Canadian Professor Josie Geller led a highly engaging and interactive Masterclass evaluating what makes treatment and clinicians most effective.
This was the ninth in the Newbridge House Masterclass series, bringing together eating disorders professionals from across the UK for training with internationally renowned specialists.
“I have known Josie for more than 20 years and have always been impressed by the work she does,” said Professor Hubert Lacey, introducing the Masterclass. “It is so relevant to all we do; to the issues we see and the challenges we face.”
Professor Geller began by considering patients’ motivation and readiness for change. She described how when starting work in the eating disorders field, she was struck by the high number of patients who were not motivated or ready for action orientated treatment.
“The evidence shows clearly that motivation is the best predictor of outcome,” explained Professor Geller. “That means one individual may have a lower BMI and high levels of distress, but if their motivation is higher, treatment is more likely to succeed than for someone with a higher BMI but lower motivation.”
Professor Geller described the treatment pathways British Columbia Clinical Guidelines which she designed. Patients are triaged into appropriate care and treatment defined by their readiness for change.
There followed consideration of motivational interviewing and collaborative versus directive styles. Professor Geller cited studies which showed eating disorders professionals stated an intention to work in a motivational, collaborative way, but in practice, frequently employed a directive stance (controlling, defensive, dominating).
“For the last ten years, this has been my purpose in life – to ask: what gets in the way? We want to work collaboratively but find it hard to stay on task.”
There followed widespread discussion about the challenges which eating disorders professionals face and how they affect stance and communication. “We need to know ourselves as clinicians: how do we react? To know – this is me at my worst and what is most supportive of me being at my best?”
Professor Geller considered the common ingredients in three widely established eating disorders treatments: cognitive behavioral therapy (CBT-E), dialectical behavior therapy (DBT) and family based treatment (FBT). Each approach was assessed in terms of three dimensions: patient engagement, skills and safety.
“My take home message is that our evidence based therapies have more in common than there is significant difference and what I’ve been looking at is not what we do but how we are doing it. In other words, can the spirit in which we deliver treatment improve outcomes?”
The basic principles of a collaborative stance were described as: no assumptions or judgements, an aspiration to help with what matters to the patient, maximising choice for the patient and always showing care and concern (even in particularly challenging scenarios).
There were also sessions considering the importance of self-compassion for both patients and clinicians and on setting treatment non-negotiables, generating broad discussion of scope and feasibility.
“Treatment non-negotiables have to be meaningful; you need to be able to look your patient in the eye and explain the rationale,” explained Professor Geller. “No matter how stringent the non-negotiables are, the patient must still have choices. We are maximising patient autonomy while also agreeing a shared, non-negotiable framework for treatment.”
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