One useful tool for work on relapse prevention is to conduct a review of goals with patients, as illustrated in Figure 8.3. This review allows the patient to put into his or her own words changes that he or she has made that have led to improvements in interpersonal relationships and eating disorder symptoms; to communicate to the therapist areas of concern that remain and require discussion before treatment ends; and to articulate plans for maintaining and building upon the positive changes made during the course of treatment.
It is often tempting for clients with BED to focus on the need to improve “diet” behaviors at the expense of interpersonal skills, so one important therapist task in these later sessions is return the focus to the interpersonal changes the patient has made that relate to improvements in the binge eating—as illustrated in this excerpt from Session 19:
muriel: Plus I realized too that I had slacked up on, uh, making my little salads ahead of time.
therapist: So if you’d had something quick—
muriel: Uh-huh, to just go ahead and grab. And, it makes a difference, I’m really, really seeing that.
therapist: So you’re saying “no” to old eating habits and you are also saying “no” to unreasonable requests that you don’t want to do. muriel: Yeah.
therapist: And how’s that been going? muriel: It’s been going pretty, pretty good. Um—
therapist: ‘Cause it kinda had creeped back up with Gabe being sick, and then you were needing to get back to, you know, setting limits. Did you include some of these ideas for staying on track on your goal reflection sheet? muriel: Yeah.
therapist: And how was that?
When you start to binge-eat, pause to think about your own emotions or hunger level and think about the situation you are trying to adjust to or deal with. Remind yourself that binge eating may provide some respite from problems or feelings of inadequacy or conflict in the short run but in the long run it diverts energy from acknowledging the difficult situations confronting you and from taking actions or making plans to change the situation. As you return your attention to the situation at hand you will be able to acknowledge your own wants and needs during these challenging interactions. In this way you will be able to make plans or begin to implement changes that are necessary to manage the situation or dispute and not get sidetracked by the negative feelings that arise from binge eating.
Figure 8.3 Sample Session 18 review of goals
muriel: It was pretty . . . enlightening. I’ve seen where I’ve grown. therapist: Oh, mm-hmm.
muriel: There was that panic about everything in the past, um, I don’t wanna say it’s all a, “hey, easygoin’ ” type of feeling now, but it just—I don’t know, I just feel that it isn’t all gloom and doom. therapist: Mm-hmm.
muriel: Uh, I feel—I used to say 100 percent or so better but it really feels 300 percent. I’m really feeling that much better. therapist: Oh, 300 percent better! muriel: Yes. therapist: Mm-hmm.
muriel: And, um, I’m just really seeing that everything is a moment at a time, a day at a time. Um, I don’t have to invent good things to make the day bearable. I think that was kinda like one of my biggest revelations. It felt like I had to constantly try to see some good, and it seemed like all of my energy, even though I was feeling bad, was directed toward not having a “pity party," and trying to find some goodness in things. therapist: Mm-hmm.
muriel: And now, and, um, now things are really going okay. therapist: Oh wow. Mm-hmm.
muriel: Uh, I’ve got a lead on a job. My cousin, she uh— therapist: Really?
muriel: Yeah. Weird. And you know how part of you is thinking like, “Don’t get too excited about it" But at the same time it’s like, this might just work out . . .