Webinar: Creating Connection in Eating Disorder Recovery: Strategies for Ongoing Support

Summary

The Canadian Association of Social Workers hosted the concluding part of their three-part webinar series on eating disorder recovery, focusing on creating connections and providing ongoing support. This session emphasized the importance of therapeutic alliances, the impacts of social contexts, and trauma-informed care in supporting individuals with eating disorders. Presenters discussed various therapeutic modalities, including CBT, DBT, and family-based treatments, and highlighted community resources available for individuals struggling with these issues. They stressed the need for a comprehensive approach, considering mental, emotional, social, and cultural factors, to effectively support recovery.

Highlights

• The webinar underlined the importance of creating therapeutic alliances to support eating disorder recovery. 🧩
• Discussions on trauma-informed care highlighted its role in understanding and treating eating disorders. 💡
• Speakers advocated for harm reduction approaches, emphasizing minimizing harm over achieving perfect abstinence from disordered behaviors. ⚖️
• The need for culturally sensitive and inclusive practices in eating disorder recovery was a key discussion point. 🎨
• A variety of therapeutic options, including CBT, DBT, and acceptance and commitment therapy were explored, along with their benefits and limitations. 🎯

Key Takeaways

• Creating a therapeutic alliance involves understanding the client's expectations and clearly defining boundaries and roles. 🌟
• Eating disorder recovery should consider broader social and cultural contexts, including systemic oppression and socioeconomic factors. 🌐
• Harm reduction approaches can be applied to eating disorders to minimize harm while recognizing that complete abstinence from disordered behaviors may not be immediately possible. ✔️
• Various therapeutic modalities, including CBT, DBT, and family-based treatments, offer structured support but should be tailored to individual needs. 🧠
• Community support resources, such as peer groups and educational workshops, play a crucial role in complementing professional treatment. 🤝

Overview

In the final part of their webinar series, the Canadian Association of Social Workers provided insights into effective strategies for supporting individuals recovering from eating disorders. The session focused on building therapeutic alliances, which are crucial for client engagement and successful recovery outcomes.

The discussion on trauma-informed care illuminated how trauma and its complex relationship with eating disorders could be addressed. Emphasis was placed on understanding the personal and environmental factors that contribute to eating disorders and utilizing trauma-informed approaches to support healing and recovery.

Various therapeutic modalities were covered, including cognitive behavioral therapy and dialectical behavior therapy, illustrating their application in treating different types of eating disorders. The presenters also highlighted the importance of community-based resources, peer support, and education, showcasing how they can significantly enhance professional treatment efforts.

Chapters

• 00:00 - 00:30: Introduction and Webinar Overview The introduction of the webinar begins with the host greeting CASW members and apologizing for a brief technical glitch. The host expresses happiness at seeing participants' virtual names appearing in the chat, encouraging those who haven't yet found the chat function to introduce themselves by sharing their location and any other details they'd like to share. Additionally, the host mentions the presence of a polling function available on the slide screen.
• 00:30 - 01:30: Welcome and Introduction of Hosts The chapter titled 'Welcome and Introduction of Hosts' introduces Alexander Zanis, the Social Policy and Communications Coordinator at the Canadian Association of Social Workers. This is the beginning of a 90-minute webinar, which is the third and final part of a series focusing on eating disorders and social work. Attendees are encouraged to engage by sharing their location and accessing additional materials via the abstract widget on their screen.
• 01:30 - 03:00: Preliminary Instructions and Webinar Functions The chapter titled 'Preliminary Instructions and Webinar Functions' provides information on accessing resources related to the presentation. It mentions the availability of handouts and previous sessions, which can be viewed on demand. The chapter also instructs on how to use the blue and white widget icons at the bottom of the screen to access additional materials for the presentation. Additionally, it briefly references a Twitter function associated with the course.
• 03:00 - 07:00: Speaker Introductions and Backgrounds The chapter introduces the course completion tracker, explaining its function and importance in obtaining a certificate of attendance. It informs that the certificate will be available an hour after the session ends, either through the platform or via email. Instructions are given on checking spam folders or logging back into the platform if the email is not received. The availability of a slide function is also mentioned.
• 07:00 - 09:00: Acknowledgement of Related Social and Cultural Issues The chapter discusses the availability of a peer-to-peer support group for social workers, organized by CASW, where members can talk about the challenges posed by the new reality they are facing. The chapter encourages registered members to join and utilize the space for questions, comments, or anything additional they wish to discuss with fellow social workers across the country.
• 09:00 - 13:00: Overview of Series and Past Webinars This chapter introduces the final part of a three-part series and features phenomenal presenters Ari Aaron and Caitlyn. It encourages attendees to explore the speaker bios to learn more about their organizations, which are noted for doing noteworthy work in social work.
• 13:00 - 21:00: Challenges and Opportunities in Eating Disorder Recovery This chapter discusses the dynamics of hosting a Q&A session within the context of eating disorder recovery. Participants are encouraged to use the Q&A tab for queries to avoid them getting lost in the chat. The chapter emphasizes the importance of organizing questions and addressing them either during the session or at the end in a dedicated Q&A period. This setup aims to ensure that participant concerns are efficiently addressed throughout the presentation.
• 21:00 - 32:00: Therapeutic Alliance Strategies The chapter titled 'Therapeutic Alliance Strategies' covers the introduction of a session or presentation focused on engaging with attendees. The speaker addresses the audience, emphasizing the importance of utilizing the Q&A tab for better coordination, especially for technical issues. Before proceeding with the presentation, there is an interactive element involving a poll to identify where the audience is from, highlighting engagement and representation from regions like Alberta, Ontario, and Atlantic Canada.
• 32:00 - 39:00: Emotion-Focused Family Therapy and Client Relationships The chapter introduces Ari Maharaj, a speaker who is excited to discuss the topic of creating connection and eating disorder recovery strategies for ongoing support. He is associated with outreach and education activities.
• 39:00 - 43:00: Stages of Change and Recovery Journey The chapter discusses the journey of recovery and the various stages of change individuals go through. It highlights the perspective of a professional at the National Eating Disorder Information Center who shares their own lived experience with mental health issues. The chapter emphasizes the importance of community mental health work and the speaker's transition from a postsecondary setting to community settings. They now focus on community education at an organization called netic, while also maintaining a private practice to support individuals facing financial barriers. Additionally, the chapter mentions the speaker's involvement in running groups through another organization, She is Place.
• 43:00 - 53:00: Trauma-Informed Care in Eating Disorder Recovery The chapter begins with introductions from speakers, including Aaron Houston, who is the training and education coordinator at Body Brave. Aaron shares his personal history with an eating disorder, having been diagnosed with anorexia nervosa at 16. He has lived experience with the condition during his late teens to early 20s. The chapter sets the stage for wider discussions on trauma-informed care in eating disorder recovery.
• 53:00 - 59:00: Harm Reduction Approach The chapter discusses the harm reduction approach in the context of pediatric eating disorder recovery. It highlights the speaker's personal experience with the pediatric eating disorder hospital system and community-based support systems. The speaker expresses admiration for social workers based on their interactions during recovery and emphasizes the importance of these professional interactions in aiding recovery. The chapter aims to provide insights and support for social workers dealing with clients with eating disorders. The narrative then transitions to another speaker, Caitlyn, suggesting a conversational format.
• 59:00 - 63:00: Types of Support in Recovery Caitlyn Axelrod, a social worker and program coordinator at Sheena's Place in Toronto, introduces herself. She has over three years of experience at Sheena's Place and has been involved in eating disorder research and volunteering for eight years. Her interest in eating disorders stems from personal connections to individuals with lived experiences, fueling her passion for providing accessible support.
• 63:00 - 69:00: Family-Based and Cognitive Behavioral Therapies The chapter discusses mental health support with a focus on body inclusivity and harm reduction. It highlights the work being done at Sheena's Place and by the speaker in their personal and professional life. The chapter emphasizes the commitment of everyone involved to assist individuals experiencing eating disorders or disordered eating, irrespective of a formal diagnosis.
• 69:00 - 76:00: Other Therapeutic Approaches The chapter explores the multifaceted aspects of health, extending beyond physical health to encompass mental, emotional, social, spiritual, and community well-being. It highlights the significant impact of inequity and injustice on health outcomes, noting that these challenges are often beyond individual or community control. The narrative acknowledges the detrimental effects of racism, intergenerational trauma, and settler colonialism, emphasizing the necessity for collective efforts to address these issues and bridge health disparities.
• 76:00 - 82:00: Common Pathways in Eating Disorder Treatment This chapter discusses the intricate relationship between health and an individual's value, emphasizing that health is not a permanent state nor an obligation owed to society. It explores the inherent worth of individuals regardless of their health status, particularly in the context of Eating Disorders. The chapter highlights the complex interactions in this field, involving professionals such as dietitians and social workers, to support individuals dealing with eating disorders.
• 82:00 - 89:00: Overview of Related Organizations and Resources The chapter discusses the involvement of various professional organizations, specifically dietitians, social workers, and mental health professionals, in historical and ongoing systemic issues related to whiteness and colonization in Canada. It highlights unethical practices such as the participation of dietitians in non-consensual experiments on Indigenous children in residential schools, the role of social workers in removing Indigenous children from their families to send them to residential schools or foster care, and the embedding of whiteness in diagnostic standards by therapists, psychologists, and psychiatrists.
• 89:00 - 100:00: Conclusion and Q&A The chapter titled 'Conclusion and Q&A' addresses the significance of acknowledging and actively working towards reconciliation in the context of mental health. It highlights how prevailing documents, treatment access, and support systems are influenced by historical traumas. The speaker, a non-indigenous settler, underscores the importance of understanding the impact of these traumas on individuals with lived experiences and emphasizes the need for a holistic approach in learning about mental health, eating, and body awareness.

Webinar: Creating Connection in Eating Disorder Recovery: Strategies for Ongoing Support Transcription

• 00:00 - 00:30 hi casw members sorry about that my screen froze briefly but hello and welcome thank you for joining us for another 90 minute session I am so happy to already see your virtual names populating my chat function if you haven't found that chat function already please pop it open let us know where in the country you're tuning in from your name any other details you want to share with us we also have a poll function up on that slide screen scen uh so feel
• 00:30 - 01:00 free to pop in there let us know where uh where in the country you are tuning in from my name is Alexander zanis and I am the social policy and Communications coordinator at the Canadian Association of Social Workers you are joining us for a 90 minute long webinar this is part three of a three-part series on eating disorders and social work if you want to pop open that abstract uh widget at the bottom of your screen you can get a
• 01:00 - 01:30 little bit more details about this presentation the handout widget also has Parts one and part two if you happen to miss those two incredible sessions uh they are available on demand so you can watch them anytime uh as well as a session will be available on demand about an hour after the presentation concludes you can see those blue and white icons at the bottom of the screen they widgets icons uh those will be everything you need to access uh additional materials for the presentation Twitter function the course
• 01:30 - 02:00 completion tracker that course completion tracker is where you will get your certificate of attendance if you are looking for one today it will not generate until the platform has uh finished the session today so please give it up to an hour you can download it directly from the platform if you log back on an hour after the event or watch your email it should be emailed to you uh if you haven't gotten it in your email check your junk folder or log back on to the platform and download it directly here we also have the slide function and
• 02:00 - 02:30 the handout widget part one part two as well as the casw peer-to-peer support group that places your space to talk about the challenges of this new reality that we are dealing with uh so please feel free to request to join that group if you are a registered uh CW member and utilize that space with questions comments anything additional that you want to say to fellow social workers across the country I am going to pop open the
• 02:30 - 03:00 speaker bio widget for everyone uh you can feel free to exit that out um but we have some phenomenal presenters today I am so happy to be joined by Ari Aaron and Caitlyn who are finishing up our like I said the third part of our three-part Series today uh their organizations are also in their speaker bio so please feel free to check out those uh organizations as well they are doing some phenomenal work in this field and as we know social work is such a
• 03:00 - 03:30 massive player in the field of eating disorder recovery so with all that being said I'm going to be on the back end feel free to use that chat and Q&A tabs there's two tabs if you have dedicated questions for the presenters for our little 10 minute uh 10 to 15 minute Q&A period at the end please use that Q&A tab that way it doesn't get lost in the chat function and feel free to type your questions throughout the presentation we'll compile them we might answer them during the presentation towards the end in that Q&A so feel free to use that box
• 03:30 - 04:00 and ask any questions that you may have of myself at csw or of our wonderful presenters also if you are having Tech issues I do recommend using that Q&A tab just so that we can help you better uh in in a bit more of a coordinated fashion than in the chat I think with all that being said I would love to pass it on let's see the results of this poll before I do okay lots of you from the Prairies I feel well represented in from being from Alberta Lots from Ontario and Atlantic Canada
• 04:00 - 04:30 phenomenal all right well I'm going to pass it on I believe we have Ari coming on who is going to start us off Ari thank you so much for being here and I so look forward to this presentation thanks Alexandra um hi everyone we're really excited to get to talk to you today about creating connection and eating disorder recovery strategies for ongoing support my name is Ari Maharaj I use he him pronouns I am the Outreach and educ ation
• 04:30 - 05:00 coordinator at the national eating disorder information center um I identify as someone with luded experience of mental health issues and have worked in community mthal Hof for about eight nine years now uh I started in a postsecondary setting and then worked into Community settings and now I'm excited to get to do Community Education work at netic while also having a um a reduced cost private practice for folks who experience Financial barriers and ways to support them while also getting to run groups through um she is place that you're
• 05:00 - 05:30 going to hear about later today and I'm going to pass it over to Aaron and Caitlyn to give brief introductions too so I'll start with Aaron if that's okay yeah of course hi everyone my name is Aaron Houston I am the training and education coordinator with body brave who we'll hear a bit about um in a bit I identify as someone with lived experience of an eting disorder um throughout my late teens early 20s um I was diagnosed with anorexia nervosa when I was 16 um and have experienced ating
• 05:30 - 06:00 kind of the Pediatric eating disorder hospital system um and Community Based supports as well um as a result of my eating disorder so really excited to um be with you today during my time um recovering from an e disorder I had a lot of interactions with different social workers um and and so I have so much respect for for the work that you all do and and hopefully some of these insights can um can be helpful to you as you navigate working with clients with e disorders and I'll pass it over to Caitlyn
• 06:00 - 06:30 hi everyone my name is Caitlyn Axelrod I use she her pronouns and I'm a social worker and the program and Outreach coordinator at sheena's place in Toronto um I've been in my role at sheena's place for just over three years now and I've been involved in research and volunteering within the Eating Disorders field for about eight years as well um I became interested in eating disorders as a result of knowing many people with their own lived experience and I am very passionate about providing low barrier
• 06:30 - 07:00 mental health support uh body inclusivity and harm reduction which we will hear a little bit more about today uh both at sheena's place and in my work and life outside of sheena's place so very excited to be here and I will pass it back over to Ari thanks everyone all of us are really committed to helping individuals who experience eating disorders and disordered eating whatever that looks like for them and regardless of whether or not they've received an eating disorder diet diagnosis we all really believe that
• 07:00 - 07:30 health is comprised of many factors it's more than just our physical bodies and includes our mental emotional social and spiritual and Community well-being we also understand that inequity and Injustice can have really insurmountable impacts on an individual's health and health outcomes and many of these barriers are far beyond any individual or community's control but we believe that we can work together to help bridge those gaps unfortunately experiences of racism of intergenerational trauma and of settler colonialism had powerfully
• 07:30 - 08:00 negative impacts on health and that Health in and of itself isn't in permeant state of being um we do not believe that being healthy or pursuing health is an obligation an individual owes to society nor is reflective of someone's value we recognize the inherent worth of individuals regardless of their relationship with health in the field of Eating Disorders I think that relationship has been really complex um both we and our clients often work with diet Ians with social workers with
• 08:00 - 08:30 therapists and each of these professions have its own complex history with whiteness and colonization in Canada for example dietitians participated in experiments on indigenous children without their or their fam's knowledge or consent in the Indian residential school system social workers have contributed to the removal of indigenous children from their homes and sent them to residential schools or to foster care therapists psychologists psychiatrists have embedded whiteness into the diagnostical and statistical manual mental disorders which continues to be
• 08:30 - 09:00 the prevailing document utiliz in the field and these are just a few examples treatment and access to treatment and access to support are all still shaped by um these things and the impacts of these traumas that um sometimes folks with lived experience have had to encounter as a non-indigenous settler we all see acknowledging these factors and actively working towards reconciliation is critical especially in the context of learning about mental health and learning about eating and Lear learning about bodies and in learning about
• 09:00 - 09:30 health and the way in which these things interact if you want to learn more about the ways you can take action some of the resources on these slides are a really nice place to start um you can click those links on the slide deck as you go in today's objectives um we're hoping to reflect on what it means to build a Therapeutic Alliance with someone who's affected by a needing disorder we're hoping to explore different modalities and types of support for people affected by needing disorder and we're hoping to help you learn about
• 09:30 - 10:00 relevant resources and referral Pathways to best support your clients um please know that you can ask questions throughout we all have the chat window open and both the chat and the Q&A are going to be monitored by the speakers who aren't speaking at that time um we also trust you to take care of yourself through this presentation I think for those who um have had difficult experiences with the conditions that we're talking about today that sometimes hearing about these things in this context can be difficult and I'm really
• 10:00 - 10:30 glad that the CW platform um is there for you that this can be accessed as an ond demand learning after like Alexandra mentioned if ever you're wondering about the sources that we're sharing you'll see at the bottom right of most slides sources on where we pulled information from and we have a full reference list included at the end um please know that you are free to um eat if you'd like or need to throughout the session today um please take care of your needs as you're encountering learning opportunity
• 10:30 - 11:00 especially with the ways in which covid-19 has still continued to really impact our structures and our routines and um our wellbeing um and please know that all of us are presenting from our personal and work contexts and the more critical thinking the better we can just speak for ourselves and we're not going to try to speak for more than just ourselves and the work that our organizations do and our experience in that and we really trust and value all of your knowledge and experience that you can bring to this conversation too so um don't need to look at this content
• 11:00 - 11:30 as like the way to do things but as tools to potentially help you reflect on your practices and your processes and inform your critical thinking as you work to better support people um affected by a needing disorder I'll pause here before we get going anyone have any questions about that okay feel free if you're typing to
• 11:30 - 12:00 pop that into the chat but I really just wanted to make sure um as Alexandra's mentioned a couple times that we've been really lucky and thankful to work with CW on having this as a series and this is part three of a series for those of you who are like oh no I've missed part one and part two please know that that's accessible on the csw on demand platform and these are the information that was covered in part one and part two an introduction to eating disorders really covered off basic information about the condition including how to recognize it the risk
• 12:00 - 12:30 factors and commonly co-occurring mental health challenges as well as exploring the ways in which Eating Disorders are interconnected with aspects of identity including things like race and gender and sexual orientation socioeconomic status and body shape and size and we ended that session with a practical piece on sharing strategies for assessment and providing support especially from a motivational interviewing lens in part two exploring diet culture and weight stigma providing care for all we explored topics around
• 12:30 - 13:00 diet culture and weight stigma and health really trying to use an anti-oppressive lens we reflected together on the implications of weight stigma and the ways in which that can inform our language and our ways of being in practice and we shared some tools and strategies for adopting eating disorder informed approaches to care especially from a weight inclusive lens so if you're looking for those things from this session know that um we're might not we might not be intentionally touching on them because we've covered them in the past but some of what we talk about today will feature
• 13:00 - 13:30 connections from those first two parts that doesn't mean don't ask those questions just know that sometimes part of the answers that kin Aaron and I might give you Arta we covered this in part one or part two if you want to go and give that a look so feel free to do that so as we get into today's content um I think some place that is really important to start with as you're thinking about your role in supporting someone with eating disorders and in their recovery journey is to start by
• 13:30 - 14:00 reflecting on the challenges and opportunities of your role so on this slide you see some challenges on the very left that Caitlyn and Aaron and I have come up with and some opportunities on the very right that we've come up with um we don't think necessarily that these capture every single Challenge and opportunity but we'd love for all of you to reflect on this list and to add things for us in the chat what are some ch challenges that you have had to face
• 14:00 - 14:30 in your role that you don't see on the left or what are some opportunities that you think you have in your role that you don't see on the right um help us fill out this list because I think all of us reflecting on our context is really important in determining our role and potentially the best way to support someone in our context for um helping someone with an eaing Disorder so take a moment and look at this and pop things into the chat
• 14:30 - 15:00 and we will also take compliments if you think our Challenge and opportunity lists are good um yeah that's a really important challenge someone's bringing a black of supervision
• 15:00 - 15:30 especially supervisors who potentially have eating disorder knowledge are able to provide consultation with a case that you've had someone El bringing up lack of specialized resources especially in Rural and Northern parts of the country this person's from Manitoba not having a thorough understanding of Eating Disorders disorder due to recognizing in client so maybe that that lack of training um around that thanks
• 15:30 - 16:00 and we hope that part one at least helped a little bit with that stigma um yeah potentially in even like having a a a youth or really anyone um potentially reach out and commit to to ongoing support that can be harder if you're in environments or in pure environments where you feel like that um maybe is going to be welcomed or supported this one's really important too a refusal of services due to
• 16:00 - 16:30 atypical presentations um you'll learn about this later on as we talk about the system but there are many aspects of care in Canada where like we don't have provincially funded services for people with certain eating disorder diagnoses like a really common eating disorder being binging disorder there's not um a lot if any of um provincially funded care services for folks to access so um those things can be really hard and are really needed especially given the prevalence of that condition
• 16:30 - 17:00 someone's mentioning sometimes multidisiplinary teams can change the narrative for the good and the bad like if you're not sometimes having your critical thinking hats on the team just becomes a group think about a client as opposed to different perspectives someone's mentioning Eating Disorders being put on the back burner and the focus put on other issues especially by other professionals on their care team that's important too and I think there's lots of power dynamics that all of us might have to face as social workers in context where we're potentially working working with um folks who have um who put more power in
• 17:00 - 17:30 their degree credential and like we feel like it's hard for us maybe speak up and Advocate on behalf of our clients understanding how to address eating disorders and clients with chronic mental health experiences for sure a lot of comorbid co-occurring conditions we have a lack of resources a lack of training and a lack of services being able to really treat the whole person and I think you all run into that not having Step Up step down treatment options for sure you'll get to
• 17:30 - 18:00 hear about some of the things that um body bird is doing in this area a bit later cooccurring things people's personal biases and beliefs we really tried to unpack that in part two traditional and cultural practices such as fasting so from a like spiritual or religious lens can be really challenging to navigate when supporting someone who's potentially in a restrictive eating dis order for sure um
• 18:00 - 18:30 media personalities and celebrities can be positive or negative in addressing these issues yeah the influences that the client might have on them I'm going to ask I feel like you all have helped really expand that challenge box and I'm wondering where you feel about that opportunities box on the very right um how do you feel about those opportunities there do you think that's too much do you think those are things you feel like you can commit to what's on your mind as you look at that box of yellow
• 18:30 - 19:00 I hope that you notice too that there's nothing in that those bullet points that say you have to cure the eating disorder um that it's all on you because it really can be difficult to do that um and I think you can be a positive part of someone's recovery Journey whatever
• 19:00 - 19:30 that looks like for them if you're a compassionate experience with someone in healthcare you've helped open up some doors for them you equip them with them some resources um some folks are adding when people feel hopeless or stigmatized we can normal normalize validate and give hope we can almost kind of be someone's like positive cheerleader in a way like a like a not only an accountability buddy but also um be able to kind of cheerlead someone on and provide that like cautious optimism about their their
• 19:30 - 20:00 Journey someone's mentioning they can take this webinar information to colleagues and open discussion from a more knowledgeable place that's a really wonderful opportunity being a positive role model especially in regards to working with youth yeah especially for many of you who are in community settings and not always in that like clinical individual office setting um your your um own being as a human and the way in which you are mindful in the
• 20:00 - 20:30 ways you're talking about eating and exercise and Body Image are all really important moving from crisis response to preventative programming and being able to advocate for that which is a really important part of the profession for sure being that like link to some of the social issues and the social um dynamics that can be underlying someone's eating disorder an opportunity to start a conversation especially um when like sometimes no one has ever asked about
• 20:30 - 21:00 their eating before and you even opening up space for them to do that can be really wonderful okay thanks everyone feel free to continue to populate that but I hope at least this has sort of been a grounding experience and knowing that I think it's important for us as we realistically think about our role in supporting someone's eating disorder of recovery that we start with a reflection of the challenges that we're facing so we can maybe acknowledge them and maybe around them and normalize some of the
• 21:00 - 21:30 opportunities of the role because I think sometimes I know for me I can feel like oh my God is it is there no one else in this person's life like do I have to do x y and Zed and I think that can be a non-helpful a non- helpful place to be when you're trying to support someone so let's move our conversation over for some strategies for cultivating a Therapeutic Alliance um I'm really open to all of your questions and thoughts and theories on
• 21:30 - 22:00 your experiences that you'd like to share um but some ways that we can maybe build on some eating disorder pieces to some of these basic Therapeutic Alliance strategies are something that I'll cover now so um in terms of orienting um your clients might have expectations of therapy based on their previous experience or their experiences of their peers or what they see in the media and I think we all can play a really powerful role in laying out the parameters of a therapeutic relationship ship and from a place of care and safety
• 22:00 - 22:30 and compassion um that can go to like Logistics like the place of meeting and the length and the frequency in the role but also talking about things like confidentiality or being real with them on the role that you think you can play as you get to learn about their their supports being transparent and honest um can also help from an orienting perspective and maybe even help you enter that relationship from a place of you and this client are going through a forest together and you're walking side by side it's not really meant in my
• 22:30 - 23:00 opinion for one person to be further ahead than the other or one person to be cutting someone off I think you're going on that walk together that ties into managing expectations understanding what their expectations from this support is and understanding what your expectations are having coming into this support Um this can include managing expectations about weight changes throughout eating disorder recovery and it's really important to not really make specific promises about a client's weight so you might have clients come in and say
• 23:00 - 23:30 things like um like they don't want to gain weight or they don't want to have their body shape change as a result of treatment and we might have a tendency to to want to maybe promise or reassure um like we won't make you gain weight above a certain number or whatever it might be and I think those are things that are hard to do our bodies are really complicated as you learned in part one and part two um and so it's really mindful that we're trying to unpack where and which that expectation is coming from for the client as opposed to and holding checking our
• 23:30 - 24:00 need to feel like we have to set that expectation um you can establish boundaries and um expectations around your role so i' like to explicitly Define my limits so me as I'm a registered psychotherapist qualifying here in Ontario and so like I'm not really qualified or feel knowledgeable in being able to provide the nutritional support let's say that um someone with an eating disorder might need in their recovery but I can maybe provide some
• 24:00 - 24:30 support with respect to have being an emotional space to process being able to talk about psychological coping strategies or sensory physiological um supports like those are things that I feel comfortable doing and you all being able to kind of name that with a client can sometimes be really helpful in establishing that Alliance in supporting autonomy this one can be really tricky and I think is really important um many with who experience eating disorders may be experiencing a loss of autonomy or have
• 24:30 - 25:00 experienced that in other especially more like structured treatment settings um or maybe being having lost like a sense of Independence in other facets of their life um the eating disorder itself can affect an individual's autonomy by challenging and changing life plans By necessitating changes in relationships and disrupting someone's identity and recognizing that this client has a need for autonomy and finding ways to support it in sessions to really make sure that they there the um Captain of their own
• 25:00 - 25:30 ship can really help build trust in that relationship and it's something that's super important and finally identify confidentiality um especially when it might be helpful like let's say um even if you're in private practice and you're working with someone and they might need some support nutritionally from a dietitian let's say um when you're working as a part of a team it's important that clients know if and how their information will be shared and you have processed in which to say that might be helpful for me and your
• 25:30 - 26:00 dietician to talk together about it what can we share what can't we share and really getting to Define that um helping to make sure that your clients understand your contact with other team members if any and being able to talk about that transparently is something that can be important um a way that I like to talk about the Canadian Healthcare System sometimes is it's it's not really a warm blanket I think it's like a quilt I think it's a patchwork of a lot of different kinds of supports and um a lot of systemic factors influence
• 26:00 - 26:30 how many patches our quilt is even going to have and sometimes we might feel like we have to work with our client to stitch together the quilt as opposed to being able to give them a blanket and maybe stitching together or quilt might be stitching together your support with a dietitian support um with a peer support with a group based support and that's maybe the start of someone's quilt being able to kind of Define that and get to talk about that actively something that's important and later on in this session we'll talk about aspects
• 26:30 - 27:00 of that quilt that we can um we can share anyone have questions on on this slide um or other strategies for cultivating a Therapeutic Alliance that you'd like to share from your experience before I move on
• 27:00 - 27:30 okay see you question I'll come back to it but one thing that I feel like is sometimes useful to to think about and this is borrowed from some folks working in Emotion focused family therapy which we're starting to see a lot more of in Canada especially as an approach to support people and families and cares who are all affected by a eing disorder um and the way to think about this is sometimes we as therapists as social
• 27:30 - 28:00 workers have these things come up these emotional markers which you can see as roots and these behavioral manifestations as you see as the leaves on this tree um so an example of how this might look like in practice is like I might feel helpless and ashamed and scared because I don't have the training I need to help my client and that might
• 28:00 - 28:30 show up in a clinical experience as avoidance as being like let me let me refer you out let me I don't know how I can help so let's move it um now like that might be important because it's important that our client get care from a competent provider and I think what I really want all of you to do is you consider our your role in supporting someone is being able to really unpack these emotional markers these roots and to make sure they're coming from a client centered place too um I really
• 28:30 - 29:00 love to believe that like there is no such thing as an unmotivated clinician like I think I've simply been more motivated to to avoid something worse from happening and so that's why it's sometimes normal to respond in the way that we see in the leaves there where we we might be overly accommodating or we might be criticizing or might be rejecting we're like we're scared sometimes that those things are going to happen um and I think these are like traps that I think are really normal for us to run into and it's really important
• 29:00 - 29:30 for us to take a moment to reflect and unpack where is this coming from and is this potentially coming from a place that's client centered or is it coming from a place that's focused on me and how do I manage the ladder as I work towards supporting the former a way that you all can do this and I know this might look small on your screen is the folks who came up with that that analogy um from The International Institute for emotion focused family therapy put together this scale um called the clinician trap scale and I found it potentially useful in you
• 29:30 - 30:00 being able to reflect on it for your own experience to note where you're going to run into traps and because I really want to emphasize here that it's normal for you to do so and it's okay if you do so they're just potentially places that you might have to be aware of transference and counter transference in the clinical relationship and where you might need to look for support for yourself from a supervisor from a peer Network whatever it might be as you run into into these traps with clients because what isn't fair is if we're not aware of those
• 30:00 - 30:30 traps and they're showing up in a clinical relationship and we're potentially um rejecting a client or blaming a client or um putting labels on a client and we're in we're undermining their care in different ways because of some of these traps that are there so I hope that this can potentially be a a self a self-reflection tool that you now have access to you can click that link to get like a bigger cop to read more about it um but but feel free to to
• 30:30 - 31:00 reflect on that something that might be important and I think finally um before I pass it over to Caitlyn I want to reflect back on in part one where we talked about stages of change as we think about someone's recovery journey of a eing disorder um it's really important to note that a stage of precontemplation where someone isn't seeing a problem with their current behavior can be really normal given the societal messages that
• 31:00 - 31:30 we see around diet culture that we impact a bit in part two um that when we initially show up as we're like motivated to come play a role in a client's recovery because they're presenting to us and they are kind of unsure or they don't really know if they want to tackle the eating disorder um or they don't really see a problem with x amount of behavior whatever it might be that this is a normal thing given the societal structures that we all live in and that identifying that that client is
• 31:30 - 32:00 in precontemplation is important just for you to make sure that you're able to assess where they're at um and that these stages of change aren't really linear that people don't always naturally move from precontemplation to contemplation to preparation to action that people can Bounce Around among multiple of these things and relapses especially during a global pandemic engaging in older patterns of behavior can be really normal in times of coping and it doesn't invalid validate where someone's at even if they have been
• 32:00 - 32:30 taking action and so again a reminder from part one that sometimes it can feel like our clients and our work with them are spinning in circles over and over and over again and I think one perspective shift that we can sometimes take for ourselves and with our clients is to really like look at this from a side view and like that bottom part of the image sees that it can be an upward spiral and progress is happening and maybe the rotation are getting fewer and fewer or whatever it might be um because
• 32:30 - 33:00 being able to be that grounded cautious Optimist with our client can be a really key part of our role and so I'd love to turn it over now to Caitlyn to talk about ways in which we can applied being trauma informed um can come into play when we're supporting someone with an needing disorder thanks Ari I love that image of the Spiral I often will actually share that with folks and groups at sheena's place um as a way of of encouraging a
• 33:00 - 33:30 reframe around some of the uh hopelessness or frustration that can happen uh with the recovery Journey so um with that I will um shift us into a conversation about trauma informed care uh for people with eating disorders and so it's really important that we are working from a trauma-informed approach when supporting people with eating disorders and disordered eating and when working with people without eating
• 33:30 - 34:00 disorders and disordered eating but especially in the context of Eating Disorders um available research does show us that there is a strong correlation between eating disorders and experiences of trauma so people who've experienced trauma especially interpersonal or sexual trauma are more likely to develop Eating Disorders than those who have not experienced trauma and this is especially the case for um Eating Disorders with binging and purging symptoms like
• 34:00 - 34:30 bulimia on the other hand people with eating disorders have a higher incidence of trauma than the general population so this relationship does go in both directions we know as well that 30% of people with eating disorders have experienced childhood sexual abuse so this is quite a high number disordered eating can be a response to trauma itself and it can also be a coping strategy or many coping strategies for managing other symptoms of trauma including those listed on the
• 34:30 - 35:00 slide so things like anxiety and panic attacks coping with depression or chronic pain nightmares flashbacks hypervigilance all of those things so in the next slide here um I'm going to take us through some of the functions of eating disorder symptoms as trauma responses and understanding symptoms with this in mind will be really helpful for support supporting people with eating disorder symptoms so
• 35:00 - 35:30 if we think back to webinar 1 for those of you who are present we talked about some of the perpetuating or maintenance factors for eating disorders so what drives symptoms what are the functions of symptoms we know that symptoms are not simply a choice people you know don't flip through the catalog and decide that they're going to just have an eating disorder because it sounds nice right we know that there are so many reasons why symptoms are occurring for people and many of the these are things that are not uh evident or visible um right off the bat
• 35:30 - 36:00 so there are a few examples here and I'll go through some of them now so for many people who experience physical or sexual trauma in particular they may develop a sense of disconnection from the body or a desire to separate themselves from the body and the overwhelming emotions that they're experiencing so this can of course impact self-concept self-esteem and Body Image which can perpetuate eating disorder symptoms we also know that body hatred shame and urges to self harm due
• 36:00 - 36:30 to self-critical views that develop After experiencing sexual trauma are quite common and so um in this way it makes sense that um that symptoms can be related to that some survivors will also engage in disordered eating as a way to avoid traumatic memories and to cope with negative emotions um we know that you know symptoms can be a powerful distraction uh from whatever else is going on in a person's life um something
• 36:30 - 37:00 to focus on something to control perhaps we know that restriction can impact cognitive functioning and memories and this can actually help a person stay numb or dissociated and similarly to substance use studies show that binge eating and purging can reduce the hyperarousal or anxiety associated with trauma often folks will describe a physical release while vinge eating or purging that allows numbing avoidance and forgetting of traumatic experiences so in this way
• 37:00 - 37:30 eating disorder symptoms can be quite self soothing for folks who've experienced trauma they may also feel threatened by uncertainty and not being in control because of whatever has happened to them so controlling behaviors around food and exercise can serve as a logical way to cope with this feeling one example of a way in which this can manifest and this is especially for survivors of sexual trauma is by using something like binge eating as a
• 37:30 - 38:00 way to change the body or to gain weight making the body quote unquote less attractive of course by diet culture standards in hopes of avoiding sexual situations contact and intimacy that represent vulnerability to harm um so in this way binge eating is often a protective response to sexual trauma um one example that we may have mentioned in part one um roxan gay and her Memo hunger provides a very powerful example of this I will add a trigger warning
• 38:00 - 38:30 there that she does go into quite a great amount of detail um but it is a really really powerful and important read so through these examples that I've just shared we can start to understand that eating disorder thoughts and behaviors can be rooted in a desire to preserve and protect oneself um I personally really dislike the language of self-sabotage or self-destructive I will never use that um with clients and folks I work with as it's evident that
• 38:30 - 39:00 even you know behaviors like self harm and Punishment are rooted in this desire to preserve and protect oneself um and so all of that to say it's very common and normal for folks who've experienced trauma to have disordered eating and understanding eating disorder symptoms in this way as I said is critical to providing care so moving along to I guess actually before we move on I'll pause are there any questions at this point um that
• 39:00 - 39:30 anyone has any comments or questions in in the chat feel free to share um and I'll do my best to address that otherwise we can wait until the end okay so I'll move on for now um to talk a little bit about trauma informed process practices and how they relate specifically to supporting someone with
• 39:30 - 40:00 an eating disorder or disordered eating symptoms so a lot of these are probably very intuitive and many if not all of you are already engaging in a lot of these things but I think uh going through this serves as an important reminder that all of us can benefit from so the first is remaining empathic and non-judgmental this is probably the most obvious one um you know remembering to validate emotions uh clients with eating disorders often feel very isolated and
• 40:00 - 40:30 alone many people have experienced a lot of invalidation or traumatic invalidation um in their lives and so validating emotions being empathic and non-judgmental is key um it's common to get caught up in the details around the symptoms that clients are engaging in but if we remember that all symptoms serve a purpose many of um many of those purposes connect to two underlying emotions um really doing our best to explore and validate those emotions in
• 40:30 - 41:00 terms of being non judgmental remembering not to make assumptions about um what a client is experiencing based on what you see or aspects of their identity and we talked a lot about this in webinar 1 um so again I'd encourage everyone to check that out if they have not working with shame is also really important shame often shows up After experiencing trauma and it can be very tied to disordered eating as a result of
• 41:00 - 41:30 uh the stigma that exists around many of the symptoms so if people feel shame as a result of experiencing trauma and then they engage in eating disorder behaviors to cope this can add layers and layers of shame to a person's experience and so working through this talking about shame we often have like Ari was mentioning the tendency to avoid um talking about certain things and shame can be a big one because it's uncomfortable and shame doesn't want to be talked about and so reinforcing that the eating disorder is not a choice just like it's
• 41:30 - 42:00 not someone's fault if they've experienced trauma is really critical psycho education can be very helpful here as well especially around the functions of symptoms like we've talked about and about things like the restrict binge cycle that we covered in webinar one learning this information can be really empowering and it can really um emphasize for people that it's not their fault um that you know they're what they're experiencing is not because they're bad or wrong or um you know not
• 42:00 - 42:30 doing what they should be doing the psycho education can be really helpful in combating shame and as I mentioned framing behaviors as self-protective and not as self-sabotage or self-critical can be very effective in combating shame as well reflecting on beliefs and biases we've talked about this a lot especially in webinar 2 the fact that we're inundated with messages that thin IES are healthy or more desirable or acceptable and that fat or larger bodies
• 42:30 - 43:00 are unhealthy or um less worthy in whatever way and so it's really important that we continue to work to unlearn this and to adopt weight inclusive practices as this is a really critical part of providing trauma informed care acknowledging and validating our own feelings and engaging in self-care as well is a big part of self-reflection so whether that's engaging in formal um therapy or you know having access to informal supports and reflecting on our own relationships with food in the body
• 43:00 - 43:30 and how this might affect our interaction with clients um and knowing too that based on our own experiences working with folks who've experienced trauma or eating disorders might not be something that you're ready to do right now or ever and that's okay um so we will be providing more information at the end about uh resources for referral mindfulness around language to um we've we've also talked a little bit about this in webinar to um but this includes observing how diet culture can
• 43:30 - 44:00 sneak into our vocabulary so using terms like overindulging or guilty pleasure binging on Netflix for example all of these terms can unintentionally reinforce shame around certain behaviors um and it's really important again when working with trauma and eating disorders and shame that we're mindful about how we speak um with our clients and just in general as well Avo voiding comments on the physical appearance or food choices of our clients or even of ourselves in
• 44:00 - 44:30 front of clients um again we talked a lot about this in our previous webinars and lastly remembering that um recognizing or placing value on weight loss or gain can be especially triggering for survivors of trauma as some survivors may actually associate a specific weight with their experience of abuse so this adds a layer of complexity and adds yet another reason why shouldn't be commenting um on weight gain or loss of our
• 44:30 - 45:00 clients next with support um supporting with safety and Boundary sting boundaries can help create safety and predictability and many folks have experienced trauma and many folks with eating disorders do not experience safety or predictability in many contexts in their lives and so this is an area that social workers can be really supportive with um you know in articulating how client confidentiality and privacy will be respected Ari also spoke to this a little bit um and
• 45:00 - 45:30 providing clear information as to what clients can expect to occur while engaging in treatment especially for folks who've never engaged in therapy or in that relationship before that sense of um predictability can really really help create safety power imbalances can also be really common experiences of trauma and so these can be counteracted by relationship ship in which survivors feel safe and equal and respected so as
• 45:30 - 46:00 a result of this therapists or social workers um should be aware of that power discrepancy in their relationships with clients and do whatever they can to minimize it Um this can be you know structured in different ways um you know making sure the clients have lots of option and choice um that clients have the right to um reject or not answer certain questions or to choose what elements of a treatment or program they'd like to engage in this can be
• 46:00 - 46:30 really really helpful in building empowerment and self-determination and agency which ultimately can work against um some of the the negative impacts that trauma can have on a person lastly on this note um coercive imp punitive methods like using a reward or punishment system or any kind of invasiveness and lack of privacy this can be very ineffective when working with any client but especially clients who have experienced trauma and it may actually be ret traumatizing um for
• 46:30 - 47:00 folks moving on to systemic trauma this is very very connected to the development of eating disorders and we have spoken about this again in webinars one and two so systemic oppression like racism transphobia and fat phobia are and the trauma caused by those systems of Oppression can influence the development of Eating Disorders um people who impact the sorry people who experience the most impacts of diet culture are likely those whose bodies
• 47:00 - 47:30 are marginalized in other ways so through racism ableism transphobia and more so really being aware of one's social location the connection between you know what what differences is this client experiencing in the world compar it to yourself um where can we bring that into the therapeutic context if that's what the client wants um and recognizing too that you know these systemic forces this may actually help externalize some of the eating disorder Voice or symptoms again working to um
• 47:30 - 48:00 combat shame focusing on strengths and um providing encouragement as well this is something that again is very relevant to all forms of of support um but really encouraging the client to see themselves as more than their eating disorder so maybe that means spending time talking about other values or other things that are important to them um and emphasizing their strengths which they inevitably have um and also being aware of how
• 48:00 - 48:30 compliments can land with people right some people are very resistant to hearing about their strength and so exploring that um with a client uh may be of interest as well one thing that's not on here is skill building so really focusing on building other coping mechanisms or strategies we know as we've talked about so far that eating disorder symptoms are survival mechanism and so as dangerous as they can be they are still vital in the absence of other safer coping
• 48:30 - 49:00 strategies and so in order for a person to decrease the frequency or intensity of their symptoms or to relinquish them Al together um alternative uh coping strategies need to be identified and adopted so I'll pause here and to ask everyone you know is anyone already doing a lot of what I've just talked about or are there other trauma informed practices that you are already using um
• 49:00 - 49:30 we'd love to hear what folks are doing um to work from a trauma informed lens either with folks who have Eating Disorders or with folks who don't so I'll pause here for a moment
• 49:30 - 50:00 give it a few more moments if there's anything anyone would like to add what trauma informed practices are you using
• 50:00 - 50:30 all right if nothing's coming to mind right now that's also completely okay this is a I think an important reflection question to take with you out of of today's presentation I see a couple things coming in in the chat yes that is definitely thank you Lee for raising that it can certainly be a big challenge um when supporting trans folks with eating
• 50:30 - 51:00 disorders yeah using non-judgmental approach being empathic when asking yes so that's important when asking questions about let's say adherence to a meal plan doing so in as neutral of a way as possible Right it can be easy to ask leading questions like um you know oh you you completed your meal plan right but that implies judgment um if they did not complete their meal plan uh and so so asking those questions
• 51:00 - 51:30 non-judgmentally so using language that reflects um you know that the the person is not the problem maybe the context of the environment is the problem building goals that are realistic together and we we'll talk about building goals actually in just a moment yes and thanks thanks for that comment as well I think you know this this
• 51:30 - 52:00 content while it is focused on eating diss it's very very broad at the same time okay so I'll move on for now and if anyone else has any other thoughts or comments about um trauma informed practices please share them in the chat um the last uh square that you'll see on on the slide here is about harm reduction and so that's what I'm going to spend the next few minutes talking about um in that harm reduction is a form of trauma informed
• 52:00 - 52:30 care all right so we often hear about harm reduction in the context of um sexual practices and substance use and harm reduction approaches have been um successfully used to optimize the safety of people uh living with HIV and AIDS and for people who engage in drug use and sex work and we rarely hear about this term in the context of Eating Disorders or even other mental health challenges um but for people engaging in disordered eating behaviors we can and
• 52:30 - 53:00 should be applying harm reduction approaches to reducing the harm of symptoms so symptoms like restriction overe exercising binging and purging and so the three squares on the bottom here um outlin some of the core tenants of harm reduction so harm reduction acknowledges that there are often safer ways to engage in certain behaviors and we can non-judgmentally plan to limit the danger to a person's health um and improve their quality of life so we don't need to be taking an
• 53:00 - 53:30 All or Nothing approach because often that actually doesn't work very well harm reduction also focuses on reducing the harmful effects of some behaviors recognizing that abstaining from or eliminating those behaviors might not be a realistic or desirable goal especially in the short term so if we um if we look at Eating Disorders specifically you know we we can't abstain from food and movement these are things that are
• 53:30 - 54:00 inherent and integral to um living and surviving and so while for some people let's say working um on you know a sub a challenge with substance use maybe abstinence is the goal and that's what's going to work well for that person but with eating that's simply not really the case um I also realize I missed the box in the middle here so essentially harm reduction also accepts that behaviors For Better or Worse are a part of an
• 54:00 - 54:30 individual's experience and occur for complex reasons that are not easy to fix so a person exists in their environment and we can't just look at a person and ask them to change or expect them to change their behavior without looking at what are all of the external um factors and causes that might be contributing to behaviors that are causing harm so moving on um some questions to consider with a client from a harm reduction approach so it's important
• 54:30 - 55:00 that a client is able to recognize for themselves um you know when to get help so what are some warning signs that the client is beginning to struggle encouraging the client to think about specific thoughts feelings or behaviors that come up often there are um signs or red flags that a person knows like oh when I start to isolate myself this is when things are going to escalate or when I start um counting calories or
• 55:00 - 55:30 going to the gym more than once a day that's when things are starting to get more dangerous for me coping skills so supporting a client and thinking about what can they do by themselves to manage the concern and what obstacles might show up when they try to use these coping skills and um planning ahead and problem solving around that working to set goals as well that reduce the harm of a specific behavior is really critical and so on this Slide
• 55:30 - 56:00 the underlined resource alternatives to self harm outlines some alternative strategies that a person can use um as opposed to self harm um and it uses uh different emotions to structure the recommendations and while this is not specific to eating disorders um many if not all of these alternative strategies can be applied um as alternatives to simp symptoms as well as to self harm and we also know that sometimes eating disorder symptoms are a form of self
• 56:00 - 56:30 harm next identifying social support so who is in the client's web of support that they can rely on um if they if there are not um specific friends or family members or healthc care providers um reaching out to um helplines um like NX helpline like at the distress center in the region that you're in if there is one um and thinking about supporting the client and identifying what to do at different levels of distress right so again avoiding the All or Nothing
• 56:30 - 57:00 thinking like every time um I'm in distress this is what I'm going to do that's probably not the same thing is probably not going to work in every situation and so maybe when the client is at an eight out of 10 in distress um calling the dist a distress center and when they're at a three out of 10 calling a friend or family member and really emphasizing for the client that they know themselves best we can't as social workers or therapists create a plan for them it really needs to be
• 57:00 - 57:30 coming from within them so next I'll talk briefly about some of the targets that we can support clients in setting and I won't be talking so much about specific symptoms um the article that is linked at the bottom here just says article about eating disorders and harm reduction this article outlines a ton of different specific harm reduction strategies for specific eating disorder symptoms so what are ways in which a person can um
• 57:30 - 58:00 minimize the harm associated with a symptom um before getting into these goals I'll give a couple examples of those um so one being with self-induced vomiting this is a common purging method that people um will use as a way to attempt to compensate um for eating or for binge eating and so there are a lot of things that a person can do um to minim miniz the harm associated with self-induced vomiting before just stopping vomiting altogether because
• 58:00 - 58:30 this again is a coping strategy that is serving a purpose and if we ask or expect someone to just stop um this might actually backfire and make things worse and so an example of one way that a person can reduce the harm associated with self-induced vomiting is by not brushing their teeth right after as this can enhance or increase erosion of enamel and so instead rinsing the mouth with water um with restriction of food intake you know taking multivitamins and
• 58:30 - 59:00 eating safe foods right we'd rather a client eat foods that they deem safe than not eat food at all so this is a really um good example of a harm reduction um type of of goal now when we're setting specific goals with people um there are a few things to keep in mind which I'll go over before passing it over um to Aaron to uh finish our our presentation today so the first thing that we want to support clients in doing is to set
• 59:00 - 59:30 concrete and specific goals so for the purpose of this slide on the next slide um the example of running is used so maybe a person is engaging in OV exercise specifically through running they're running a lot to the point that it's causing harm um physically emotionally mentally socially all of that so creating a goal that is concrete and specific we know this through smart goals setting for folks who are familiar with that acronym that is going to be more effective than setting a vague goal
• 59:30 - 60:00 so the example here changing running frequency from daily to four times a week as opposed to the goal being I'm just going to change my running pattern it's also important that goals are doable and realistic uh and not too big or too difficult so again we want to avoid all or nothing thinking or an abstinence mindset here um if the goal is I'm going to stop running altogether that might actually um backfire in that
• 60:00 - 60:30 if the person is unable to meet this school because it's so big or difficult this could increase feelings of Shame self-criticism and hopelessness and so setting a doable or realistic goal the example here only running after a meal um this um ultimately is a better idea according to harm reduction as well setting goals that can be quickly and easily monitored um as opposed to goals that are ambiguous or lacking guidelines um so this means that
• 60:30 - 61:00 the person will be tuning into their thoughts and emotions um as they um as they engage in Behavior which can of course be beneficial in many ways um but if a person is unable to track how the goal or progress towards that goal is going or how it's making them feel then it's really difficult to move forward um or to step back and assess how things are going next um it's important that goals are prioritized so that the immediate Target
• 61:00 - 61:30 Target focuses on minimizing risk from the behavior and then the long-term goal focuses on improving comfort so again with running you know the immediate Target could be making sure that a person is only running after they have an adequate um nourishment in order to allow them to do so right if someone goes for a run and they haven't eaten anything that day there are a lot of bad things that could happen um and so that initial goal being the immediate risk
• 61:30 - 62:00 and then future goals being around okay what kind of movement can this person do that is comfortable and enjoyable um as opposed to starting with a goal like that and then lastly setting goals with support or a plan so making sure if we ask someone to just start working on a goal even if it's one that they've identified but there's no support in place to help them achieve that goal again we might be setting them up um for disappointment or failure and so if a
• 62:00 - 62:30 person has supports like you know this is I'm going to work towards my goal and then I'm going to call this friend or I'm going to attend this support group um or if I have the urge to go for a run what am I going to do instead and so supporting people with problem solving um and working on alternative coping strategies so that's where I'll end the harm reduction section for today there's a lot more we could talk about and again I'll refer you to the article at the bottom um this is something that's being
• 62:30 - 63:00 more and more talked about in the Eating Disorders field um it's something that like I said is not commonly addressed um in this context but it's really important that um folks are taking this approach or considering it when supporting people with eating disorders so the last thing I'll show you before passing it over to Aaron is this web of support I apologize if it's small on your screen but you should be able to um see it larger when you download it
• 63:00 - 63:30 essentially just reminding everyone that um you know having a web of support is important um it's you know impossible or very difficult for a person to recover from an eating disorder on their own or with only like one type of support and everyone's web of support is going to look different since everyone has different needs um but there are some examples here of different categories of support that folks might find helpful and at the end of today we will again be providing you with more examples about
• 63:30 - 64:00 each of these different um types of support and with that um I will pass it over to Aaron awesome thanks so much Kaitlyn we are now going to spend some time kind of just going through different um types of support and and so we we've touched on a lot of these kind of different things throughout the conversation and some of you have mentioned them in the chat or in the Q&A and so we're going to spend a little bit of time just kind of diving into them um obviously we could do
• 64:00 - 64:30 entire courses on these um types of support and people have and we have those resources available in the slides if you want to to really dig into any of these or learn more about them but we just want to provide a bit of a quick overview um for people with eating disorders the idea of recovery can be really overwhelming or um down right terrifying so it isn't easy to reach over help and and much less to really like begin the work to to work towards recovery in a meaningful way so finding the best and most appropriate treatment
• 64:30 - 65:00 option for each individual takes time um you might need to try a few different approaches or they might need to try a few different things so we're going to explore a few of the most common therapies and program types for people who are experiencing e disorders so there's psychoeducation which Caitlyn talked a bit about which can be really empowering and help to reduce shame kind of those skill building and understanding um you know the what's what's happening um in their experience um support and support groups and peer support can help in reducing isolation
• 65:00 - 65:30 enhancing connection Eating Disorders can be kind of conceptualized as relational challenges um and there's some great peer support resources that are um I think put in the chat maybe it was the Q&A um but um she's placed us some great stuff for on peer support um as well as um eting disorders Nova Scotia does some great work around that as well um nutrition counseling can be really helpful to have clients understand nutrition in meaningful ways and so it's important um in those pieces it's really really important if we are
• 65:30 - 66:00 having those conversations with people struggling with eating disorders um that the dietician or nutritionist that they're working with is eating disorder or health at every size informed to ensure that they're not doing more harm than good um and then that experience isn't detrimental to um their recovery and then there's medical supports as well so um the physical consequences of an e disorder dehydration um osteopenia that kind of stuff um they may need people may need support in that ways um and medication to treat concurrent conditions as well such as anxiety
• 66:00 - 66:30 depression or ADHD and then of course there's Psychotherapy which we are going to kind of dig into a little bit more um over the next couple of slides so family based treatment fbt is a treatment option for children adolescence with an eating disorder um it is primarily designed SL specifically designed for people who live at home with their family um that's kind of a an important caveat within the experience of fbt is it's the family unit kind of
• 66:30 - 67:00 working towards recovery and so living at home is an important part of that so it's normally for children or adolescence um and currently it is the leading treatment for adolescence um struggling with with eating disorders um important caveat to that which um was brought up in the Q&A fbt uses the the parent child Bond as a foundation for treatment so it may not not be for every family um research has shown that it is highly effective and maybe faster than other treatments um but as was mentioned
• 67:00 - 67:30 in the Q&A um fbt is often seen as the best practice but the but if the family Dynamic is abusive or toxic um fbt is not likely going to be a treatment approach that has positive or recovery focused outcomes so um really important that at the very least there is kind of that Foundation um of a child parent bond that is based in in respect um that's kind of the the very very base of that if that is not there or if it is not a healthy um you know conducive to
• 67:30 - 68:00 to a therapeutic um kind of alliance between parent and child for um for that family then fbt is most likely not going to be an appropriate appropriate option so for for lots of families it is a great um option a great approach but for others um it should not be kind of the only consideration so fbt focuses on expanding treatment outside of the the clinical setting and bringing it into the home um and kind of the everyday life of the client so families as a unit
• 68:00 - 68:30 are provided with skills resources and hand have an active role in the client's treatment so there's three phases um that they kind of go through as the the person recovers so phase one is full parental control so the parent is really kind of um in control of the kind of refeeding process um meals that kind of stuff um especially for people who have struggled with restrictive eating disorders for a while you know they don't have hunger cues or or they um you
• 68:30 - 69:00 know going to the frge and making a meal is not um an automatic response for them and so having someone who you know has those hunger cues and can be saying um you know this is um when we are going to eat and and that kind of stuff is really really important phase two is kind of that gradual Return Of Control to the individual who is struggling um so kind of slowly the person um gets their um autonomy back and and kind of helps with some of those eating processes as well and then phase three
• 69:00 - 69:30 is kind of establishing that healthy Independence so the person um kind of takes that control back and is and is um in their own um in their own space doing doing those things so again not fit for every single person but a good resource for some and there is um a link there to a training that is specific to fbt um it's specifically for anorexia nervosa which is what fbt is is primarily used for um but can be a good resource um for anyone kind of just interested in learning a bit more about fbt more
• 69:30 - 70:00 generally okay fantastic um cognitive behavior therapy um is the leading evidence-based treatment for eating disorders um Beyond fbt and for um Eating Disorders more generally Beyond just restrictive or Orum anorexia nervosa um so CBT is a psychotherapeutic approach that involves kind of a variety of techniques most of you are probably fairly familiar with CBT so I don't want to um bore you with
• 70:00 - 70:30 my understanding of CBT but um it is often the first line treatment for adults um with theun nervosa and Vine disorder um it's not normally recommended for people who are severely malnourished due to kind of a lack of cognitive processing abilities um and so the they don't necessarily have the full ability to engage in that therapy adequately um but maybe later on when that kind of refeeding has begun and they're back to to cognitive processing um in the way that they they would like
• 70:30 - 71:00 to be it's um a good a good option so in 2008 um an updated manual for enhanced cognitive behavioral therapy or cbt-e as we see there was released and it was designed to treat all eting disorders so it was kind of comprised of two formats um a focused treatment which is similar to the original and then a broad treatment with extra kind of modules on mood in tolerance perfectionism low self-esteem I'm and interpersonal difficulties that contribute to the maintenance of being
• 71:00 - 71:30 disorders so some examples of um processes within CBT or what that might look like for individuals with in disorders um kind of the cognitive um challenging of dietary rules so identifying what rules someone has about um eating or their body or um the maintenance of of their body and then challenging them behaviorally so kind of going against um what that what that rule is um a development of Continuum thinking to replace All or Nothing um so rather than
• 71:30 - 72:00 BL and white really kind of creating that gray and and exercising the the muscles of creating that space um and the use of Behavioral experiments even um so for example if a client believes that eating um something will cause them to gain x amount of weight they would be encouraged to eat that thing and then kind of experiment to see if it does cause them to gain that weight um which in most most likely will not um and so those kinds of things are are a big part of of CBT and there is a training there as well um if you want to learn a little
• 72:00 - 72:30 bit more about those specifics DBT or dialectical um behavior therapy it um is kind of an offshoot of of CBT and so it helps to connect cognitive and behavioral therapies as a way of helping someone learn and adapt healthier methods of coping um with painful emotions and kind of through acceptance and and change so based on the model that assumes that mental health problems are largely caused by an inability to handle our emotions
• 72:30 - 73:00 properly um and so if that's something that a client is is struggling with is kind of those big emotions or or um the emotional capacity DBT could be an option for them so it works to address kind of under control um which is what we might call binging or purging through like um kind of the four main skills which are um distress tolerance emotional regulation and um interpersonal Effectiveness skills and mindfulness um for this to to be a part of their treatment regular eating does have to be a part of the client's life so again
• 73:00 - 73:30 similar to CBT if someone um does not kind of have the cognitive capacity to um be taking part in this type of therapy it might not be the best approach at this time so DBT um in its traditional form can be really effective in treating binge eating disorder and purging um through emotional regulation distress tolerance and mindfulness um and then RBT which is radically open dialectic behavior therapy is a newer form of DBT that addresses Over Control um whereas traditional DBT addresses that under control so it's a ro um DBT
• 73:30 - 74:00 helps supporting individuals increasing flexibility and reducing rigidity and perfectionism so traits that are more traditionally associated with um restrictive Eating Disorders like anorexia um as well as people who might be on the autism spectrum are struggling with Autism Spectrum Disorder so of those four main skills some examples of what that might look like for someone someone who is struggling with an eating disorder um under mindfulness the mindfulness skill you might practice mindful eating so um practice the
• 74:00 - 74:30 practice encouraged that during meal times someone is eating mindfully um rather than maybe experiencing that loss of control that they might feel when they are binge eating they're are encouraged to um you know focus on the food and and what does it feel like and taste like and smell like and and those kinds of pieces is really bringing that mindfulness into it um distress tolerance involves learning to tolerate negative emotions or crisis situations without responding um in the ways that might be a coping technique for them
• 74:30 - 75:00 such as binging or purging um and so really building an awareness of emotions um and then slowly building those skills to um to respond to those emotions in different ways um and Dr Nita federici has a great um DBT specifically for eing disorders um training that is linked there acceptance and commitment therapy um is another one it has its roots in CBT um and it's considered to be like a
• 75:00 - 75:30 third generation of the behavioral therapies that are designed to help clients um to commit behavioral change and manage their emotions so it's based on um therapies that focus on behavioral change such as CBT and DBT so act um challenges clients to choose different behaviors despite distressing distressing emotions that might be present so it's an effective treatment for eating disorders because it encourages is more flexible and inclusive sense of self um that is anchored in kind of the direction of one's values so it's really really
• 75:30 - 76:00 focused on what is someone's values and how can we live in accordance to those values in our actions or in what we are doing um so clients can reflect on their values um ways of accepting um they may not like their body right now and how can they move towards their values even if they're not liking their body right now what would that look like or what would that um involve in terms of their behavior for them to live in accordance to those values that they've spent the time to identify um and then they they practice acceptance while still addressing the very real cultural
• 76:00 - 76:30 challenges around body acceptance um and and not negating those in any way but then kind of work towards still living in accordance with their values even though um there all are kind of all of these other aspects and how can we cope and and live a life that feel we feel more aligns with our values versus societal values and so there are kind of couple different um aspects of um act that are that are really really powerful one is cognitive diffusion which um
• 76:30 - 77:00 centers on an individual's ability to have an experience without their thoughts or feelings dominating the event um so someone um living with an i disorder is being urged by a family member to seek professional help um and rather than maybe shame or um anxiety or or anger um kind of you know rising up and and completely dominating that experience um perhaps they can still feel that shame they might still recognize that shame um but cognitive
• 77:00 - 77:30 diffusion would be to acknowledge that emotion and the concerns and then kind of move forward um and so recognizing that um emotions are a part of life and they are there but they don't necessarily have to be at the steering wheel they can be passengers um passengers to that experience rather than um the driving force the next one really quickly that we'll cover is motivational interviewing we covered this
• 77:30 - 78:00 um a lot more in depth in our first um session that you can have access of to the recording of it's a form of talk therapy and kind of a guiding style of communication um that encourages clients to take control and focuses on the need for change so very much connected to those stages of change that Ari talked about earlier um so it's the process of recovering from an eting disorder um and and it's not easy kind of going through those stages of change a motivational interviewing motivational interviewing
• 78:00 - 78:30 is just kind of meant to help kind of move around around that wheel and up that spiral and so there's lots of great examples that we put into that first training that um you are you are welcome to go through and and look at um but it's really listening to the client observing that client um and and looking at where they are in terms of their um you know ambivalence or willingness to change and then how can we kind of help support them wherever they are um and the eatinger um toolkit for um primary
• 78:30 - 79:00 care providers NBC has a great um has a great document on that there as well excellent and there are of course a lot of additional therapeutic modalities that are really really important um that we are not going to touch on in depth but really important for us to mention so these are options that maybe haven't necessarily seen funding um funding for or have been able to have them necessarily be the go-to evidence based
• 79:00 - 79:30 um but have been around for a really long time and can be really really powerful parts of someone's healing so um landbased healing education or treatment are vital when it comes to um culturally safe models of care for indigenous peoples who are struggling with mental health issues more generally and eting disorders um and so these are practices that should not be undertaken by non-indigenous people um but all practi practioners I think it is helpful to have an understanding of and appreciation for these treatment approaches to help support clients who
• 79:30 - 80:00 may benefit from from them or participating in them so it's important that we think about culturally safe models of care um and what will most benefit our client and their needs expressive therapies such as art dance or even yoga are designed to promote physical and emotional healing um so these forms of therapies are not necessarily concerned with specific therapeutic therapeutic outcomes but more concerned with the process um and most often giving the client the opportunity to really connect with their bodies in a very kind of physical
• 80:00 - 80:30 specific way um so music therapy can can work in a lot of ways music being played during meals to help reduce stress um lyrics and songs might be help um might help in terms of getting people to talk about things that they they might not be um willing to or or able to um to specify in their own experience dance therapy tries to show how action are connected to your feelings um and helps people to kind of really make that connection between mind and body and then art therapy using drawing or paintings or um any kind of Visual Arts
• 80:30 - 81:00 or dramatic arts um improv those kinds of things um give people a way to express and explore their feelings in different ways and kind of also help facilitate that Mind and Body Connection um guided self-help is another option that um we might talk a little bit about um so with eating disorders or mental health in general a lot of recovery um occurs outside of the clinical setting and so this can be a useful tool to help patients gain control over their lives do some of that processing themselves um
• 81:00 - 81:30 and they can explore different tools like self-help books or other informational resources um so there's lots of treatment options treatment for in disorders is not a one-sized hotol approach um it can take a lot of trial and error but that's just um a few of the resources that are available and some extra resources for you to look at there and I'll will hand it back over to Ari for the next couple of
• 81:30 - 82:00 slides yeah appreciate everyone um taking a moment to um take in all that information um these next two slides look overwhelming but I hope that as we go through them um the pathways will become clear and I hope that at the end when we offer you a resource to help you navigate that yourself um we're able to do that together so the key word over these next two slides is common Pathways as in they're the ones that um our
• 82:00 - 82:30 services at NC through our toll-free helpline or our chat service encounter most frequently as we help people navigate the system of care for eating disorders and we start often with on a medical pathway with primary care providers and that might be someone's GP or family doctor or that might be someone's pediatrician or that might be a walk-in clinic I think it's really important to not that many people across the country don't have access to a regular family doctor or a primary care provider and I really want everyone to
• 82:30 - 83:00 know that it doesn't matter if someone's following you um it it doesn't matter if you don't have a regular provider if all you're looking for is a referral to a hospital-based program in that a walk-in clinic can also provide that provide that referral so um you can see that Arrow there between primary care provider and Specialized Hospital programs because you do need a referral from a doctor to get access to any of our provincially funded care programs across the country and that might refer to inpatient care to day treatment care
• 83:00 - 83:30 or to outpatient care um what's really important to note is that patients don't often get a say on the type of program that they fit in once you're assessed by a hospital um the system is very chronically underfunded and under resourc and so um the assessment is almost purely based on the assessments of needs by that by that intake worker and by that hospital to be able to see um what program might be most um available for that for that client and
• 83:30 - 84:00 based on the severity of their needs too so it's really important if we're talking to a patient um to a client about uh expectations around hospital-based care that we are setting those expectations appropriately that we might not get to choose if it's impatient or day treatment or outpatient and I think we are very much in a period of flux and change as a system at the moment um given the way in which covid-19 has impacted um common common ways that many of these programs operated and as everyone figures out
• 84:00 - 84:30 what the word hybrid means um we're all going to have to encounter that too but this is currently the way that this is set up the last point that I really want to draw your attention to on this slide is that bottom left corner where it says emergency department um it's really important to note that the ER does not let people bypass weight lists for hospital-based programs in most cases which is why there's no Arrow connecting the emergency department to the hospital based programs often where that's helpful is if we um H if a client maybe
• 84:30 - 85:00 needs medical stabilization or there's risk involved um or there's cases of a medical emergency and for many people with restrictive Eating Disorders um that might that might include things like um feeling faint or feeling heart palpitations or chest pain those might be those might be signs that um bodies and organs are starting to um feel the effects of a needing disorder or co-occurring conditions um so that's something that's really important to
• 85:00 - 85:30 knowe I'll move on to the next slide which covers common mental health Pathways to receiving treatment and support and so there's two main clusters here that I'm going to draw your attention to the public services cluster in the top left and right underneath it that private Services cluster and let's start with private because I think it's a simpler one to explain um private services are fee for service Services um they may be covered by Private health insurance and self-referral is often
• 85:30 - 86:00 accepted except for some residential programs so often many of us are providing individual or group therapy in a private way on an ongoing basis and often with folks who are specialized with treating Eating Disorders is helpful um and there are also some residential programs in in Canada but there are many there are very few I think when you compare us to our neighbor Neighbors in the South and so I very frequently will have clients ask us on the heline like where where are the residential programs in Canada because
• 86:00 - 86:30 folks have been Googling and reading experiences of people who have received support in the US where residential is really common and unfortunately in Canada I feel like is it isn't as common nearly to the same amount where residential can be really helpful is that interprofessional care delivered in a hom likee environment especially for folks who um are at the point of medical stability but are really want to experience some of that psychological change that's there and in Canada there are some programs that are private and some programs that are public which is why there's both of those arrows
• 86:30 - 87:00 connecting to residential programs if we move to Public Services by this definition it's free or covered by provincial or territorial health insurance and some of the ones that I'm really going to focus on are community- based programs because you have examples of of them presenting here with me today um some of us provide individual or group therapy that's often a bit more time limited um it may not be specific to eating disorders and there's often a weight list um but that can be an option in some communities there are many
• 87:00 - 87:30 providers who are able to to provide support and skill building groups so these are structured or open groups focused on providing a space for Collective healing Andor building adaptive skills some of these may have a weight list and some of these don't and then there are many wonderful peer support programs Aaron gave a shout out to um Eating Disorders Nova Scotia there's also looking glass British Columbia um there are some folks who are providing that kind of support across the country whether that's online whether that's in person whether that's
• 87:30 - 88:00 group or whether that's individual mentorship there's a real variety of chat versus video versus meetings um that can happen through peer support and we're really starting to see advances in this area thanks to the hard work of of community- based organizations um what's really important to note is that um navigating the system can be really complicated for many people and so as we work our way to talking about the work of our organizations and where we fit in as we wrap up our webinar um I want
• 88:00 - 88:30 everyone to know that ntic exists for this reason um we have a national toll-free English-speaking telephone heline and an online web chat service that supports people across the country you have thousands of contacts every year and 65% of them are so are people who are personally affected who um are reaching out for support but um a good onethird of them are friends our carers our professionals trying to look to navigate that same complex system that I've gone through in two slides with you
• 88:30 - 89:00 um and trying to get support for their loved one so please know that you can reach out it's Anonymous it's confidential um and you don't need to refer you don't need a diagnosis or anything like that to access and um we have a searchable online directory of 700 plus treatment and support providers across the country that cover off that private services that cover off our provincially funded services that cover off our community support groups um where you can learn about resources to best equip your client resources that
• 89:00 - 89:30 are Health at every size informed follow a non- dieting philosophy often practicing from a weight inclusive Manner and have identified training and eating disorders and that's why we have that publicly available for people um so please do use us if you feel like you need help navigating that pathway but I hope that us going through that a little bit with you here um was helpful and I'm going to turn it over to
• 89:30 - 90:00 Kate Hi everyone um so just quickly about sheena's place um we are a community mental health charity um in Toronto and we support people with lived experience of eating disorders and also caregivers and loved ones um we exclusively Provide group-based support so no individual therapy or treatment um all of our groups are are free of charge and no diagnosis or referral is required the only eligibility criteria that we have are that folks have to be at least 17 years old and residing in Ontario so
• 90:00 - 90:30 unfortunately that um only applies to the one Province um but for those who are in Ontario we are currently offering about 30 weekly groups online um and this includes the general drop-in support groups you see listed on the slide um but links are included here for the full program calendar as well as for INF sessions to learn more these are open to your clients and also yourselves anyone who wants to attend um and registration for our winter season will
• 90:30 - 91:00 start this coming Monday at 10: a.m. um and in addition to our groups we also provide Outreach and education opportunities like this one um as well as um trainings for smaller teams of healthcare providers or people in supportive roles um so please reach out if that's something you're interested in as well and I'll pass it to Aaron thanks Kaitlyn um body Rave is um a community organization I'm a
• 91:00 - 91:30 charitable nonprofit that were we are based in Ontario and we very much work from a steps care approach we do not go all the way to the top of Steed care with impatient um Hospital based treatment but we kind of cover a few of these different steps so um people kind of enter um at the the beginning the entry um Step which is self-guided support um psycho educational workshops we have um these weekly sessions called recovery sessions that are um people with lived experience kind of sharing their story on a topic or or those kinds
• 91:30 - 92:00 of different pieces last week it was um coping with bad body image days and then we have a self-guided support program so people walk through kind of those self-guided pieces um through one of our apps called care team not one of our apps we only have one app um but it's called care team and so um you are connected with kind of the body brave community in that space but um are kind of going through a self-guided process with a few additional supports and so that is open to anyone 17 plus across Canada um can be accessing that support
• 92:00 - 92:30 um and you can find information for signing up to that on our website there's no need for a referral or a diagnosis so people can sign up themselves and we have lots of people who do or um people can encourage their clients or others to sign up a step up we have um group treatment so we have dropping groups as well as 10we Clos groups on um a variety of different topics so um we have living body brave for people living in larger bodies typically struggling with bingeing disorder um we have um on the journey
• 92:30 - 93:00 which is more about maintaining recovery and um um staying in those spes and those kinds of things and so people can enter those spes as well and a step up from that if clients need it is one-on-one um specific treatment that's kind of on um unlimited as needed basis so we provide medical assess assessments um Psychotherapy and then um 10we guided self help specific with a healthcare provider um and then we also kind of on that base level there have education and prevention as well um specifically for professionals so we have an entire
• 93:00 - 93:30 course for social workers and psychotherapists a course for dietitians and a course for Physicians and primary care providers that are um asynchronous so they can be done on your own time um they're all virtual and and just kind of go into depth but some of the things that we've talked about today and and so that is body brave that is the work that we do and um how your clients or individuals that who are struggling with e disorders um can get involved the next few slides um are just
• 93:30 - 94:00 resources for your use so um please download these slides and you will have access to all of these things um forever so Ean disorder treatment we go into um treatment programs Hospital based programs um as well as general support virtual support um nationally and internationally all those pieces and then we have resource recommendations um so general information trainings um all of those kinds of things as well um that are there for you
• 94:00 - 94:30 and you can go through and access I don't know that we have time for questions um is there any in the Q&A that anyone else would like to oh Alex is here she can take over hi I uh I know we are a little bit over time I'm actually going to bring everyone online if everyone's okay with that Ari and Caitlyn as well um so yeah so we are we are kind of close to the end of the time and I do see that our wonderful presenters did
• 94:30 - 95:00 answer people's questions in the Q&A already um but for folks who do have to hop off feel free to hop off if you do want to log back on for this little Q&A piece that we're going to do here for a couple minutes um you can come back on when this a recorded version or whatnot um for those of you folks who can stay on for a couple minutes we're just going to do a a few questions but what phenomenal content so I don't want to wrap it up just yet um one of the questions in the chat
• 95:00 - 95:30 was uh interesting and I do see that Ari did respond but potentially wanted to dis and Aaron responded but potentially wanted to discuss it out loud um what about not discussing the harmful effects of having excessive weight what if the client asks about this that's an important question yeah thanks for bringing it up I'll like read out I realized that the answer was private and so just I think it's a great question that other folks might have been thinking about um one
• 95:30 - 96:00 strategy that I know I like to try with clients is like get to unpack how they Define health and help them see their health Beyond just weight as a focus of support as we talked about um in part two of the session specifically weight is a determinant of Health but in many cases people's focus on it overvalues how much weight actually determines when we're talking about health more broadly and so we will obviously have clients ask us about these things and I think I like to from a non-lame perspective come
• 96:00 - 96:30 from a place of like let's unpack the reasons why you're asking about it and where you've heard these things who's influenced your relationship with your weight and fundamentally try to get to like where are your goals on as a as a human in general and where do you want to be and how do we make that conversation broader Beyond weight I don't know Aaron and Kaitlin if you choose want to add on to that yeah I added on really briefly just to what you said um in the Q&A there um
• 96:30 - 97:00 AR but yeah just just moving beyond whatever that kind of specific excessive weight might be and and looking at what is underline that so um you know if it is fear of excessive weight or those kinds of things um is it really just like a desire for a more positive body image and and really you know making the connection that body image is is not related to your body but it is related to your mind and so it is a change of the mind that has to happen in that space and and making sure that that's kind of what you're addressing um is is
• 97:00 - 97:30 what they're actually trying to get at if you're talking about excessive weight and and yeah maybe that means having them Define recovery or Define health in those different ways just like Ari said um yeah that's all that I would add wonderful uh okay one of the other questions here which you did also respond to but I will say out loud because some other folks might have the same question um can you say a little bit more about the social location and prevalence working with youth it doesn't
• 97:30 - 98:00 seem like the systemic impact is clear rather the social construct of adoles of the Adolescent environment I'm interested in hearing more about your thoughts on this thanks um yeah this is an this is an interesting worded question are are you guys good to take it on or do you want me to try and tease up bit of it yeah I think I can try like I and I appreciate um the question ask her
• 98:00 - 98:30 helping us like deconstruct it a little bit on it sounds like the thing to talk about is how do we bring up that intersection of the larger system as well as the individual's direct social system that's being in there and I think when we're bringing up like unpacking that as a recommendation when we're talking about trauma informed approach I think it's opening up space within our environment with a person to like name those things I think I believe that we
• 98:30 - 99:00 have a lot of power as as humans who are trying to help in acknowledging things as potentially being part of their experience and when we name them we give them validation and if we give them validation we potentially open up conversations where the client then gets to lead a conversation on how their relationship with their parents or how their relationship with their like food insecurity or how their relationship with their race or whatever it might be um come into and inform their experience with an eating disorder to me at least
• 99:00 - 99:30 in my way of working like your experience with an eating disorder it just happens to be the way that stress has decided to manifest at that time it manifests in the relationship that causes disruption around eating or eating related stuff and so to me it can be workplace Dynamics it can be peer group dynamics it can be stuff on social media whatever it might be but if we name that like that can be a reality for someone and we like give that to a client to see if they're willing to go there then I think we take their lead on
• 99:30 - 100:00 whether they're willing to go there or not but I think it's on us to name it so that way um clients don't have to feel like they have to sit in that messiness in that like very Tangled ball of yarn by themselves I think we can help them pull out strings to the extent that they want to actually take the string in their is my Approach yeah I think I think in social work we use the term social location a lot to try and identify uh the systems around
• 100:00 - 100:30 us and how we fit in within our social con context in the um systems around us um I do see one of the pieces saying that are there any specific areas of prevalence that we should be considerate of according to research uh I'm not sure what areas of prevalence um you're referring to um yeah I can touch on this I think briefly if if you mean areas of prevalence as in like certain communities or certain identities of experiences that seem to be more at risk
• 100:30 - 101:00 for an eating disorder the two that I think all three of us um like Caitlyn myself and Aaron all generally highlight are um folks belonging to TS LGBT btq communities often are at higher risk of experiencing eating disordered disordered eating stuff some statistics show like even five times higher than S there s gender heterosexual peers and so if you have a queer client or a trans client or someone navigating their gender in different ways like opening up
• 101:00 - 101:30 and making sure we're asking questions around their eating or their body image or their movement and their relationships with that I think becomes extra important because they're likely having to navigate something around that the second kind of experience is like a class-based poverty intersection with food insecurity I think that um is also one where we're seeing more and more research come out on how both dietary restraint and potential binge eating sometimes come up as responses to food
• 101:30 - 102:00 insecurity that can often have like a lot of complex emotions with someone around like the guilt or the shame that someone now might feel if they are trying to save food for family or potentially now overeating um an aspect of their food and feeling out of control while doing so when they felt like they should have been able to conserve that all of that can happen because of the ways in which food insecurities like um really put our own relationship with our body cues out of lack and so I think from a social location perspective those
• 102:00 - 102:30 two communities are the ones that come up for for me Aaron and kayn but feel free to jump in you two if you have anything else I'll just um point to I what I commented in the chat um which is that we do provide more information about prevalence and um different communities who are affected and what some of those intersections look like in the first webinar so um you can check that out if you have not
• 102:30 - 103:00 already Yes okay well in closing we we actually don't have any more Q&A uh messages I think we got through a lot of them during the presentation it is so wonderful to be joined by such great presenters so just a huge thank you uh to all three organizations for the time effort energy spent there's a lot that goes on behind the scenes before we come live for you today so just a huge shout out to our wonderful presenters for all the work that they've done on not just
• 103:00 - 103:30 one not just two but three parts of this series for social workers um please feel free to utilize those recordings you just register normally it should bring you right into the system or use your registration confirmation emails you get to access any of these recordings we will be sending out a final now available on demand for all three Parts email so you can watch out for that or send it to your peers to your colleagues to your bosses uh to fellow students if you're a student joining us today uh
• 103:30 - 104:00 this is a very very very important field of of social work that we should be spending time learning more about your certificate of attendance will be emailed to you about an hour after the presentation concludes so watch your email for that or feel free to log back on to the platform and download it here directly as always we love to hear your comments and your feedback and the survey that will pop up on the screen after this presentation has concluded since this is the end of our three-part series please do fill out that survey and let us know how you how you
• 104:00 - 104:30 processed this whole series and what you thought about it so that we can build and grow over at CW I'll give my final words to our wonderful presenters I'm sad this is the last of our three-part series but excited for the future uh that we have to collaborate and partner uh in the coming months years uh but any final thoughts before we wrap up today I don't think so just thank you so
• 104:30 - 105:00 much to everyone for for joining and and engaging in these conversations um it's we are so thankful for yeah all of your um your work as participants throughout these three sessions and thank you so much to CW and um Alex and everyone for for having us it's been so fun wonderful with that we will end it thank you all we'll see you at the next time
• 105:00 - 105:30 bye