Free Dialectical Behavior Therapy for Binge Eating and Bulimia by Debra L. Safer, Christy F. Telch, Eunice Y. Chen Page A
interview follow.
1. Develop a therapeutic alliance.
2. Gain an understanding of the client’s overall eating diffculties. 3. Provide clients with a rationale for DBT treatment.
4. Orient clients to treatment and obtain commitment.
5. Review treatment expectations for the client and the therapist. 6. Provide logistical information and opportunity for questions. 7. Convey enthusiasm.
Especially in settings in which the diagnostic assessment has been conducted by a member of the team other than the therapist (e.g., research assistant, study physician), the pretreatment interview may be the frst opportunity for the therapist to actually meet the client. The most important goal of this meeting is for the therapist (or cotherapist when treatment is in a group format) to begin to develop a therapeutic alliance. The second goal of the pretreatment interview is to provide the therapist with an opportunity to gain a general picture of the client’s diffculties with eating. In the case of Sarah, age 36, in Chapter 8, her binge eating and purging tended to occur during evenings when her husband traveled and she had been particularly stressed supervising her two children’s homework and getting them ready for bed.
The third goal is to provide a rationale for the treatment the client is about to commence. This involves introducing the client to the Emotion Dysregulation Model of Problem Eating (Appendix 3.1), with the therapist assessing the model’s personal relevance and ft for the client.
The fourth goal involves orienting the client to the treatment’s goals and tar— gets and obtaining the client’s commitment to these. This includes a discussion of the concept of treatment-interfering behavior (e.g., not coming to therapy). Obtaining a commitment to treatment attendance sets the stage for addressing treatment-interfering behaviors should they emerge. The ffth goal is to review treatment expectations for both the client and the therapist. These are listed in Appendices 3.3–3.5. The sixth goal is to provide practical information, such as the dates and times of treatment, and to give the client an opportunity to ask questions. Typical questions posed by clients are described later. The seventh and a fnal goal of the pretreatment interview is to provide the therapist with the opportunity to convey
32
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA enthusiasm about the start of treatment and the client’s participation. The therapist’s conviction about the value of the treatment and confdence in the client’s ability to succeed increase the chance of a constructive start to treatment—flled with positive expectations and hopefulness.
Orienting the Client to the Pretreatment Interview and Dates of Treatment
Therapists begin the pretreatment interview by introducing themselves. Make sure to express enthusiasm even during this frst meeting, perhaps saying some— thing such as: “I’m very happy you’ll be joining us. We’re all so excited about this treatment approach.” Explain that the purpose of the pretreatment interview is to get to know the client and to provide an overview of the treatment program, as discussed later.
From the outset, it is important to underscore the link between commitment to the course of treatment and the client’s ability to overcome her or his binge eating (and purging) behaviors. For example, the therapist might say: “We know that it is very important to you to stop binge eating [and purging] and to gain control over your eating behaviors. Your accomplishing these goals is very important to us, too. One thing we assume is that if you could change these behaviors on your own, you would have done so by now. To give this treatment a chance to work, you’ll need the full course. It is crucial to commit to coming to each session even when you don’t feel like it—especially then!—or it is particularly inconvenient. You might think about it as being prescribed a
1. Develop a therapeutic alliance.
2. Gain an understanding of the client’s overall eating diffculties. 3. Provide clients with a rationale for DBT treatment.
4. Orient clients to treatment and obtain commitment.
5. Review treatment expectations for the client and the therapist. 6. Provide logistical information and opportunity for questions. 7. Convey enthusiasm.
Especially in settings in which the diagnostic assessment has been conducted by a member of the team other than the therapist (e.g., research assistant, study physician), the pretreatment interview may be the frst opportunity for the therapist to actually meet the client. The most important goal of this meeting is for the therapist (or cotherapist when treatment is in a group format) to begin to develop a therapeutic alliance. The second goal of the pretreatment interview is to provide the therapist with an opportunity to gain a general picture of the client’s diffculties with eating. In the case of Sarah, age 36, in Chapter 8, her binge eating and purging tended to occur during evenings when her husband traveled and she had been particularly stressed supervising her two children’s homework and getting them ready for bed.
The third goal is to provide a rationale for the treatment the client is about to commence. This involves introducing the client to the Emotion Dysregulation Model of Problem Eating (Appendix 3.1), with the therapist assessing the model’s personal relevance and ft for the client.
The fourth goal involves orienting the client to the treatment’s goals and tar— gets and obtaining the client’s commitment to these. This includes a discussion of the concept of treatment-interfering behavior (e.g., not coming to therapy). Obtaining a commitment to treatment attendance sets the stage for addressing treatment-interfering behaviors should they emerge. The ffth goal is to review treatment expectations for both the client and the therapist. These are listed in Appendices 3.3–3.5. The sixth goal is to provide practical information, such as the dates and times of treatment, and to give the client an opportunity to ask questions. Typical questions posed by clients are described later. The seventh and a fnal goal of the pretreatment interview is to provide the therapist with the opportunity to convey
32
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA enthusiasm about the start of treatment and the client’s participation. The therapist’s conviction about the value of the treatment and confdence in the client’s ability to succeed increase the chance of a constructive start to treatment—flled with positive expectations and hopefulness.
Orienting the Client to the Pretreatment Interview and Dates of Treatment
Therapists begin the pretreatment interview by introducing themselves. Make sure to express enthusiasm even during this frst meeting, perhaps saying some— thing such as: “I’m very happy you’ll be joining us. We’re all so excited about this treatment approach.” Explain that the purpose of the pretreatment interview is to get to know the client and to provide an overview of the treatment program, as discussed later.
From the outset, it is important to underscore the link between commitment to the course of treatment and the client’s ability to overcome her or his binge eating (and purging) behaviors. For example, the therapist might say: “We know that it is very important to you to stop binge eating [and purging] and to gain control over your eating behaviors. Your accomplishing these goals is very important to us, too. One thing we assume is that if you could change these behaviors on your own, you would have done so by now. To give this treatment a chance to work, you’ll need the full course. It is crucial to commit to coming to each session even when you don’t feel like it—especially then!—or it is particularly inconvenient. You might think about it as being prescribed a
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