Hidden Eating Disorders: Attachment and Affect Regulation in the Therapeutic Relationship

From the time I began working at a clinic that specialized in therapy with individuals with eating disorders, I have repeatedly encountered cases of clients hiding these symptoms from their therapists. When they finally do reveal the disorder, their therapists often worry that their clients are more disturbed than they thought and that, they, the therapists, did something wrong in the therapy. Although some therapeutic rupture can be part of the picture, I have found that these disclosures often reflect a client’s growing trust in the therapist’s presence and ability to help with feelings that have been, until now, dealt with through the eating behaviors themselves. In my attempts to understand what happens before and after an individual shares a hidden eating disorder with a therapist, I have found ideas from attachment theory, in particular those that explore links between attachment, affect regulation, and self-reflection, to be very helpful. Many authors have noted that eating disorders are related to problems with attachment, loss and separation, and affect regulation. Difficulties in these areas make it hard for clients to be self-reflective or use insight productively. In this article, I discuss my experience with the integration of these dynamics, which I have found to be key to successful psychotherapy with clients who hide their eating disorders.

Organisationsentwicklung als Thema von Erwachsenenbildung und Supervisionscurricula

Zusammenfassung  Der Beitrag beschreibt Planung, Verlauf und abschlie?ende Beurteilung eines gruppendynamischen Seminars, in dem für angehende Supervisorinnen und Supervisoren das Thema Organisations-Entwicklung dargestellt und vermittelt werden sollte. Ausgangspunkt war die Kl?rung des Inhaltsraums von Organisations-Entwicklung als geplantem sozialen Wandel, der auf sozialwissenschaftlicher Grundlage zielgerichtet, strategisch und mit Zeitperspektive in der Zusammenarbeit zwischen externer und interner Sach-, Prozess- und Entscheidungskompetenz durchgeführt wird. Als Ziele des Seminars wurden festgelegt, Organisations-Entwicklung als sozialwissenschaftliches Instrument zu begründen, Organisations-Entwicklung-Schritte zu konzipieren und sie kollegial zu kommunizieren. Darüber hinaus wurden Qualit?tskriterien für das Seminar formuliert: Praxisn?he, Kl?rung des Inhaltsraum Selbstorganisation, Selbststeuerung, Ressourcenaktivierung, Konfliktregulierung, Analyse des Gruppenprozesses, Nutzung von Feldkompetenz und Verhaltensmodellen, Etablierung von Feedbackschleifen, Koordination und Synergie, kollegialer Austausch und Kl?rung pers?nlicher Organisations-Entwicklungs-Fragen. Bausteine und Lernorte des Seminars waren das Plenum, die Lernpartnerschaft, das OE-Team, die Beobachterfunktion, die Tagesreflexion, die Sitzung Frage und Antwort, die Darstellung von Praxisf?llen, das Plenum-Feinsteuerung, die Analyse der Arbeitsprozesse des OE-Teams sowie Transfer und Auswertung. Der tats?chliche Verlauf des Seminars wird aus der Perspektive des Leiters kommentiert. Anhand von Verlaufsbeobachtungen und Teilnehmer?u?erungen wird der Eindruck begründet, dass diese Form des Vorgehens als lernintensiv, autonomief?rdernd und für die zu erwerbende Supervisionskompetenz als praxisrelevant betrachtet werden kann.

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This article describes the plantification, progress and final evaluation of a group-dynamic seminar for future supervisors in which the topic organization development was presented and introduced. The content of organization development was first defined as a planned social change which is executed based on social sciences in a goal-oriented, strategic way which considers the time perspective of the cooperation between external and internal specialised-, process- and decision competence. Goals of the seminar were to justify that organisation development is a social science tool, to plan organization development steps and to communicate them to peer seminar participants. Further more, the following quality criteria for the seminar were formulated: practice orientation, definition of self-organisation content, self regulation, resources activation, conflict regulation, group process analysis, field competence and behaviour models usage, feedback establishment, coordination and synergy, mutual peer exchange and finding answers to personal questions about organization development. The building blocks and learn places of the seminar were the plenary sessions, the learning partnership, the od-teams, the observer function, the day analysis, the questions and answers session, the case study presentation, the analysis of the work processes as well as transfer and evaluation. The progression of the seminar is commented from the point of view of the seminar leader. Progress observations and participant’s feedback justify the impression that this way to conceptualise provides an intensive learning experience, supports autonomy and provides relevant and practical supervision competence.

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J?rg Fengler ist Professor der Psychologie an der Universit?t zu K?ln, Heilp?dagogische Fakult?t. Arbeitsschwerpunkte sind u.a. P?dagogische und Klinische Psychologie. Er ist Herausgeber dieser Zeitschrift.     

<Emphasis Type="Italic">„Mönche aus Wien,bitte lüftets eure Geheimnisse</Emphasis>.“ Über die Abweichungen der Beratungspraxis von den Idealtypen der Organisationsberatung

A discrepancy between the explicit theories of organizational consulting and consulting in practice has to be assumed. This paper analyzes the difference between front stage and back stage in organizational consulting. Therefore the idealtyps of organizational consulting are reconstructed and put in contrast with actual consulting behaviour (on the basis of 48 interviews with consultants). As a result three thesis can be stated: Based on the clients’ expectations a divergence between the idealtyps and the consulting practice has been identified, which leads to convergence in the consulting practice (convergence thesis). For systemic consulting (in German: Systemische Organisationsberatung) this divergence is as significant and vast (value transfer thesis) that it doesn’t seem justifiable to take it as an independent approach on organizational consulting (three realtyps thesis).     

The Impact of Social Desirability Biases on Self-Report Among College Student and Problem Gamblers

The impacts of two types of social desirability bias, self-deceptive enhancement (SDE) and impression management (IM), were examined on self-reports of gambling problems, measured by the South Oaks Gambling Screen (SOGS), and recent gambling behavior, as measured by the Timeline Followback (TLFB) method, in a sample of college students (N = 191), and a sample of treatment-seeking problem gamblers (N = 49). Consistent with our expectations, IM was negatively associated with SOGS scores in both samples. IM was most highly correlated with SOGS scores among treatment-seeking participants (r = −.44, p < .01). Substantial numbers of participants in both samples had high enough IM scores as to call into question the validity of their self-report gambling data, according to published interpretive guidelines. With respect to SDE, we had predicted that it would be positively related to gambling behaviors and gambling-related problems, but found that SDE was inversely related to SOGS scores in both samples. Very little evidence was found for social desirability effects on TLFB scores. Thus, preliminary evidence was obtained that self-report data on gambling problems, but not on gambling behavior (frequency of gambling and amount of time and money spent), may be susceptible to the effects of impression management in both college students and treatment-seeking gamblers.     

Real Limits in the Virtual World: Self-Limiting Behavior of Internet Gamblers

The recent expansion of Internet gambling has stimulated debate, policy, and research on this relatively new phenomenon and its potential consequences. The current study focuses on bettors experiencing problems by sampling Internet gamblers who imposed limits on the amount they were allowed to deposit to a betting site. We analyzed the betting transactions over 18 months of all gamblers who subscribed to an online betting site in February, 2005 (N = 47,134), 567 of whom utilized the site’s self-limit feature. Self-limiting gamblers played a wider variety of games and placed more bets than others prior to imposing limits. After imposing limits, self-limiters reduced their activity, but did not reduce the amount they wagered per bet. Time spent gambling, not just money spent, appears to be an important indicator of gambling problems. Self-limit programs appear to be promising options for Internet gamblers at-risk for gambling problems.

Speaking Out: Youth Led Research as a Methodology Used with Homeless Youth

Participatory action research is well documented with marginalized groups, but less is known about participatory action research with homeless youth. The use of youth led research as a methodology was examined among a population of homeless youth. Peer researchers (n = 10) reported on their experience utilizing youth led research methodology. Results indicate that youth led research is a promising methodology for use among homeless youth. Participants reported that the approach positively impacted the quality and quantity of data that could be collected from participants. Further, peer researchers reported individual benefits of feeling that participating in the project mattered, that people listened to them and that they had a voice.     

The Relation Between Therapeutic Alliance and Treatment Motivation in Residential Youth Care: A Cross-Lagged Panel Analysis

This study investigated the longitudinal relation between therapeutic alliance and treatment motivation in a sample of 174 adolescents receiving residential treatment in the Netherlands. Structural equation modeling with a cross-lagged panel design was used to examine the relation between therapeutic alliance and treatment motivation up to 9 months of treatment. Results revealed that autoregressive associations between initial therapeutic alliance and alliance at subsequent time points were significant, whereas for treatment motivation a significant association was found after 6 months, but not after 9 months. Results also showed that a higher level of therapeutic alliance after 3 months was predictive of a higher level of treatment motivation after 6 months. Furthermore, a higher level of therapeutic alliance after 6 months was predictive of a higher level of treatment motivation after 9 months. Implications for research and clinical practice are discussed.     

The Impact of Formal and Informal Respite Care on Foster,Adoptive, and Kinship Parents Caring for Children Involved in the Child Welfare System

This paper reports the results of a quantitative 42-item survey that explored foster, adoptive, and kinship parents’ (N = 160) utilization of different types of respite services (formal, informal, and a mixture of formal and informal), as well as their impressions of the impact of respite care on aspects of their lives related to family cohesion and stability, caring for their children, and their personal wellbeing. An exploratory cross-sectional, survey design was used to assess both the formal and informal respite care experiences of the foster, adoptive, and kinship caregivers. Two-tailed Fisher’s exact tests were used to examine the relationship between the type of respite received and caregivers’ respite experiences. Findings indicated that parent experiences differed depending on the type of respite services they received. Specifically, parents who used a mixture of formal and informal respite reported positive experiences related to respite more frequently than the other two types of respite groups, while those who received only informal respite reported less benefit than others. Parents who used formal respite (either alone or mixed with informal respite) reported greater stress reduction. The greatest increase in family stability was reported by parents who received a mix of informal and formal respite. While this study revealed clear benefits for families to using both informal and formal respite services, the findings suggest that formal respite care was helpful to parents regardless of whether used alone or in combination with informal care.     

Household Debt and Adult Depressive Symptoms in the United States

This study used data from Waves 1 (1987–1989) and 2 (1992–1994) of the National Survey of Families and Households in the United States and a series of regression models, some of which included individual-specific fixed effects, to estimate associations of particular types and levels of debt with adult depressive symptoms. Results suggest that household debt is positively associated with greater depressive symptoms. However, this association appears to be driven by short-term (unsecured) debt; we found little evidence of associations with depressive symptoms for mid- or long-term debt. The link between short-term debt and depressive symptoms persisted with alternative estimation strategies, including defining debt in absolute and relative terms. Furthermore, this association was particularly concentrated among 51–64 year-old adults, those with a high school education or less, and those who were not stably married throughout the observation period. These findings suggest that short-term debt may have an adverse influence on psychological wellbeing, particularly for those who are less educated, approaching retirement age, or unmarried.     

Loss of Control as a Discriminating Factor Between Different Latent Classes of Disordered Gambling Severity

Analyses of disordered gambling assessment data have indicated that commonly used screens appear to measure latent categories. This stands in contrast to the oft-held assumption that problem gambling is at the extreme of a continuum. To explore this further, we report a series of latent class analyses of a number of prevalent problem gambling assessments (PGSI, SOGS, DSM-IV Pathological Gambling based assessments) in nationally representative British surveys between 1999 and 2012, analysing data from nearly fifty thousand individuals. The analyses converged on a three class model in which the classes differed by problem gambling severity. This identified an initial class of gamblers showing minimal problems, a additional class predominantly endorsing indicators of preoccupation and loss chasing, and a third endorsing a range of disordered gambling criteria. However, there was considerable evidence to suggest that classes of intermediate and high severity disordered gamblers differed systematically in their responses to items related to loss of control, and not simply on the most ‘difficult’ items. It appeared that these differences were similar between assessments. An important exception to this was one set of DSM-IV criteria based analyses using a specific cutoff, which was also used in an analysis that identified an increase in UK problem gambling prevalence between 2007 and 2010. The results suggest that disordered gambling has a mixed latent structure, and that present assessments of problem gambling appear to converge on a broadly similar construct.