Confidentiality is a cornerstone of the therapeutic relationship. The ethics of my profession require that all communication between my patients and me remains confidential. In other words, I cannot disclose the information a patient reveals in session, or my own impressions about a patient, to anyone without the patient’s explicit written consent. Of course, there are exceptions to the rule. I am a mandated reporter of child abuse, and if a patient is imminently suicidal or homicidal, I have a duty to notify the appropriate parties in order….
Read More : Confidentiality in Adolescent…
I recently read an article in the International Journal of Eating Disorders entitled Managing the Chronic, Treatment-Resistant Patient with Anorexia Nervosa (Strober, 2004). Though eloquently written and artfully persuasive, this was probably the most depressing journal article I have ever read. The author, Michael Strober, seeks to help readers “resolve the paradox of caring for patients who seem so decidedly opposed to change.” Essentially, Strober advises psychologists to avoid pushing, or even encouraging, full nutrition and weight….
Read More : Palliative Care for Anorexia…
All too often, we confuse strength with stoicism. We see an apparent absence of negative emotions and presume courage. We see an unadulterated expression of sadness and assume fragility.
I see this sometimes with new therapy clients. Like most of us, they’ve bought into the American dream (or American nightmare), where hard work, free will, and rugged individualism are viewed as keys to success and anything less is perceived as weakness or failure. When I ask how they feel about entering therapy, they report feeling weak for needing….
Read More : Redefining…
Earlier this week, I read about a hospital program that provides medical stabilization for patients with eating disorders. The medical director of this program wrote that if a patient “refuses” meals and liquid supplements, the staff observes the patient, without intervention, for approximately 48 hours. If the patient continues to “refuse” nourishment after that point, the physician and psychologist have a discussion with the patient about using a nasogastric tube, but recommend oral feeding instead.
Disheartened to read about this….
Read More : Food, Safety, and…
Despite miraculous advances in science, medicine, and technology, the rates of mental illness in the western world are higher than ever before. For instance, the rate of depression in the United States is ten times higher today than it was just two generations ago. Most mental illnesses are biologically-based and genetically-transmitted, but genes don’t change that fast, and we are biologically quite similar to our ancestors. Prior to the 20th century, human beings faced more risk and hardship on a regular basis than most of us will ever know,….
Read More : Lifestyles of the Depressed and…
Regardless of their diagnosis or primary presenting problem, most of the clients I see are struggling with some sort of anxiety. From an epidemiological perspective, this is not surprising. Anxiety disorders affect more than 40 million American adults in any given year and are more prevalent than any other type of psychiatric disorder.
Why are we so anxious? I would attribute it, in large part, to evolution. Anxiety is a universal emotional reaction experienced by all humans and most non-human species as well. Anxiety is a useful….
Read More : Fear…
“It’s about control.”
This statement has been applied to everything from OCD to eating disorders to self-injury to domestic violence. But, really, what does this statement mean?
When I hear that X is about Y, I generally interpret this statement in one of two ways: 1.) Y is a theme of X or 2.) Y is the most salient feature of X. For example, if someone says that Romeo and Juliet is about undying love, my interpretation is that undying love is a primary theme….
Read More : What’s That…
Those who know me professionally are well aware that I am an advocate of the Maudsley Method of Family-Based Treatment and that I use this approach to treat my adolescent patients with eating disorders. What they may not know is that Maudsley principles pervade my treatment philosophy for eating disorder patients of all ages, regardless of the treatment approach I employ with them. For example:
• I always externalize the eating disorder and teach my patients to do the same.
• I firmly believe that patients do not choose eating….
Read More : Maudsley Is As Maudsley…
More Americans than ever before are taking psychotropic medication. The number of people on antidepressants doubled between 1996 – 2006, yet the number of people seeing mental health professionals declined during that time period. Over 80% of prescriptions for psychotropic drugs are written by primary care physicians. I find these trends a little hard to swallow.
The overuse of psychotropic medication and the corresponding underutilization of behavioral and psychosocial treatments are disturbing on several levels. First, these trends….
Read More : Jagged Little…
When American men and women make the courageous choice to join the armed forces, they realize that they may sacrifice their lives for their country. What they may not realize is that they are now more likely to commit suicide than they are to die in military combat.
The incidence of suicide in the military has increased steadily since the Iraq war began in 2003. There were 67 suicides in 2004, followed by 85 in 2005, 102 in 2006, and 115 in 2007. The 2008 statistic – 128 suicides – is the highest we’ve seen since record keeping….
Read More : Military…
