The Art & Science of Treating Bariatric Patients

A Therapist’s Perspective

from a Patient’s

Point of View

Charlie Bowman,

MS, LCSW, LMFT, LCAC

The map is not the territory.The map steers us towards healthy

living but the

journey is

singularly our own!

Case StudyCharles Bowman57 y.o. w/m/mMax Weight: 388#Max BMI: 54.1Surgery Date: 12/7/2007Surgeon: John Huse, MDHospital: St. Vincent CarmelProcedure: Open Roux-en-YFamily Hx: + for obesity, diabetes, HBP, arthritis, cancerMental Status Pre-Surgery: anxious, depressed, obsessed with obesity

Outcome: The Surgery was Successful

Congratulations Mr. Bowman, We’ve successfully removed your inner critic!

Why Gestalt Therapy?

Holistic theory

B=ƒ(P,E)

“Alimentary” model

Awareness is curative

Internal and external support

No “resistance” in gestalt

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

Internal Support Breathing Body awareness Learning to chew

External Support Support groups! Medical support Social support

Grieving loss of food/binges Setting realistic expectations

Progression: Early Post-Surgery

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

Surgery is One Support for Lifestyle Change

0

20

40

60

80

100

6 12 18 24

Surgical Support Behavioral Support

Amount of

Support

Time in Months Post-surgerySource: John Guare, Ph.D.

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

ResourcesMindless 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