TREATMENT PLAN Client: Lara Clinical Impression: Bulimia Nervosa Description: Individuals with bulimia nervosa regularly engage

in discrete periods of overeating, which are followed by attempts to compensate for overeating and to avoid weight gain. There is variation in the nature of the overeating but the typical episode of overeating involves the consumption of an amount of food that would be considered excessive in normal circumstances. Binge eating is followed by attempts to undo the consequences of the binge through self-induced vomiting, misuse of laxatives, severe caloric restriction, diuretics, enemas, or excessive exercising, etc. The bulimic's selfevaluation is centered on the individual's perceptions of his/her body image. The diagnostic criterion of bulimia nervosa requires that the individual not simultaneously meet criteria for anorexia nervosa. The diagnosis requires that individuals must binge eat and engage in inappropriate compensatory behavior at least twice a week for three months.

PROBLEMS IDENTIFIED

PLAN OF ACTION

DATE

EXPECTED OUTCOME

1. Dysfunctional or Irrational thoughts about food and weight resulting in binge-eating, purging and excessive exercise

Cognitive February 28, 2010 The client will have Behavioral Therapy significant reduction in Phase 1 binge-eating, a. Build a therapeutic purging, dietary alliance restraint and b. Establish the role over concern with of the client as an weight and shape. active collaborator in treatment c. Assess the core patterns and features of the client's eating disorder d. Orient the client to the CBT model of eating disorders e. Educate the client about the importance of homework in CBT f. Establish monitoring

procedures for eating and weight g. Eliminate dieting and normalizing eating throughout the day h. Develop delay strategies and alternatives to bingeeating and purging i. Learn the skills of imagery, rehearsal and relaxation training j. Challenge assumptions about the over evaluation of shape and weight k. Provide information to the client Phase 2 a. Eliminate forbidden foods b. Identify dysfunctional thoughts c. Cognitive restructuring d. Problem solving e. Continue to challenge assumptions overevaluating weight and shape f. Broaden the focus of treatment by identifying and challenging the eating Phase 3 a. Review high-risk situations and specific strategies to prevent relapse b. Promote adaptive coping skills

c. Facilitate recovery from slips

2. Disturbed body image

2.1 Correcting body image distortions a. Modify body image misperceptions through cognitive and behavioral strategies b. Use dance and movement therapies to enhance the integration of mind and body c. Use imagery and relaxation interventions to decrease anxiety related to body perceptions. 2.2 Modifying cognitive distortions about body weight, shape and eating responses /behavior. a. Help the client identify cues that trigger problematic eating responses / behaviors and body concerns; the thoughts, feelings and assumptions and eating regulation responses; and the consequences of the eating behavior. 2.3 Identifying social support

March 3, 2010

The client will express clear and accurate descriptions of body size, body boundaries and ideal weight

systems that will reinforce accurate body perceptions and adaptive eating responses. a. Include family members in the evaluation and treatment planning process b. Assess the family as a system and the impact of the eating disorder on family functioning c. Initiate group therapy to mobilize social support and reinforce adaptive responses

3. Low self-esteem

ConfidenceBoosting Exercise Program Day 1: Mental Confidence a. Record your thoughts. b. On a blank sheet of paper, write down all your thoughts for thirty minutes. c. Don't censor these thoughts. Put down your darkest thoughts if they arise. d. Make sure that you complete the full thirty minutes. e. Write down everything that you think, then throw the piece of paper away.

March 4, 2010

To ensure that the client turn this ideas into real confidence in her personal life. To increase the client's self-esteem

Day 2: Physical Confidence a. Walk with Confidence b. A confident walk should be relaxed and loose or it could be brisk and upright. c. Try or experiment with different walks wherein you would feel comfortable. Day 3: Tolerations a. Make a list of those things in your life that you are tolerating from: *home * school *well-being b. From your list, choose to: *do one thing around the house *do projects/homeworks *improve one aspect of well-being -going to gym Day 4: SelfEncouragement a. When you are clear abut the qualities you have, say this yourself before going to school and at various times throughout the day, such as lunch. Example: Today I will be bring the qualities of good organization, punctuality, support for others and customer service

skills." b. When you have finished your day's work, remind yourself of the qualities that you brought to the place.

Caban, Jareen T Psychology major

Sign up to vote on this title
UsefulNot useful