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I met Roni Maislish through LinkedIn (he is in Israel), as we both work in mental health and specifically with eating and emotions. We both recognize the emotional aspects of obesity and that it can be an emotional-mental-issue. Roni says, “Most of the time, when people talk about eating disorders, they forget the field of overweight and the emotional side of this field.” Roni created this workshop for therapists, family physicians, dieticians, and related professionals, which I will talk about more below.
Find four downloadable worksheets on emotions, eating, and body image at the bottom this article. I have used these worksheets when working with people over the years. Shannon Mick, NCC, LPC, CCATP, CTMH
By Roni Maislish
Therapist workshop – The Emotional aspect of Obesity (Introspection through the relationship with food and eating as a gate to change, cure and healing)
Background – How many times you had been surprised by overweight patients that told you to “fix them quickly”, who for years after years trying to lose weight, sometime seceded and then back again, gain the weight back? How many time your faith in your patient dissipate and you felt anger and frustration that he or she is not committed enough to the process like you? And how many times you felt that you are not able to understand emphatically (near-experience) why those patients cant keep on fighting, controlling and avoiding in their food and eating’s issues? and how many time you realized and told yourself that something is missing?
For all of you therapist from a variety methods and approach who dealing with the emotional aspect of overeating, overweight, emotional eating, emotional non-eating, non-acute eating disorder, obesity and more – you all most welcome to workshop (short educating program) where you become familiar, study and also go in depth to a new dimension which will enable you to see, understand and experience the “food and eating’s issue” not as a “problem to solve” but as a unique way that a specific person use to “tell his story” while integrate and keeping safe his “self”. And From this kind of listening stance we will be able to make place to our patients, while helping them finding their subjective way toward healing and restoring their wounded, un-develop and neglected self.
The workshop – In the beginning I will present my attitude in the last 15 years (which changing and modifying in time) for dealing with emotional eating’s issues. I will share with you my straggles, dilemmas and personal questions that occupied me since early childhood and connect it to my journey (both personal, academic and professional) and how I established and combined theories which gradually help me to meet myself and my patients from a “different” perspective (that sometime we can feel as if you speak an ancient languish).
Doing so, I will manly focus in two theoretical and clinical paradigms to help us to understand ideas I formulate these years– I call it: “the fat remember”/”the fat’s emotional role” (or, “if the fat will able to talk, what it will say?”):
The first paradigm based on Didier Anzieu’s work (manly his book :”I-Skin”, which written in French “Le Moi-Peau”) who dealt on the emotional-sensorial clothing (“I-Skin”) that a human beings wear from early childhood and making adaptation trough the years to avoid invasiveness and secure the self from hurts and fragmentation. In his work Anzieu present 8 function of this psyche soma’s envelop like holding, handling, protecting and more. In my work, regarding Anzieu’s ideas, I explore the fat, the overweight, mostly in the abdomen (but not always) and its role to establish and contributing the building of those 8 functions in case that the self no longer develop normally. For instance we will learn together about the connection of the stimulation-shield function in the “I-Skin” clothing to the gaining weight process to build “fat armor” against attacks on the self.
Later on, I will present the “self-Psychology” paradigm while understanding deeply that defense and resistance is not something that the therapist need to break, remove, overcome, or even to melt so we can see emotional aspects and reasons of gaining weight’s process as a reminder from a depress self which struggle to survive non-emphatic world. This self, as I see it, is still hoping that someone (maybe the therapist) will see beyond the “fat story” and help the patient to restart its “inner self program” and recover those years of deprivation.
Regarding the topic of this workshop and self-psychology, In his second book, “The restoration of the self” (1977, pp 80-81) Kohut refer to the triad: oral fixation, pathological overeating and obesity and present the understanding of the classical approach that deals with drive-awareness and the ability to control the drive (via its suppression, sublimation, inhibition of its aim, displacement, or neutralization). Instead, Kohut’s claim is that “the child asserts his need for a food-giving self-object” and “the child needs empathically modulated food-giving not food”. If this need remains unfulfilled, Kohut continue, then the child retreats to a fragment of the larger experiential unit, i.e., to pleasure-seeking oral stimulation (depressive eating). Kohut add that increasing awareness to those process renewed movement toward psychological health.
The combination between Anzieu’s theory and Kohut’s perspective, while adding the work of Eigen (Toxic Nourishment, Emotional Starvation), Ogden (The Autistic-contiguous position), McDougall (Theatres of the Body) – will all helps us to build new platforms and ideas which open new possibilities to understand the patient’s pain, to find beauty in the defensive-structure of the patient (his overeating patterns) and further on to develop the patient self-ability to heal and grow himself while seeing us ganging and flexible in our empathy enabling him to change too.
During our learning and in between the theoretical conceptualization that we will create, I will share with you some example from my clinical work. The main part in this section will be the “mindfulness meal” where we will be able , to search different possibilities for introspection of the connection between our relationship with food/eating and others relationship (family, marriage, career, friends, money, faith and more). In this mindfulness-experiential process, we will use motive like: choice, miss, lose, regret, planning, disintegration, aesthetics and more, to understand how a certain movement from our eating place’s seat to the buffet table represent original selfobject needs. That will help us to vary and enrich our empathic capability and responses to those patients that their selfobject need didn’t met yet and have a very complex relationship with food and eating. For example: One of the participants in the workshop can become aware that the way he choosethe food was similar to how others choosing and he can realized that he didn’t ask himself what are his special and authentic needs. Then he can share about that kind of pattern in other relationship (for example – he choose where to study upon his unique need or was it a “social decision”). That mindfulness experience of understanding will take us, as a group, to discuss how some of our patients will prefer the “socially eating” pattern which can give them a response for their twinship’s (alter ago) needs (they eat the same food like everyone so they feel part of the group, and the world). Those kinds of introspections around the table will encourage us to think about more emphatic response’s possibilities for more kind of needs (mirroring, idealizing).
If we will have enough time we will practice in pair the question: “for what I am really hungry for? (The dialogue between emotional hunger and physical hanger) and mediate on the “role of the fat” and more. We will complete our journey with sharing our experience and understanding, we will ask ourselves what surprise us today and we will have some time for questions and answers.
About the instructor –Roni Maislish M.A (psychotherapist and clinical social worker).
From 2005 I am working with overweight’s patients dealing with emotional eating that come from emotional long-term neglected. I the last 2 year I am working in Tel Hashomer (Sheba) hospital in an overweight treatment center (part of the endocrine institute) while between 2006-2011 I saw eating disorder’s patients (and their parents) in Soroka Hospital. From 2007 working as emotional eating’s therapist. Leading groups both for therapist and non-therapist, short workshop and year-long dynamic-study groups. Beside working with patients, I involve deeply in education-prevention roles schools, pre-school, eating disorder’s clinics, accompanying nutritionist, mantel health department, and much more .in 2008 I participated in a 5 days retreat in California leaded by Geneen Roth (the author of the bestseller “When food is Love”).
Introduce myself and give a little information on my credentials.
Check your valid photo ID to verify that you are who you say you are.
Review the In Case of Emergency plan. I’ll also review who your emergency contact is with you and jot down your current location address.
Review the housekeeping paperwork that you completed, such as the Notice of Privacy Practices and Informed Consents.
Briefly talk about the SimplePractice platform and what’s available to you through your client portal.
I’ll answer any questions that you may have.
Review the Intake Questionnaire that you completed.
Collaborate on the Treatment Plan, covering issues or symptoms that you’d like to work on, goals and outcomes, and steps towards those goals and managing symptoms.
Discuss anything you could work on in between the initial session and the second session. If appropriate, I’ll probably suggest that you have a private journal or notebook to take notes during sessions and to use throughout the week.
Answer any questions that you may have.
Verify your current location address.
Check-in. Talk about how your week was and how you’re doing.
If we need to, review the Treatment Plan.
Talk about things going on and work towards your goals that reflect the Treatment Plan. How we work towards your goals is 100% unique to you. We will also identify your strengths and interests and where we can use them.
Discuss what you could work on over the next week.
Telemental health has actually been around for several years.
• Telemental health is only for the underserved and those who live in rural areas.
Anyone can use telemental health. It saves travel time, gas money, and can more easily fit into a busy schedule.
• You miss out on nonverbal cues with telemental health.
During video chat, nonverbal cues can still be picked up. Proper room lighting, camera placement, and having a strong internet / wifi connection play an important role in this. The mental health professional will let you know if they can’t see you.
• It takes longer to develop rapport with telemental health.
It takes the same amount of time as in-office sessions to develop rapport, keeping in mind that the counselor should be a good fit to work with.
• Telemental health is not secure.
Telemental health can be set up HIPAA compliant and secure to the standard of ethics. There are multiple safeguards in place.
For about nine years, I worked as a counselor in higher level of care settings. A ton professional growth occurred during those years. I taught people how to better cope, apply therapeutic strategies, and believe in their own strengths. Days ranged from 8 to 16 hours long. One month, I took an overnight shift. I battled insomnia due to the crazy hours. What I learned during those times still helps me. And I beat the insomnia.
About a year ago, I felt the desire to go into outpatient private practice. It would be a completely different experience, slower pace, though still always busy. I was interested in business. For almost an entire year, I researched how to properly set up the independent contractor and business details, then chipped away at putting the pieces into action. I was also pregnant, so there was no hurry during this process.
The business didn’t start out as teletherapy. I shared an office with another counselor and saw people in-office. That was alright, but I wasn’t happy with a few of the business aspects that weren’t within my control, nothing counseling related. It felt off. I didn’t feel like I was supposed to be there. In the back of my mind, I was thinking about teletherapy, but I didn’t believe that it could be as secure as in-office and wondered about some ethical aspects. I had a lot of questions. Back while I was researching how to set up the business, teletherapy came up, but I had too many concerns about doing harm or something going wrong. So I didn’t go there.
Well, Coronavirus struck and places went into lockdown. Our office was open because we were essential workers. Coronavirus was my sign to leap into teletherapy. I took a 12.5 hour course on properly running a teletherapy private practice and did more research. No one was inquiring about services due to the lockdown. I jumped ship and into the new waters, I swam.
As everything fell into place, it was rewarding on many levels, personally and professionally. Of course, I was setting everything up from scratch, doing it the hard way to save money because I was just starting out. I created my own documents, made sure everything was HIPAA compliant, secure, and private, and used as much free software as I needed. It ran like clockwork. How about that?!
I completed continuing education and became certified in telemental health and in treating anxiety. My business grew and remained steady over the next year. With my heart full, I wanted to upgrade my business and give more to my clients. I researched practice management software and EHR software, comparing all of the platforms, perks, ease of use, and which one would be the best fit for myself and my clients. I went with SimplePractice because it was intuitive and had a great client portal.
The free trial was handy, I picked through everything that SimplePractice offers and learned about it. When it came to getting the system and paperwork to align with what I already had set up, it was a bit overwhelming and difficult. SimplePractice has good “how to” videos and I was getting daily emails from them to make sure things were going well. After fiddling around during that free period, my business was operating on SimplePractice. So happy!
My small private practice has come a long way within a year, as it started from scratch and now uses a fancy EHR. There’s a lot to be proud of and grateful for in this journey of business ownership. The practice has been fruitful. I look forward to meeting and helping people in the years to come.
Mental health professionals: use this code below to try out SimplePractice, and when you’re ready to sign up for a paid account, receive a $50 discount.
What National Certified Counselor (NCC) Means to Potential Clients
Counselors can have multiple letters or credentials behind their name. One that most people are familiar with is Licensed Professional Counselor (LPC). Counselors can be board certified, have a certificate in a specialty (addiction, marriage and family therapy, anxiety…) and treatment method (Cognitive Behavioral Therapy, Solution-Focus Brief Therapy, Dialectical Behavior Therapy…).
The Counselor is Committed
The NCC is voluntary, it is not required to practice (licensure is a requirement), but it is an additional step that counselors can take to display and ensure the high level of service that they provide their clients. Counselors who have NCC are dedicated to the counseling profession.
The counselor voluntarily submits to an established conduct review conducted by professionals in counseling
Counselors work with sensitive health information. If a client or somebody has a question about their actions, they may follow an established process to obtain a neutral review of their concern.
The counselor is required to remain current with developments in the profession
Continuing education that is approved by the National Board of Certified Counselors (NBCC) is required in order to maintain the NCC. This ensures that the counselor is current with all areas of the profession.
The counselor may have areas of specialties
The counselor demonstrates expertise with NBCC specialty certifications. These include, Certified Clinical Mental Health Counselor (CCMHC), Master Addictions Counselor (MAC) and National Certified School Counselor (NCSC). Certifications reflect that they have met national standards for a specialty practice, with additional education and experience and a specialty examination.