Post on 22-Feb-2016
description
The Art & Science of Treating Bariatric Patients
A Therapist’s Perspective
from a Patient’s
Point of View
Charlie Bowman,
MS, LCSW, LMFT, LCAC
The map is not the territory.The map steers us towards healthy
living but the
journey is
singularly our own!
Case StudyCharles Bowman57 y.o. w/m/mMax Weight: 388#Max BMI: 54.1Surgery Date: 12/7/2007Surgeon: John Huse, MDHospital: St. Vincent CarmelProcedure: Open Roux-en-YFamily Hx: + for obesity, diabetes, HBP, arthritis, cancerMental Status Pre-Surgery: anxious, depressed, obsessed with obesity
Outcome: The Surgery was Successful
Congratulations Mr. Bowman, We’ve successfully removed your inner critic!
Why Gestalt Therapy?
Holistic theory
B=ƒ(P,E)
“Alimentary” model
Awareness is curative
Internal and external support
No “resistance” in gestalt
Progression of Psychotherapy: Pre-Surgery
Additional assessment Decision making pre-surgery Managing anxiety pending
approval and surgery Early education Trust in bariatric team Identifying emotional eating
and problems
Internal Support Breathing Body awareness Learning to chew
External Support Support groups! Medical support Social support
Grieving loss of food/binges Setting realistic expectations
Progression: Early Post-Surgery
Progression: Late Post-Surgery Dramatic, rapid changes in self-image requires support for adjustment through periods of disorientation
Preventing sabotage by working through inner conflicts supports behavioral compliance: Polarities & authority conflicts
Homeorhesus: Finding the “new normal” in metabolism, relationships, proprioception and movement
Surgery is One Support for Lifestyle Change
0
20
40
60
80
100
6 12 18 24
Surgical Support Behavioral Support
Amount of
Support
Time in Months Post-surgerySource: John Guare, Ph.D.
Multi-disciplinary Integration
Bariatric Hospital Team ASMBS Certified Surgeon Psychologist Dietician/Nutritionist
Exercise Physiologist Bariatric “Life Coach” Physical Therapist Psychotherapist
The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime. ~ Babe Ruth
ResourcesMindless Eating: Why We Eat More Than We Think, (2006). Brian Wansink, New York: Bantam Dell. This book identifies how to lose weight through awareness of purchasing, serving, eating habits and orientation to food.
Gestalt Therapy: An Introduction to the Basic Concepts of Gestalt Therapy. (2010). Clinical introduction to basic concepts in Gestalt therapy.
Gestalt Therapy: A Guide to Contemporary Practice, (2010). Phil Brownell, New York: Springer Publishing. Basic modern introduction to Gestalt therapy.
Gestalt Therapy for Addictive and Self-Medicating Behaviors, (2012). Phil Brownell, New York: Springer Publishing. Technical use of Gestalt therapy in addictions treatment.
Body of Awareness: A Somatic and Developmental Approach to Psychotherapy, (2001). Ruella Frank, Cambridge: Gestalt Press. Demonstrates how movement plays a critical role in a developing self-awareness..
Gestalt therapy focuses on unblocking the barriers clients experience to being fully alive and present. It emphasizes dynamic awareness and contact with one's internal and external environments. Particular attention is paid to the development of creative adjustments and the relationship that develops between therapist and client in the moment. For more information and training opportunities go to http://www.indygestalt.com