, L.G. (in press). Efficacy of the third wave of behavioral therapies: A
systematic review
and meta-analysis. Behaviour Research and Therapy.

Hofmann, S.G., & Asmundson, G.J.G. (in press). Acceptance and mindfulness-based
therapy: New wave or old hat?   Clinical Psychology Review.

For geekier philosophy of science type folks, there was a recent criticism of
Functional
Contextualism, which was discussed on the ACT listserv as well.

Ruiz, M. R., and Roche, B. (2007, Spring). Values and the
Scientific Culture of Behavior Analysis. The Behavior Analyst, 30(1),
1-16.

Hope that helps!


emily


Emily Sandoz, M.S.
Graduate Student
University of Mississippi
eksandoz@...
337.371.5440


--- In eatingconcernsandcontextualpsychology@yahoogroups.com, "Rikke Kjelgaard"
<rikkekjelgaard@...> wrote:
>
> Hello everybody,
>
> I am a student at the University of Copenhagen currently finishing my
> theoretical Master Thesis about CBT for obesity and the potential use
> of ACT in this intervention.
>
> I am very enthusiastic about ACT and cannot seem to come up with any
> reasons why traditional CBT should be preferable. I still need to
> produce a sound discussion though, so I was wondering if anyone could
> help me with a reference to some articles that actually criticize ACT?
>
> Best regards and Christmas greetings,
>
> Rikke Kjelgaard
>

Tyler,

Thanks for introducing yourself and welcome!

I know that experience of being attracted to the theory but having trouble
practicing it
when really scary stuff shows up.  And not just because my clients tell me about
it...

One thing that I've found to be useful in helping to move my clients toward
acceptance is
to meet them where they are and present situations in which it is easier for
them to "do"
acceptance.

We'll practice acceptance of less threatening kinds of uncomfortable thoughts
and feelings
right there in the therapy room (e.g., frustration with traffic or
disappointment over a
cancelled lunch) before moving slooooooooowwwwwwly to their most central (and
most
fused/avoided) private experiences.

And then we'll notice, out loud, what that was like, how that was different and
wonder
how that might work with other things that show up for them.

(I'd be happy to talk more about what this looks like if I'm being too vague.)

In the end, I don't care if they buy the theory or not.  I just care about
teaching them some
skills that they can add to their repertoires so that when hard things show up,
they have
choices.

emily

Emily Sandoz, M.S.
University of Mississippi
eksandoz@...
337.371.5440





--- In eatingconcernsandcontextualpsychology@yahoogroups.com, "Tyler Beach"
<jtbeach78@...> wrote:
>
> Hi group,
>
>
>
> I work as a psychotherapist at a residential eating disorders facility.  I'm
> new to ACT work.  I'd done some reading on it and recently went to a
> training offered by an ACT psychologist at Duke.  I was originally trained
> in DBT and mindfulness based psychotherapy, but after going to this recent
> training, I realized I was doing a bit of ACT work (sans terminology or
> framework) without even knowing it!  For about a year I have been slowly
> moving away from some of the distraction and blocking strategies taught by
> DBT (which IMO certainly have their place for certain populations) and
> leaned more heavily into the defusion strategies and mindfulness
> experiencing skills.  I find the work very rewarding and intense.  It is
> always an adventure during the intro stage, especially when I am engaging a
> client in a conversation where I am actually asking them to stop fighting
> their thoughts of being "fat" and corresponding feelings.  My experience is
> that most clients are quite intrigued and like the theory, but tend to
> become more ambivalent in the presence of actual affect or intense thoughts.
> I wonder if others are coming up against that and what strategies they use
> to keep a client engaged in the approach vs. avoidance.
>
>
>
> --Tyler Beach, LCSW
>

Hi all...

We've been getting a little bit of a rush in membership activity, only to find
that the
conversation very very quiet here recently.

So I'm sitting here wondering...  What are we all doing?

For those of us who are doing therapy - how are we applying contextual
approaches in
the room?  What are we doing?  What are we seeing?  What are we wondering about?

And those doing research-  What questions are we asking?  How are we getting
them
answered?

And for everyone - Is there a way that this community might support your work in
these
areas?

Hope you are all well,

em

Emily Sandoz, M.S.
Graduate Student
University of Mississippi
eksandoz@...

Dear Stella,
Sorry for the delay in responding.
I have not had an experience with BN groups per se. For the last 3 years I have
been working individually with clients with a variety of eating disorders on an
outpatient basis. I was hoping to start some groups but had not had a chance
yet. Here is what I can answer based on my experience:
1)  We are wondering how behaviorally focused your groups are, in
terms of targeting and changing the binge purging behaviors?- ie.
do you focus on reducing binge eating and purging as the
predetermined, main goal of the group or do you have a general goal
of helping them to identify and accept their values and live a vital
life, with the idea that the ED behaviours will change in the process
of them taking active steps towards pursuing their values?
I usually start off with the values and then any behavior change is done in the
context of these values. I invite clients that if they are willing and if it is
important to them to make changes then to commit to change and proceed to do
that. So I do not outright try to change their binge eating behavior, I want
them to see that this is something that prevents them from their valued life and
become willing to commit to making a change and then help them do that.
2) Ambivalence is a feature of Bulimia and we often have EDNOS clients
with extremely restrictive food intakes and they are pre-
contemplative towards making changes in this area. Do you meet with
the group clients separately beforehand to do some pre-commitment
work with those who are ambivalent and to work on engagement before
the group commences?
As I have not done such groups yet, I can speak from my experience with other
groups (e.g. panic and social anxiety). I think though that this is an empirical
question that needs to be examined. I would say that ambivalence should be a
topic of the group that can be addressed as such. I presume that group members
will help each other as well with the ambivalence expressed so I would use this
in the groups.
3) Do you target each session based on where the majority of the group
are at, or are the sessions structured in a predetermined order? ie.
We're wondering how early to bring in values...?
Based on other ACT groups I run, we had a predetermined agenda (manual) and we
went by that. Again this is an empirical question that needs to be addressed.
Regarding values, I have started to include them at the very beginning. I find
the start of treatment to be much smoother with values than with creative
hopelessness- just my preference. Again, the order of the treatment components
needs to be examined further.
4) if you have come up with a content outline, are you willing to
share it with us?
Unfortunately, I do not have something written up. Basically, I follow the ACT
treatment as outlined in the book, except that I introduce values at the
beginning. Most metaphors can be adapted to this population and I do so as I go
on. I hope to find some time to write some of this up.
5) Measures- I also use a daily monitoring form of binge eating, food diary and
mood monitoring.
6) In my other groups we had done a 6 and 12 month follow-ups. With individual
clients I try to do such follow-ups as well. It would be great if you have the
resources to include longer follow-ups as well.
Sorry that a lot of this is is not as specific. Hopefully with more of us doing
this work, things will become much more specific in the near future.
Please let me know if I can be of more help.
Maria


Maria Karekla, Ph.D.
Licensed Clinical Psychologist and Director of Clinical Practical Training,
Assistant Professor,
Intercollege and The Center for Therapy, Training, and Research (KESY),
Nicosia,
Cyprus
(357)22795100 or (357)22351274

________________________________

Áðü: eatingconcernsandcontextualpsychology@yahoogroups.com åê ìÝñïõò Stella Dyer
ÁðïóôïëÞ: Ðáñ 17/8/2007 9:02 ðì
Ðñïò: eatingconcernsandcontextualpsychology@yahoogroups.com
ÈÝìá: [eatingconcernsandcontextualpsychology] Bulimia group questions



Hi Alix and Maria (and all!),

I'm not sure if I sent this correctly, so here it is again:

Thanks for kindly offering to share your experience in running ACT
for BN groups. As you will see, we have heaps of questions to ask
you! (Sorry in advance!). I've sent this to everyone, in case they
are also interested in these issues. P.S If anyone else wants to
comment on their experiences, feel free!

Here they are:

* Do you have a mix of presentations in the one group? (ie. BN + BED
or AN). We were wondering whether there is a problem in putting both
BN and Binge Eating Disorder in the same group-ie. is there a
likelihood of BED clients learning purging as a new unhealthy
behaviours?
* We are wondering how behaviourally focused your groups are, in
terms of targetting and changing the binge purging behaviours?- ie.
do you focus on reducing binge eating and purging as the
predetermined, main goal of the group or do you have a general goal
of helping them to identify and accept their values and live a vital
life, with the idea that the ED behaviours will change in the process
of them taking active steps towards pursuing their values?
* Ambivalence is a feature of Bulimia and we often have EDNOS clients
with extremely restrictive food intakes and they are pre-
contemplative towards making changes in this area. Do you meet with
the group clients separately beforehand to do some pre-commitment
work with those who are ambivalent and to work on engagement before
the group commences?
* Do you target each session based on where the majority of the group
are at, or are the sessions structured in a predetermined order? ie.
We're wondering how early to bring in values...?
* if you have come up with a content outline, are you willing to
share it with us?
* We are already familiar with ED measures, but were wondering
whether you are aware of other outcome measures that pick up on ACT
consistent outcomes, besides the AAQ?
* How many weeks did you run your groups for?
* What kinds of outcomes have you had?
* Are you doing any longer term follow ups?

Well I did warn you that there were a lot of questions here, didn't
I! We're hungry for answers, but don't feel obligued to answer
everything, anything you can share will be great food for thought
(pardon the pun!)
Thanks very much in advance,
Stella ;)

---------------------------------------------------------
Stella Dyer
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
Watt Street, Newcastle NSW 2300
Ph. (02) 49246820
Fax: (02) 49246801
---------------------------------------------------------

>>> "C. Alix Timko" <catimko@...> 9/07/2007 11:53 pm >>>
Hello Stella,
I use ACT with this group as well and had success with it. I second
Maria - is there anything specific you were wondering about?
Alix

--
C. Alix Timko, Ph.D.
Department of Psychology
University of Pennsylvania
3720 Walnut St.
Philadelphia, PA 19104
Telephone: 215-746-4260
Fax: 215-898-7301
E-mail: catimko@...

Dear Stella and all,
Good questions. I look forward to your comments.  I just took Steven's
training and was wondering how to use ACT  with AN. Health and self
care do not seem to be high values. Do I support her moving ahead with
other values and forget about weight unless it is dangerous?
Alma Dell
> * We are wondering how behaviourally focused your groups are, in
> terms of targetting and changing the binge purging behaviours?- ie.
> do you focus on reducing binge eating and purging as the
> predetermined, main goal of the group or do you have a general goal
> of helping them to identify and accept their values and live a vital
> life, with the idea that the ED behaviours will change in the process
> of them taking active steps towards pursuing their values?
> * Ambivalence is a feature of Bulimia and we often have EDNOS clients
> with extremely restrictive food intakes and they are pre-
> contemplative towards making changes in this area. Do you meet with
> the group clients separately beforehand to do some pre-commitment
> work with those who are ambivalent and to work on engagement before
> the group commences?

> We're wondering how early to bring in values...?
> * if you have come up with a content outline, are you willing to
> share it with us?

Hi Alix and Maria (and all!),

I'm not sure if I sent this correctly, so here it is again:

Thanks for kindly offering to share your experience in running ACT
for BN groups. As you will see, we have heaps of questions to ask
you! (Sorry in advance!). I've sent this to everyone, in case they
are also interested in these issues. P.S If anyone else wants to
comment on their experiences, feel free!

Here they are:

* Do you have a mix of presentations in the one group? (ie. BN + BED
or AN). We were wondering whether there is a problem in putting both
BN and Binge Eating Disorder in the same group-ie. is there a
likelihood of BED clients learning purging as a new unhealthy
behaviours?
* We are wondering how behaviourally focused your groups are, in
terms of targetting and changing the binge purging behaviours?- ie.
do you focus on reducing binge eating and purging as the
predetermined, main goal of the group or do you have a general goal
of helping them to identify and accept their values and live a vital
life, with the idea that the ED behaviours will change in the process
of them taking active steps towards pursuing their values?
* Ambivalence is a feature of Bulimia and we often have EDNOS clients
with extremely restrictive food intakes and they are pre-
contemplative towards making changes in this area. Do you meet with
the group clients separately beforehand to do some pre-commitment
work with those who are ambivalent and to work on engagement before
the group commences?
* Do you target each session based on where the majority of the group
are at, or are the sessions structured in a predetermined order? ie.
We're wondering how early to bring in values...?
* if you have come up with a content outline, are you willing to
share it with us?
* We are already familiar with ED measures, but were wondering
whether you are aware of other outcome measures that pick up on ACT
consistent outcomes, besides the AAQ?
* How many weeks did you run your groups for?
* What kinds of outcomes have you had?
* Are you doing any longer term follow ups?

Well I did warn you that there were a lot of questions here, didn't
I! We're hungry for answers, but don't feel obligued to answer
everything, anything you can share will be great food for thought
(pardon the pun!)
Thanks very much in advance,
Stella ;)


---------------------------------------------------------
Stella Dyer
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
Watt Street, Newcastle NSW 2300
Ph. (02) 49246820
Fax: (02) 49246801
---------------------------------------------------------

>>> "C. Alix Timko" <catimko@...> 9/07/2007 11:53 pm >>>
Hello Stella,
I use ACT with this group as well and had success with it. I second
Maria - is there anything specific you were wondering about?
Alix

--
C. Alix Timko, Ph.D.
Department of Psychology
University of Pennsylvania
3720 Walnut St.
Philadelphia, PA 19104
Telephone: 215-746-4260
Fax: 215-898-7301
E-mail: catimko@...

Hey guys!

I just wanted to apologize to anyone whose been waiting in membership purgatory.
The site
was having trouble and I could not add anyone for a while.  Sorry about that! 
You are all
welome here!

emily


Emily Sandoz, M.S.
Graduate Student
University of Mississippi
eksandoz@...

Hi Alix and Maria (and all!),

Thanks for kindly offering to share your experience in running ACT
for BN groups. As you will see, we have heaps of questions to ask
you! (Sorry in advance!). I've sent this to everyone, in case they
are also interested in these issues. P.S If anyone else wants to
comment on their experiences, feel free!

Here they are:

* Do you have a mix of presentations in the one group? (ie. BN + BED
or AN). We were wondering whether there is a problem in putting both
BN and Binge Eating Disorder in the same group-ie. is there a
likelihood of BED clients learning purging as a new unhealthy
behaviours?
* We are wondering how behaviourally focused your groups are, in
terms of targetting and changing the binge purging behaviours?- ie.
do you focus on reducing binge eating and purging as the
predetermined, main goal of the group or do you have a general goal
of helping them to identify and accept their values and live a vital
life, with the idea that the ED behaviours will change in the process
of them taking active steps towards pursuing their values?
* Ambivalence is a feature of Bulimia and we often have EDNOS clients
with extremely restrictive food intakes and they are pre-
contemplative towards making changes in this area. Do you meet with
the group clients separately beforehand to do some pre-commitment
work with those who are ambivalent and to work on engagement before
the group commences?
* Do you target each session based on where the majority of the group
are at, or are the sessions structured in a predetermined order? ie.
We're wondering how early to bring in values...?
*  if you have come up with a content outline, are you willing to
share it with us?
* We are already familiar with ED measures, but were wondering
whether you are aware of other outcome measures that pick up on ACT
consistent outcomes, besides the AAQ?
* How many weeks did you run your groups for?
* What kinds of outcomes have you had?
* Are you doing any longer term follow ups?

Well I did warn you that there were a lot of questions here, didn't
I! We're hungry for answers, but don't feel obligued to answer
everything, anything you can share will be great food for thought
(pardon the pun!)
Thanks very much in advance,
Stella ;)


---------------------------------------------------------
Stella Dyer
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
Watt Street, Newcastle NSW 2300
Ph.  (02) 49246820
Fax: (02) 49246801
---------------------------------------------------------

>>> "C. Alix Timko" <catimko@...> 9/07/2007 11:53 pm >>>
Hello Stella,
I use ACT with this group as well and had success with it.  I second
Maria - is there anything specific you were wondering about?
Alix

--
C. Alix Timko, Ph.D.
Department of Psychology
University of Pennsylvania
3720 Walnut St.
Philadelphia, PA 19104
Telephone:  215-746-4260
Fax:  215-898-7301
E-mail:  catimko@...

Hello Stella,
I use ACT with this group as well and had success with it.  I second
Maria - is there anything specific you were wondering about?
Alix

--
C. Alix Timko, Ph.D.
Department of Psychology
University of Pennsylvania
3720 Walnut St.
Philadelphia, PA 19104
Telephone:  215-746-4260
Fax:  215-898-7301
E-mail:  catimko@...

Dear Stella,
I have been using ACT with clients with Bulimia and Anorexia for a few years now
and I will be happy to share my experiences with you. Is there something
specific you would like help with? You can e-mail me back channel also if you
want.
Good luck
Maria

Maria Karekla, Ph.D.
Licensed Clinical Psychologist and Director of Clinical Practical Training,
Assistant Professor,
Intercollege and The Center for Therapy, Training, and Research (KESY),
Nicosia,
Cyprus
(357)22795100 or (357)22351274

________________________________

Áðü: eatingconcernsandcontextualpsychology@yahoogroups.com åê ìÝñïõò Stella Dyer
ÁðïóôïëÞ: Ðåì 5/7/2007 9:40 ðì
Ðñïò: eatingconcernsandcontextualpsychology@yahoogroups.com
ÈÝìá: [eatingconcernsandcontextualpsychology] ACT for bulimia Nervosa



Hi all,

Yay, this is my first post- I've finally overcome the fear! Better now than
never!!

I am an ACT therapist from the eating disorders service in Newcastle, Australia.
Both myself and Carla Walton attended the last conference in London (hi again if
we've already met!!!)

We're interested in commencing an ACT group for clients with Bulimia Nervosa and
we're keen to contact those of you who already have experience in this area. Can
you please share any contacts or resources/experiences that you have found
helpful so far with this population?

We also work with the restrictive folk using individual ACT and we find this
group much tougher, paticularly when they are in the pre-contemplative stage. I
am hoping that we could post a few discussions around these issues and how
others have dealt with it sometime soon too....

Please reinforce my 'bold' move with a response!!

Thanks very much,
Stella

---------------------------------------------------------
Stella Dyer
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
Watt Street, Newcastle NSW 2300
Ph. (02) 49246820
Fax: (02) 49246801
---------------------------------------------------------

Hi all,

Yay, this is my first post- I've finally overcome the fear! Better now than
never!!

I am an ACT therapist from the eating disorders service in Newcastle, Australia.
Both myself and Carla Walton attended the last conference in London (hi again if
we've already met!!!)

We're interested in commencing an ACT group for clients with Bulimia Nervosa and
we're keen to contact those of you who already have experience in this area. Can
you please share any contacts or resources/experiences that you have found
helpful so far with this population?

We also work with the restrictive folk using individual ACT and we find this
group much tougher, paticularly when they are in the pre-contemplative stage.  I
am hoping that we could post a few discussions around these issues and how
others have dealt with it sometime soon too....

Please reinforce my 'bold' move with a response!!

Thanks very much,
Stella

---------------------------------------------------------
Stella Dyer
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
Watt Street, Newcastle NSW 2300
Ph.  (02) 49246820
Fax: (02) 49246801
---------------------------------------------------------

Heh. I might have known you would have some ideas! I should have
called you first. I know several folks over at the Emily Program
(several of them go to the Eating Disorders Journal Club hosted I
think at the moment through the Department of Epidemiology), but not
Doug; I will give him a try. Thanks!

--- In
eatingconcernsandcontextualpsychology@yahoogroups.com, "Billig, John"
<john.billig@...> wrote:
>
> Hi Margit!
>
>
>
> I recently gave a talk at the Emily Program on ACT.  There is at
least
> one therapist there, Doug Perry, who is very interested in ACT, has
had
> a little training, and I think is planning to attend the ACT Summer
> Institute 3 in Houston.  You could try calling him @ (651) 645-5323.
>
>
>
> John
>
>
>
> John P. Billig, PhD, ABPP
>
> Supervisor/Program Manager, Mental Health-Primary Care Integration
Team
>
> Minneapolis VA Medical Center
>
> One Veterans Drive (116B)
>
> Minneapolis, MN 55417
>
> Ph: 612-725-2073
>
> ________________________________
>
> From: eatingconcernsandcontextualpsychology@yahoogroups.com
> [mailto:eatingconcernsandcontextualpsychology@yahoogroups.com] On
Behalf
> Of margitberman
> Sent: Tuesday, June 19, 2007 10:03 AM
> To: eatingconcernsandcontextualpsychology@yahoogroups.com
> Subject: [eatingconcernsandcontextualpsychology] New Member and
Question
> about a Therapy Referral
>
>
>
> Hi!
>
> I'm Margit Berman, and I'm a visiting assistant professor of
> counseling psychology at the University of Minnesota (until the end
> of the summer, at which point I will be at the University of
> Maryland). I got some training in ACT at the Minneapolis VA Medical
> Center, from John Billig and his colleagues, while I was on
> internship, and was intrigued enough to want to do some research on
> it. Currently I'm doing a small (N < 10)process and outcome pilot
> study using ACT for AN (with a protocol I adapted from the Heffner
&
> Eifert self-help book), with the aid of some terrific eating
> disorders researchers here in the departments of Pediatrics and
> Psychiatry. I wish I'd realized this listserv existed when we were
> putting together the study, but I'm delighted to have discovered it
> now!
>
> My main question for the list is on behalf of one of my
participants.
> She's done very well with the ACT approach in treating her AN, and
> she would like to continue with ACT therapy if possible. Do any of
> you know if there is anyone in the Twin Cities area who does ACT
for
> patients struggling with eating disorders? This patient has
struggled
> with her anorexia for many years, and needs a therapist who is
> experienced with eating disorders as well as ACT.
>
> Thanks so much for any advice/referrals you may have. Cheers!
>

Hi!

I'm Margit Berman, and I'm a visiting assistant professor of
counseling psychology at the University of Minnesota (until the end
of the summer, at which point I will be at the University of
Maryland). I got some training in ACT at the Minneapolis VA Medical
Center, from John Billig and his colleagues, while I was on
internship, and was intrigued enough to want to do some research on
it. Currently I'm doing a small (N < 10)process and outcome pilot
study using ACT for AN (with a protocol I adapted from the Heffner &
Eifert self-help book), with the aid of some terrific eating
disorders researchers here in the departments of Pediatrics and
Psychiatry. I wish I'd realized this listserv existed when we were
putting together the study, but I'm delighted to have discovered it
now!

My main question for the list is on behalf of one of my participants.
She's done very well with the ACT approach in treating her AN, and
she would like to continue with ACT therapy if possible. Do any of
you know if there is anyone in the Twin Cities area who does ACT for
patients struggling with eating disorders? This patient has struggled
with her anorexia for many years, and needs a therapist who is
experienced with eating disorders as well as ACT.

Thanks so much for any advice/referrals you may have. Cheers!

Okay,
So here are some thoughts -- sorry if they are not relevant.  I would recommend
using some sort of pre-screen a la Yalom for the first set of groups until you
get some of the bugs out in terms of how you approaching certain things.
Getting participants who are on the same page with the same level of motivation
will reduce drop outs and will provide a slightly more homogeneous group at
first.
I would try to make sure that if you have really symptomatic women (sorry for
the more sx specific language -- it is what I am more familiar with for
brainstorming) -- than try to make sure they are more or less in the same place
-- that is, I wouldn't have bulimics who really want to be anorectic in a group
with a number of low-weight restrictors. Though you could get at a lot of
really good clinical/values stuff with that - it is also really easy for
contagion to occur. That being said, I would make sure that you have good
confidentiality in effect - including no contact outside the group (for those
that meet weekly).  I have seen some groups turn into "how to be better at
having an eating disorder" or "how do I get one, 'cause i like the way you
look" groups.  I think an ACT perspective would really discourage this in
general – but best to alleviate it as much as possible.  If you have a number
of student and non-student members in the group together, you could get some
interesting dynamics – but college students do have different issues than
non-students – so you would have to move them rather quickly through the
forming and storming phases so that they could see past some of the superficial
aspects to the control issues – again, I don’t really have experience with ACT
in a group so this may work a bit differently than I am used to.
I think that if you make data collection part and parcel of the program it won’t
be devaluing at all.  In my experience we used a battery for the group screen
and then a short series of questionnaires at the beginning of each group and
then finally the battery at the end of the group series. If it is included in
the consent process and explained during the screen it usually goes over pretty
well.  Esp. if it is made clear that they will be helping others as well.
Wait list – where I worked this was pretty common on an outpatient basis just
because there weren’t enough groups running at any given time.  With
sub-clinical issues it shouldn’t be too much of a problem – with clinical EDs I
would think it would get trickier.  If they were medically stable and if the
wait list wasn’t too long than it might be okay ethically – but you may want to
compare to group tx as usual (so a standard Yalom type group) or do
psycho-education or biblio therapy.  Just some thoughts.

2) Questions - What questions would the group be interested in asking of this
project?
Are there assessments, activities, organizational factors etc... that you would
like to see
included/implemented?

Hmm.  Let me think and I am sure I will have lots of good stuff later!

Alix,

First on the target population - I desribed them vaguely as "individuals with
eating
concerns" because that is how we are recruiting participants.  In other words,
the
description of potential participants' target behaviors will be functional
rather than
topographical. (Off the top pf my head, something like, " for people whose
concerns about
their bodies or eating patterns have gotten in the way of the life they want to
live.") The
clinic through which we will be providing the workshops and groups is located on
the
university campus, but serves a large number of clients from the community.  I
am not
sure what kind of pre-screening we will have, but it will probably allow the
groups to be
populated with a range of behavioral topographies, including whether food or
body stuff is
more salient for them.  We are not limiting the group to females, but imagine
that it may
end up that way.

emily

--- In eatingconcernsandcontextualpsychology@yahoogroups.com, "C. Alix Timko"
<catimko@...> wrote:
>
> Hi Emily,
> A few questions about the group first -- then I am sure I'll have some
> thoughts.  You mention it is for those with eating concerns --
> specifically what will your group look like (I assume you are doing
> pre-group screening)... college students?  Adults in the community?
> Those with disordered eating or eating disorders?  So are you talking
> solely sub-clinical or solely clinical level eating problems or a mix?
> Body image -- will you let those in who have more body image issues per
> say (that is, the body stuff is more salient for them than the food
> stuff).  Will it be heterogeneous in terms of gender or homogeneous?
>
> Or are these all things you are still figuring out?  :)
> Alix
>
>
>
>
> --
> C. Alix Timko, Ph.D.
> Assistant Director of Undergraduate
>  and Graduate Studies
> Department of Psychology
> University of Pennsylvania
> 3720 Walnut St.
> Philadelphia, PA 19104
> Telephone:  215-746-4260
> Fax:  215-898-7301
> E-mail:  catimko@...
>

Hi Emily,
A few questions about the group first -- then I am sure I'll have some
thoughts.  You mention it is for those with eating concerns --
specifically what will your group look like (I assume you are doing
pre-group screening)... college students?  Adults in the community?
Those with disordered eating or eating disorders?  So are you talking
solely sub-clinical or solely clinical level eating problems or a mix?
Body image -- will you let those in who have more body image issues per
say (that is, the body stuff is more salient for them than the food
stuff).  Will it be heterogeneous in terms of gender or homogeneous?

Or are these all things you are still figuring out?  :)
Alix




--
C. Alix Timko, Ph.D.
Assistant Director of Undergraduate
	 and Graduate Studies
Department of Psychology
University of Pennsylvania
3720 Walnut St.
Philadelphia, PA 19104
Telephone:  215-746-4260
Fax:  215-898-7301
E-mail:  catimko@...

Hi all.

I am working on a protocol for a project I am mounting here at Ole Miss using
ACT with
individuals with eating concerns.  We hope to start with a half day workshop and
follow up
with those interested using weekly group sessions.  I'm looking for 2 things
from this
group:
1) Answers - If you have experiences that you think might help to guide this
project, by all
means, please share them.  I have questions about your experience a) using a
group
format with this population, b) having individuals with drastically different
presentations
participating, c) how to collect data in a way that doesn't devalue the
participants'
experience, d) how to handle ethical and research design issues with a wait list
control, e)
many other things I haven't thought of yet.

2) Questions - What questions would the group be interested in asking of this
project?
Are there assessments, activities, organizational factors etc... that you would
like to see
included/implemented?

Please, if you have Answers or Questions, take a minute to send them my way.

I will, of course, keep you guys updated on the project as it takes shape and
make the
protocol and any data available once we are done.

Thanks,

emily

Emily Sandoz, M.S.
Graduate Student
University of Mississippi
eksandoz@...

Susan,

The purpose of this list is to provide a forum for people who are interested in
the
application of Relational Frame Theory and/or Acceptance and Commitment Therapy
to
the understanding and treatment of all kinds of eating concerns.  While intended
to be
mainly of use to clinicians and researchers, we keep this list open to allow
anyone to
participate and share ideas.

This list is not meant to provide specific professional advice.  However, people
may be
willing to share their experiences in using ACT to help individuals suffering
with
overweight and related concerns.  I know that there are many of us out there
working in
this area...  Guys?  Any general experiences you'd be willing to share?

I also would like to direct you the organization behind this work - the
Association for
Contextual Behavioral Science.  The association's website has a remarkable
amount of
content available, and is the home to other ACT forums that may be of use to you
as well.
You might start here http://www.contextualpsychology.org/
act_theory_and_weight_control with Jason Lillis' excellent conceptualization of
weight
control from an ACT perspective.

Finally, if this list is not quite what you are looking for, you may find the
ACT for the Public
listserv to better suit your interest, as a forum for non-professionals to
discuss ACT.
There are professionals on that list, as well, many of whom are willing to help
people
understand the ACT model, and how it might be applied with different
difficulties.  You
can check that list out at
http://health.groups.yahoo..com/group/ACT_for_the_Public/.

Hope this helps!


emily