Weight Regulation Meets Group Psychotherapy at the Neural Cleft
Sunday, June 12, 2011, from 9:15 am to 12:15 pm.
Northeastern Society for Group Psychotherapy Conference
Weight Matters: what the effective 'brain-wise therapist' needs to know about modern attachment theory, interpersonal neurobiology and their affect on those struggling with weight regulation and weight control. Knowledge of cutting edge science will be integrated with somatic, experiential, and group psychotherapy techniques. Didactic/Lecture, Experiential, Demonstration, Discussion.
Objectives
- Learn current science and thinking in the weight regulation field through a brief synthesis of the field.
- Develop fresh group strategies for the person with challenging weight regulation problems, incorporating the somatics involved.
- Recognize and address solutions to developmental trauma.
- Create treatment strategies for affect regulation and dissociative self-states.
- Advance knowledge from classical attachment theory to modern attachment theories.
- Apply attachment theory and neuro-science to group techniques.
- Translate and restate the language of overeating and overweight to terms of regulation and dysregulation
Patients who come to your practice with over eating, weight regulation, and body image problems defy classical DSM IV diagnosis from an eating disorder perspective. They present daunting biochemical as well as self-regulatory problems. Although daunting, they come for our help and we are challenged to treat them.
Overeating and weight regulation are not considered eating disorders. Binge eating disorder (BED) has recently become a proposed diagnosis to be admitted to the DSM. However, all patients with eating issues do not quality for BED. Those who eventually come into a psychotherapist's office have probably "failed" at institutional and commercial programs for weight loss.
Conceptually, I have moved from thinking about these patients from a strictly psychoanalytic and psychodynamic viewpoint, and begun unraveling their issues in line with the paradigm shift away from drive theory to interpersonal neurobiology and modern attachment theory. This shift incorporates development of self, attachment patterns, and development of self-regulation. In this shift, the symptom, overeating, becomes a high caloric regulatory and compensation mechanism. The resultant weight problem, which ensues, has a bio-chemical life of its own.
In the treatment realm, group psychotherapy had been vastly underutilized and has essentially been put in the background. Currently, cognitive behavioral therapy is considered to be the gold standard of treatment. But, sole use of cognitive behavioral therapy has been shown to have its limits. Most patients lose, 5-10% of initial weight, the current standard of criteria for success. However, patients usually regain 30-35% of their weight loss in the year following treatment and many return to their baseline weight within 5 years. Success rates in obesity programs are grim.
What is missing in treatment? Looking at this cluster of patients from the traditional psychodynamic psychoanalytic model has its restraints. New technology has allowed us to access the brain, which has shown us that the development of regulation starts long before the drive models that Freud conceptualized. It is important not to throw out the baby with the bath water, so to speak, but add on to what we already know, and upgrade our work in current thinking. The current work in interpersonal neurobiology and modern attachment theory gives clarity to what is missing and can only add to the repertoire of a traditionally group trained psychotherapist. It is time that we begin apprehending these patients from a different model. Modern attachment theory and interpersonal neurobiology lends to a different conceptualization and thinking about them clinically. These can be incorporated into group psychotherapy adding to the richness of this model. Group, utilizing these newer concepts, can be a regulatory mechanism for those challenged with regulatory problems. Active engagement in this newer thinking, can lead to developing fresh group strategies for those with these daunting problems.