Reference no: EM133979779

Eating Disorders

Now, I want you to read the following description of a client that you are going to pretend showed up for an assessment at your imaginary eating disorders clinic. Then, I want you to answer a series of questions about the client.

Here is the description of what happened and what you found out after two sessions with a new client:

Initial Description of Client

Kendrick Jefferson is a tall and slender, 20-year-old, African-American man who came into your eating disorder clinic for an evaluation. He is 5"11" tall and is 150 lbs. He filled out intake paperwork in the waiting room that indicated he has never been in any kind of psychiatric treatment before. He currently lives in Washington DC and is unmarried, but is in a long-term relationship with his boyfriend, Stephen Chen. The two men live together. For his occupation Kendrick wrote that he is a dancer/student/landscaper. His boyfriend is an architect.

In the section asking Kendrick to list his current symptoms, he checked that he has a fear of being overweight, that he feels out of control around food, that he eats more food than most people would eat at one sitting, that he purges what he eats most days, and sometimes more than once a day. He also indicated that he struggles with anxiety, self-esteem, and feelings of guilt.

When you went to get Kendrick from the waiting room you noticed that he was sitting with an attractive man of about 30. After bringing Kendrick back to a private room, the interviewer began by asking Kendrick,

"So, what brings you here today?"

He answered, "My boyfriend. He is worried about me and he insisted I come, but I don't think there is anything wrong with me."

"Well, what leads your boyfriend to think you need help?

He replied, "He thinks I am obsessed with my weight and food, that I have a problem......well, I do get out of control around food sometimes and then I try to get rid of what I eat by throwing it up. I try to stay within 1800 calories a day and if I go over I throw it up. I also try to make sure I work out every day.

"Have you lost any weight recently?"

"About 10 lbs. I would like to lose more and I think I can if I could just get myself to stay on a clean diet."

"How often do you feel out of control and eat a lot of food and then throw it up?

"A few times a week, I guess. Well, maybe more than that lately. Most days lately. Throwing up food, though, that is pretty normal. I'm a dancer. I have to be thin and in shape and I worry about it and I do what I have to do.. If I could just stop eating so much junk, it would be fine. I don't have an eating disorder, I just am not very disciplined when it comes to food."

"What do you eat when you feel out of control?" you asked

"Bread. Donuts. Cake. I can eat a whole cake in ten minutes." Kendrick laughed as he said it, but there was a lot of pain behind his voice.

"How long has this been a problem for you?"

"Uh.....About four years. I decided I would only eat healthy food, but I kept breaking down and eating junk. It got worse after my mom kicked me out of the house because I am gay. I've got Stephen now. He looks after me. Sometimes I wish he would back off though. He thinks I have to stop throwing up everything I eat, but he doesn't get it. If I actually got really fat then maybe he would understand. I can't be fat."

"What would happen if you were fat?"

"I'd have no future and Stephen would leave me."  I'm already too heavy. I need to lose another 10 lbs. at least."

During the rest of the two sessions Kendrick answered the questions he was asked politely. His answers indicated that he does not drink or use recreational drugs and he has never done so. He currently gets little enjoyment from life, has little interest in sex, and he has been having a lot of trouble sleeping. He often cannot fall asleep, and he often wakes up in the middle of the night and cannot go back to sleep. When that happens, he often goes for a run, but sometimes he binges and purges. He used to self-harm by cutting his arms and thighs, but he said he has not done this in three years. His answers also indicated that he has low self-esteem.

As a child, Kendrick grew up in a strict family. He has three older brothers and one younger sister. The children were encouraged to be athletic and to be high achievers. He remembers never feeling like he measured up to the expectations of his family or of the religious community they were a part of. He remembers first noticing that he was attracted to other boys at about the age of nine. He hid this from everyone. When he was 14 his parents split up. This was due to his mother leaving his father, "who is a total bastard." When asked why he said that about his father, Kendrick mentioned that his father used to hit his mother when she disagreed with him. He denied that his father routinely hit the children, although his father's punishments for being "bad" could be severe and included a harsh whipping with a belt or extension cord. Neither of his parents gave him much attention, he said, except when he was bad.

After his parents split his brothers continued to live with his father. Kendrick and his sister, the youngest children in the family, lived with their mother.  Kendrick's father had tried to get custody of all of the children, but in an arbitration it was decided which children would live with whom. The court had not been informed of the abuse in the home.

Kendrick, his mother, and his sister, moved to a different part of town. When his sister began dance class Kendrick began to go to dance class with her because someone needed to take her. Gradually he began to join the class. He quickly realized that he had finally found something he excelled at doing.

When he was 15 his sister observed him holding hands with a boy he met on the web and she told his mother. His mother insisted he stop hanging out with "those kinds of people" and began to allow him no freedom. She urged him to repent and reject his evil desires. This continued for two years, and then during his senior year of high school, Kendrick decided he could not take it anymore. He told his mother nothing was ever going to change his sexuality. She ordered him to leave her home and his father refused to take him in. He began to live on the street or in the homes of older "friends" he met on the web. When he was 18 he met Stephen and he began dancing with a local, contemporary dance company.

Near the end of the first session, Kendrick confided that two months previously his mother sent him an email asking if she could see him. He debated about whether to contact her, and after two weeks he called her. His mother told him that she had been diagnosed with breast cancer and was undergoing chemotherapy. She wanted him to come and visit her. Kendrick said he would visit her, but he had not been to see her and had not returned her phone calls or emails after the initial phone conversation.

Questions:

1. If you had to diagnose Kendrick with the information provided so far, what diagnosis do you think would best fit his symptoms? Why?

2. What is one thing about Kendrik that is a resilience factor and suggests he will do well in treatment? What is one thing that might make it difficult for him to improve?

3. What are three goals as his therapist you would have in treating him in terms of what you think would be most important to happen for him to get better? List three goals in order of importance, in your mind, for the therapy to go well and for him to improve.