The Art & Science of Treating Bariatric Patients

1. The Art & Science of Treating Bariatric Patients The map is not the territory. The map steers us towards healthy living but the journey is singularly our own! Charlie Bowman, MS, LCSW, LMFT, LCAC A Therapist’s Perspective from a Patient’s Point of View

2. Case Study Charles Bowman 57 y.o. w/m/m Max Weight: 388# Max BMI: 54.1 Surgery Date: 12/7/2007 Surgeon: John Huse, MD Hospital: St. Vincent Carmel Procedure: Open Roux-en-Y Family Hx: + for obesity, diabetes, HBP, arthritis, cancer Mental Status Pre-Surgery: anxious, depressed, obsessed with obesity

3. Outcome: The Surgery was Successful Congratulations Mr. Bowman, We’ve successfully removed your inner critic!

4. Why Gestalt Therapy? • Holistic theory • B=ƒ(P,E) • “Alimentary” model • Awareness is curative • Internal and external support • No “resistance” in gestalt

5. Progression of Psychotherapy: Pre-Surgery • Additional assessment • Decision making pre-surgery • Managing anxiety pending approval and surgery • Early education • Trust in bariatric team • Identifying emotional eating and problems

6. Progression: Early Post-Surgery • Internal Support • Breathing • Body awareness • Learning to chew • External Support • Support groups! • Medical support • Social support • Grieving loss of food/binges • Setting realistic expectations

7. Progression: Late Post-Surgery Dramatic, rapid changes in self-image requires support for adjustment through periods of disorientation Preventing sabotage by working through inner conflicts supports behavioral compliance: Polarities & authority conflicts Homeorhesus: Finding the “new normal” in metabolism, relationships, proprioception and movement

8. Surgery is One Support for Lifestyle Change Behavioral Support Surgical Support Amount of Support Time in Months Post-surgery Source: John Guare, Ph.D.

9. Multi-disciplinary Integration • Bariatric Hospital Team • ASMBS Certified Surgeon • Psychologist • Dietician/Nutritionist • Exercise Physiologist • Bariatric “Life Coach” • Physical Therapist • Psychotherapist The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime. ~ Babe Ruth

10. Resources Mindless Eating: Why We Eat More Than We Think, (2006). Brian Wansink, New York: Bantam Dell. This book identifies how to lose weight through awareness of purchasing, serving, eating habits and orientation to food. Gestalt Therapy: An Introduction to the Basic Concepts of Gestalt Therapy. (2010). Clinical introduction to basic concepts in Gestalt therapy. Gestalt Therapy: A Guide to Contemporary Practice, (2010). Phil Brownell, New York: Springer Publishing. Basic modern introduction to Gestalt therapy. Gestalt Therapy for Addictive and Self-Medicating Behaviors, (2012). Phil Brownell, New York: Springer Publishing. Technical use of Gestalt therapy in addictions treatment. Body of Awareness: A Somatic and Developmental Approach to Psychotherapy, (2001). Ruella Frank, Cambridge: Gestalt Press. Demonstrates how movement plays a critical role in a developing self-awareness.. Gestalt therapy focuses on unblocking the barriers clients experience to being fully alive and present. It emphasizes dynamic awareness and contact with one's internal and external environments. Particular attention is paid to the development of creative adjustments and the relationship that develops between therapist and client in the moment. For more information and training opportunities go to http://www.indygestalt.com