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Therapy with Eating Disorders and Addictions
Dr. Dawn-Elise Snipes PhD, LPC, LMHC
Clinical Director,
Based in Part on Brief Therapy with Eating Disorders by Barbara McFarland, and the Overcoming Disordered Eating Protocol by the Centre for Clinical Intervention

– Shifting paradigms to one of resourcefulness vs. sickness
– Identifying key interviewing questions to develop a strengths-based alliance

Prevalence of Eating Disorders
– 20% of women struggle with disordered eating
– 10-15% of people with eating disorders are male
– 40% of male football players were found to engage in disordered eating
– Muscle dysmorphia and body fat preoccupation is seen in a majority of bodybuilders and wrestlers
– 90% of people with eating disorders become symptomatic between 12 and 25

Risk Factors
– Psychological Risk Factors
– Low self-worth and low-self esteem /Feelings of inadequacy
– Obsessive behaviors regarding food and diets and may often also display obsessive-compulsive personality traits in other parts of their life.
– A strong, even extreme drive for perfectionism.
– They have unrealistic expectations of themselves and others
– In spite of their many achievements, they feel inadequate.
– They see the world dichotomously
– Negative affect: depression, anxiety, anger, stress or loneliness
– A sense of lack of control in life
– Wanting to take control and fix things in an unhappy life, but not really knowing how, and under the influence of a culture that equates success and happiness with thinness, the person tackles her/his body instead of the problem at hand.

Risk Factors
– Interpersonal
– Troubled personal relationships
– Difficulty expressing emotions and feelings (including alexthymia)
– History of being teased or ridiculed based on size or weight (negative inner critic)
– History of physical or sexual abuse.
– Some people with eating disorders use the behaviors to avoid sexuality.
– Others use them to try to take control of themselves and their lives by creating and winning the power struggles inside
Risk Factors
– Interpersonal
– Inside they still they feel weak, powerless, victimized, defeated, and resentful.
– People with eating disorders often lack a sense of identity and try to define themselves by manufacturing an admired exterior.
– Often they desperately want healthy connections to others but fear criticism and rejection

Risk Factors
– Family Risk Factors
– Family history of an eating disorder
– Familial attitudes toward weight, dieting and eating
– Overvaluing appearance
– Making jokes about appearance
– Deficit in emotional support and secure attachment
– Overly enmeshed or detached family dynamics: Smothered in overprotective families, or abandoned, misunderstood, and alone
– These families tend to be overprotective, rigid, and ineffective at resolving conflict.

The Therapeutic Relationship
– Determines clients
– Willingness to openly discuss and explore behavior patterns
– Willingness to consider altering eating behavior
– Willingness to disclose accurate information

Motivation Determinants
– The clients sense of safety/alliance with the therapist
– Sense of self-efficacy and empowerment
– Client and therapist have similar goals for treatment
– The cost/benefit of the current behaviors
– Fear of fat vs. desire to be healthy
– Social pressures vs. desire to change
Motivation Dimensions
– Physical
– Affective
– Cognitive
– Environmental
– Relational

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