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 self-
evaluation 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 PLAN OF ACTION DATE EXPECTED

IDENTIFIED OUTCOME

1. Dysfunctional or Cognitive February 28, 2010 The client will have

Irrational thoughts Behavioral Therapy significant
about food and reduction in
weight Phase 1 binge-eating,
resulting in a. Build a therapeutic purging, dietary
binge-eating, alliance restraint and
purging b. Establish the role over concern with
and excessive of the client as an weight and shape.
exercise 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 binge-
eating 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 over-
evaluating 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 2.1 Correcting body The client will

image image distortions March 3, 2010 express clear and
accurate
a. Modify body image descriptions of
misperceptions body size, body
through cognitive and boundaries and
behavioral strategies ideal weight
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
 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 Confidence- March 4, 2010 To ensure that the

Boosting Exercise client turn this ideas
Program into real confidence
in her personal life.
Day 1: Mental To increase the
Confidence client's self-esteem
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.
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: Self-
Encouragement
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