November 3, 2012

"A lover of truth"

I recently had a pretty typical exchange on a forum with people who actually treat real families that should chill the blood of those who understand the peril for the patients facing these attitudes and - therefore - denied appropriate care. I won't share the people involved for a number of reasons but mostly because this is not unusual. I feel parents really need to know and talk about the fact that this kind of discussion between clinicians is going on - in offices, at conferences, in trainings - without objection. These are real attitudes and I believe they are causing genuine harm. When these conversations go on among professionals there is a strong ethic of "everybody's right except the one criticizing." Objections are called "black and white" and the refuge of "everyone's different" is standard.

Without question, "brainspotting" and toxic families and dream analysis appall those who run evidence-based clinics but I see no movement in the professional field to call out or stand against such practices. But what about these patients? Who is protecting them? How are their parents to know how baseless and harmful this is before it is too late?

This conversation, like so many of the same, starts with some baseless assertion and a trail of false ideas. When objected to, the responses reveal other concerning misconceptions. In the end, nothing changes and no one is accountable.



11 comments:

  1. Hi Laura! As you know, I'm a psychology student and former AN sufferer. I think there is something so strange (an unethical!) in the field of psychology - we seem to not hold ourselves accountable. Rather, we sit there and we're nice to each other and never challenge each other to actually help patients. In what other field would a lack of challenging ideas be okay? In what other field would no benchmarks for success and efficacy be okay? I see this in my classes and in interactions with supervisors, etc. There are a small minority of clinicians who share my opinion, but politics get in the way of us being heard. It's complicated - as you know far better than I do!

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  2. Well, part of the problem is that we're talking, by definition, about people who go into it because they want to help people. They are "people people." They aren't crunching numbers or leaving it at the office - and they didn't pursue the profession to just recite out of manuals or not bring their own gifts and skill to it.

    But if they could go back and look at the history to see that we're doing the same stuff to ED patients as we did to other psychiatric disorders - and even TB and ulcers - it might be bracing.

    And then there are people like you who care and are doing your homework but using a very different set of assumptions about the disorder and treatment. So we can't tar everyone with the same brush... but we need a way to know the difference!

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  3. Well that's torn my good humor to shreds and I am now going to vent loud and long at such baseless and quite frankly, incompetent "ivory tower", blue sky thinking. I was going to try and fit in as many other trite, well-worn, baseless phrases as the other contributors to this forum, but quite frankly lost interest.

    I am assuming this particular pearl of wisdom is from that joyous AED forum (which, people, you can join if you just spend $125).

    Firstly many mental disorders have similar symptoms but, "C" if "Anorexia is an addiction like any other" why do you think that your particularly unscientific theory has not been noticed and adopted by the top eating disorder clinicians in the world, people who have been researching and running clinical trials and working towards developing life-saving treatments for eating disorders?

    As a United Kingdom citizen and thankfully spared the endless self-promotion that is so prominent amongst "treatment centres" and so-called clinicians in the United States, I am very sceptical and cynical about such sweeping groundless statements such as these. I was therefore horrified to see that you practice this non-evidence based nonsense in the UK. I have read the NICE Guidelines on Eating Disorders cover to cover on more than one occasion and have yet to discover any "link" between eating disorders and addiction.

    Let's take your second statement

    "It is the minds projection onto the body of feelings of extreme self hate. People with Anorexia have intense feelings of guilt and their shame is toxic."

    What? Just exactly what do you mean by that statement?

    Hold on a second. Just let me run upstairs and tell my 81 year old mother, who developed anorexia 2 months ago, after a series of intrusive medical tests upset her bowels and made it uncomfortable to eat. Both she and the top eating disorder clinician she is seeing in London will be SO relieved to know that if Mum would stop being toxic, ashamed and hating herself, she'll feel (and get?) better. After all, your theory must be right?

    "The person with anorexia has placed themselves in the role of family scapegoat. They have taken on responsibility for highlighting all that is dysfunctional within their family unit. They are the family's reflection. On some level the family are not nurturing ythemselves. There are strong feelings of self hate, and of slipping away within all members."

    Hmmm. Let me think really hard about this one (whilst grinding away a layer of enamel about your dreadful prose, spelling and punctuation!). What utter tripe.

    I am ashamed of your self-promotion and in my opinion, frankly quite cuckoo ideas. The thought of you treating someone with an eating disorder and helping their family fills me with horror.

    The other contributors appear to me to be as cuckoo as the original poster. "Eating disorders are multi-layered" (often, yes) "and negative energy propelled by who knows what". Huh?

    If this is the AED forum, I would be knocking on the AED's door asking what on earth they are going to do about it. If it is one of those "linked-in" discussion, I despair but am less bothered. The linked-in groups I belong to start such discussion as

    "Breatharian Jasmuheen on living on light, ending world hunger, and the gifts we can receive when we align back to our pure essence nature."

    under psychology discussion group. I am all for breathing but hello? Breathing solving world hunger - now why didn't I think of that?

    Probably for the same reason, eating disorder specialists (and not self-promoting "gurus") don't think about shameful toxicity when faced with anorexia in an 81 year old....



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  4. I'm afraid the approaches expressed in the comments, above, from eating disorder professionals are confirmed by two recent studies. In one, researchers interviewed 118 clinicians in Canada who treat eating disorders. After compiling the data, the researchers concluded that the quality of traing these individuals received was "questionable," the level of qualifications was also "questionable," and the competency within the group was "uncertain." The survey found that fewer than half the eating disorder clinicians had received any clinical training in eating disorder treatment whatsoever. The two main conclusions were 1) "Eating disorder treatment provided by community clinicians generally does not align with evidence-based practice guidelines," and 2) "The desire to tailor treatment to an individual client assumes mistakenly that the intent of beneficence yields improved outcomes." Von Ranson, Psychotherapies Provided for Eating Disorders By Community Clinicians: Infrequent Use of Evidence-Based Treatment," 2012 Psychotherapy Research, pp. 1-11.
    A second recent study surveyed 298 eating disorder treatment providers. In addition to finding evidence of substantial job burnout, the survey also revealed that one-half of the treatment providers acknowledged a personal history of an eating disorder, a mood disorder, or both. Warren, "A Qualitative Analysis of Job Burnout in Eating Disorder Treatment Providers," Eat Disord 2012 May; 20(3): 175-95 There is no indication that a provider needs to demonstrate that he or she is recovered in order to be licensed to treat eating disorder patients.
    In my view, parents need to be extremely careful when selecting a treatment provider if their child or adolescent suffers from an eating disorder. Based on the data from these two surveys, it appears that the field of eating disorder treatment is composed of a high percentage of people who are, unfortunately, not qualified.
    CB-US

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  5. Lack of accountability, failure of professional associations to set standards, and a poor level of public awareness all collude to fail parents seeking help.

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  6. Basically Laura it is failure to recognize anorexia nervosa as a physical, medical illness, allowing professors of English, practitioners of psychoanalysis, "former" sufferers to weigh in with equal credibility to medical providers.

    Psychiatry, to the extent it has failed to adopt the findings of neurobiology, lives in the previous centuries along with blood-letting. Other physicians are not far behind them. The word that this is a severe brain disorder has yet to penetrate the general practitioners' lexicon, much less that parents do not (indeed could not) cause it.

    Charlotte, agree 100%. I have received a lot of criticism and dire warnings about being "marginalized" by my refusal to participate any longer in the AED forum after they silenced "further discussion" about "parents do not cause" and "brain disorder". If indeed this is from that forum and it is not courageously jumped on with both feet ....well, I rest my case.

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  7. I'm with you, Julie.

    Charlotte, this is not the AED forum, but similar things are posted there and the result is the same: attacks on those who call it out -- not on those who hold AND PRACTICE these ideas on real victims.

    I feel powerless to protect these families as they have no reason to doubt all this psychobabble until it goes pear-shaped, and even then often believe the problem is their own failings and not the baseless witchcraft being practiced on them.

    The only tool I have is to bring it to the light, I think. And to call on the professional world which DOES have the power, to act. Just how bad would a professional's practice have to be to bring sanction? Just how off does a practice have to be to bring consensus on the line?

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  8. P.S. My apologies for casting aspersions on witches.

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  9. In the United States, if an eating disorder treatment provider uses psychobabble rather than evidence-based treatment approaches, he or she can be sued under the malpractice laws. This is an option more families need to consider. Concern about malpractice liability has led to general improvements in medical care in the U.S. For example, hospitals now pay greater attention to infection control than they did many years ago, in part as a result of malpractice liability awards. Extending the general requirement to use evidence-based approaches to the treatment of eating disorders would similarly be a step in the right direction.

    I'm not saying that all treatment of eating disorders in the U.S. is carried out in a negligent fashion, but much of it is. I'm also not saying that imposing malpractice liability is the only solution to the problem. However, I do think that where appropriate malpractice liability can serve as a deterrent to non--evidence based approaches to care.
    CB-US

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  10. I could see using that tool to change practice but struggle to think of what would motivate a family to do it. Most families won't know that they've been mistreated, will be too caught up in finding effective treatment, and - more to the point - will have trouble proving damages when the effects of poor treatment will not be immediate.

    But the greatest problem will be that there will always be more expert witnesses who will defend treatment or state that no one really knows what to do, reliably.

    Or, worse yet: the patient will simply be held responsible for his or her behaviors - not the clinician.

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  11. Laura,
    The problems you raise concerning the difficulty of proving a malpractice case are legitimate, but there are ways around the difficulties. For example, it is a well established principle in American health care law that a professional who provides health care to a child or adolescent generally must obtain the parents' advance, informed consent. In order for the consent to be informed, generally the parents must be given relevant information from the clinician, including a list of reasonable treatment options, the known benefits and risks of each, and evidence, if any exists, supporting each option. The parents are then free to select among the reasonable options. If an eating disorder clinician, however, goes ahead and gives the patient a treatment based on "brainspotting" or other weird approach, and fails to give the parents complete and accurate information about other options, including FBT, the clinician probably has not done her job of giving parents reasonable information and the parents' consent therefore was not informed. In this circumstance, the parents would have a good case that the clinician failed to perform a reasonably professional job and the parents did not give effective consent. This would entitle the parents to, at least, a return of the money they paid to the clincian. It would not be necessary to prove that the patient's outcome would have been better or anything else about the patient. Instead, the theory is that the family was not given what it bargained for -- reasonably professional advice.
    In addition to a possible malpractice case, families could also consider filing a complaint with the state agency that licenses psychotherapists. These agencies will typically investigate complaints. The agencies are empowered to take enforcement action if a therapist has engaged in unprofessional conduct.
    CB-US

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