Lecture 6

Patient and Therapist Perspective in Clinical Context

• Patients may enter the clinical context with feelings of hopelessness, needing guidance, and a fear of failure, while therapists may be thinking about the hopelessness of the situation, having the answers, and the importance of following a plan.
• The client may feel like health professionals do not listen or reject them, and therapists may feel the same way about obese patients.
• From a treatment strategy perspective, patients may want fast weight loss, while therapists are concerned about rapid weight regain.
• Therapists may advocate for slower weight loss for better maintenance, while patients may be frustrated with the time this takes.
• Patients may believe that diets don't work and that they need medication or surgery, while therapists may encourage habit changes and express concerns about yo-yo dieting.
• When discussing biology, patients may attribute hunger to being genetic, while therapists suggest eating more frequently to avoid hunger.
• Patients often feel overwhelmed by stress, depression, and anxiety, leading to emotional eating and a feeling of being unable to control their eating, while therapists may suggest focusing on emotional problems before weight loss.
• The therapist may see maintenance as nearly impossible with more than 95% of patients regaining weight, while patients may be optimistic about achieving and maintaining weight loss.

Psychological Theories and Weight Control

• Psychological and emotional factors are deeply intertwined with weight control.
• The relationship between psychological variables and weight change is complex, influenced by behavior, satisfaction, and motivation levels.
• "Restraint" in the context of weight loss is defined as the desire and intention to limit food intake through dietary rules.
• The Restraint Scale, developed by Herman & Polivy, measures this restraint.
• Restrained eaters tend to overeat when confronted with forbidden foods or after breaking their diet.
• The boundary model of weight regulation suggests a set point for hunger and satiety. Dieting can shift these boundaries.
• Restraint theory and Cognitive Behavioral Therapy (CBT) promote a high restraint and low disinhibition combination for weight loss.
• Studies have shown that restraint increases during treatment, which may be linked to weight loss, but raising this question: can high restraint and low disinhibition be maintained in the long term?
• "Non-dieting" approaches prioritize flexible restraint over rigid rules to improve weight control.
• The concept of self-regulation plays a significant role in weight management, affecting goal setting, planning, and emotional responses.
• Weight outcomes are influenced by voluntary, goal-directed activity, highlighting the importance of intentional change in behavior.
• States of depression and apathy can negatively impact weight management efforts, leading to poor choices and less positive outcomes.
• The Stages of Change model examines weight management through the lens of weight concern, self-efficacy, restraint, moderation, and internalization of lifestyle change.
• Different groups (e.g., college dieters, pre-bariatric surgery individuals) demonstrate varying levels of weight concern, self-efficacy, and other constructs related to weight self-regulation.

Therapeutic Alliance and Ruptures

• Maintaining a strong therapeutic alliance is critical for successful weight management.
• Ruptures in the alliance can arise from disagreements about goals, tasks, or emotional bonds, impacting outcomes.
• Clients often conceal negative thoughts and feelings about treatment, leading to a lack of open communication.
• Two primary markers of alliance ruptures are withdrawal and confrontation.
• Early detection and addressing of ruptures through open communication is key to prevent dropout and poor results.

Improving the Therapeutic Alliance

• A bi-directional perspective on the therapeutic process, with both therapist and client equally invested, is essential.
• Understanding the client's perceptions, expectations, and responses is critical before suggesting changes.
• Therapists must recognize and address minor ruptures in the alliance proactively.

Overall Conclusions

• Psychology is central to effective weight treatment, helping to understand the client's internal world, environmental impacts, and the therapy interaction.
• All members of the multidisciplinary team are involved in a kind of behavior therapy, emphasizing the importance of understanding change processes in the client and the therapist-client relationship.
• Ultimately, successful therapy requires both the therapist's expertise and the client's willingness to change.