Magazine article Clinical Psychiatry News

Countertransference Can Derail Eating Disorder Tx. (Strong Reactions Are Common)

Magazine article Clinical Psychiatry News

Countertransference Can Derail Eating Disorder Tx. (Strong Reactions Are Common)

Article excerpt

BOSTON -- Countertransference reactions in eating disorder treatment have received little attention but are in fact widespread and often unsettling, Dr. Charles Portney said at a meeting of the Academy for Eating Disorders.

Such reactions can severely undermine therapy and may even lead to therapist burnout. But if properly understood, they may provide clinically useful information, said Dr. Portney of the University of California, Los Angeles.

Eating disorder patients represent a population particularly likely to arouse strong reactions in clinicians: They are often relentlessly complaining and critical, or, conversely, "maddening in their superficial compliance," Dr. Portney said at the meeting, also sponsored by University of New Mexico. Multiple comorbidity is common, and prolonged, multidimensional treatment is typically required.

"If the therapist provides constant reassurance and feedback without receiving any him or herself, it's a recipe for burnout," Dr. Portney said.

Clinicians who work with substantial numbers of such patients may become overcritical of them or abandon all attempts at maintaining a collaborative stance. Treatment may become unidimensional: The treater stops individualizing patients and falls back on a routine approach. He or she may get nasty or cross boundaries.

Burnout prevention strategies include consultation, supervision, regular staff meetings, and attention to the need for gratification in one's own life, Dr. Portney said. More generally, a therapist's personal response to issues raised by eating disorders and patients may influence his or her clinical approach. If a treater has significant obesity or body image difficulties, for example, it may compromise his ability to be objective in assessment and in such areas as setting caloric requirements.

The temptation to use eating disorders as a "proving ground" for one's discipline or pet theory can hurt therapy by leading to premature generalization after a few successes. …

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