CBT-E Clinical Note

Psychotherapist Clinical Note CBT-E Clinical Session Note Session #: 8 Stage of Treatment: Core Modules Model: Fairburn Modules in Use: Regular Eating, Addressing Dietary Restraint, Body Image Concerns Questionnaires Reviewed: EDE-Q (score 3.5, decreased from 4.1 last session), BDI-II (score 18, stable) --- Session Focus The session focused on further challenging dietary rules and exploring the client's fear of weight gain, linking it to underlying self-worth beliefs. --- Client Update Eating behaviours since last session: Client reported increased regularity with meals, managing to stick to planned meal times on 5 out of 7 days. Restriction remains a challenge, particularly with 'fear foods', but no reported bingeing or compensatory behaviours. Emotional state and mood: Mood has been moderately stable, with occasional dips related to body dissatisfaction. Client identified triggers as social media comparison and fitting into certain clothes. Weight and weighing: Client engaged in weekly weighing as agreed and discussed her anxiety surrounding the number. She noted a slight increase but was able to process it with therapist support, linking it to normal fluctuations rather than failure. Self-monitoring: Self-monitoring was completed diligently, providing clear insights into patterns of eating and associated thoughts/feelings. Client demonstrated improved ability to identify triggers for unhelpful eating behaviours. Events impacting eating or mood: Client reported an argument with a friend which temporarily impacted her mood and adherence to regular eating, but she was able to recover quickly with self-compassion. --- Summary of Session Check-in: Client reported a challenging but productive week, highlighting progress in regular eating alongside ongoing struggles with body image and fear foods. Parents reported positive observations of client's mood and increased engagement at family meals. Weight & Health: Client's weight was stable this week, and discussion focused on separating weight from self-worth. --- Tasks & Interventions • Agenda items: Review of self-monitoring, challenging dietary rules, body image work. • Self-monitoring reviewed: Thorough review of completed self-monitoring forms, highlighting progress in regular eating and identifying areas for further intervention regarding fear foods. • Cognitive techniques: Guided discovery used to challenge the client's 'all-or-nothing' thinking regarding food and body image. Evaluation of rules around specific 'forbidden' foods was initiated. • Behavioural strategies: Continued reinforcement of regular eating patterns. Planned exposure task for a 'fear food' (chocolate) to be initiated this week. • Work on formulation: Reviewed the client's current formulation, specifically the link between strict dietary rules and body image concerns, and how these maintain her eating disorder. • Module content addressed: Focused on Module 4: Addressing Dietary Restraint and aspects of Module 6: Body Image Concerns. • Homework reviewed: Reviewed the previous week's homework of consistently eating three meals and two snacks, noting 70% adherence. --- Therapist Process Notes Collaboration and engagement: Client was highly collaborative and engaged throughout the session, openly discussing difficulties and insights. Therapeutic alliance remained strong. Use of formulation or Socratic dialogue: Socratic dialogue was effectively used to help the client explore the irrationality of some of her core beliefs about food and body weight, and to develop alternative, more balanced perspectives. Therapist style/reflection: Maintained a compassionate yet directive stance, ensuring key CBT-E interventions were delivered whilst also validating the client's emotional experience. --- Plan for Next Session • Continue challenging dietary restraint and fear foods. • Further exploration of body image thoughts and development of coping strategies. • Reinforce self-monitoring for consistency. Next Appointment: 1 November 2024 Planned focus: Exposure to fear foods, body image work, and relapse prevention strategies. --- Homework Assigned tasks: Continue regular eating, complete planned exposure to chocolate, continue detailed self-monitoring, and record thoughts/feelings related to body image. Plan to review: Review self-monitoring, discuss experience of fear food exposure, and explore body image reflections. --- Risk & Safeguarding Risks disclosed or observed: No new risks or safeguarding concerns identified. Client reports reduced urges for compensatory behaviours. Action taken: Continued monitoring of eating behaviours and emotional state. Safety plan remains in place.