Welcome to another blog post about an awesome professional with resources to share! Dr. Danielle Keenan-Miller works for UCLA as the director of the Psychology Clinic. She is also the author of The Binge Eating Workbook, a fantastic resource for professionals working with clients with eating disorders. Keep an eye out for her upcoming course with Simple Practice for treating binge eating behaviors. Check out her interview below!
1. Tell me about your clinical work and professional background?
I entered graduate school at UCLA with an interest in researching mood disorders, particularly the biological and psychosocial mechanisms that cause depression and bipolar disorder to run in families. Along the way, I fell in love with doing clinical work and realized that I wanted to have a career that helped me use my background in research to bring science into treatment. I was also fortunate to have an opportunity to get experience doing supervision during my graduate training and internship year and began to see clinical supervision as a way of broadening my impact beyond the number of clients I could see myself in practice. After a postdoctoral position at the Semel Institute for Neuroscience and Human Behavior studying an intervention for youth at high risk of developing bipolar disorder, I took a job focused primarily on teaching and supervision at the University of Southern California. A few years later, I was thrilled to have the opportunity to return to UCLA to become the director of the UCLA Psychology Clinic. In that role, I oversee a busy community clinic, conduct research on psychotherapy and supervision, teach graduate coursework, and supervise some of the most wonderful graduate students in the world. I also have a small private practice focused on evidence-based psychotherapy for adults.
2. I can tell from your CV that you have a huge variety of clinical interests! How do you keep up with all of it? How do you decide what to focus on next?
One of the great things about working in an academic setting is that I am surrounded by colleagues and students who represent a variety of areas of expertise. It provides a wonderful opportunity to stay aware of important developments in the field that might otherwise not be on my radar, and to access information and trainings in cutting edge approaches. I love being able to bring that information back into my practice, whether that’s my individual work with clients or my supervision of graduate trainees.
3. Your book focuses on preventing binge eating – how did you come to this project?
I first developed an interest in treating eating disorders as I was entering my clinical internship in my sixth year of my doctoral program. I did my internship year at a student counseling center, and I was thrilled to be supervised by the director of the center’s eating disorders program. It was there that I fell in love with doing eating disorders treatment. The clients I was working with were smart, ambitious, and vibrant young people who dedicated far too much of their precious mental energy to thoughts about calories, exercise, weight, and shape. I found that once we could loosen the grip that the eating disorder had on their minds and behaviors, they were able to flourish in ways that improved not only their own lives, but those of the communities around them. I was very moved by their resilience and the tremendous internal power that they redirected into other aspects of their lives. My supervisor from internship and I remained colleagues and friends, and she approached me a few years ago about the idea of writing a book together. From our own clinical experiences, we knew that there was a lack of resources that we felt comfortable recommending for binge eating; most books were either too dry or too far afield from the established science. From there, it was a natural and happy decision to collaborate to create The Binge Eating Prevention Plan workbook.
4. What is your approach to treating disordered eating? This is an important specialty that a lot of clinicians (myself included) don’t really get training in.
My approach to this work is that we need to address both the parts of the disordered eating that are about food and the parts that are not about food. That means helping people to regularize and broaden their diets so that they’re eating in a way that feels nourishing, satisfying, and joyful. It also means identifying the internal and external triggers for unhelpful eating behaviors, including problematic thoughts about themselves or about food, challenging interpersonal relationships, difficulties with emotion regulation or distress tolerance, unhelpful habits, and distorted emphasis on weight and shape in defining their lives.
5. What advice would you have for clinicians who want to be competent in treating disordered eating?
My first piece of advice is that every clinician should have some background in at least the assessment of disordered eating. We know that eating disorders often go undetected, both by clients themselves and by clinicians and medical providers. For example, only about a quarter of individuals with binge eating disorder who are attending therapy bring up their binge eating to their mental health provider. It’s incumbent on mental health providers to take the lead in inquiring about client difficulties with eating or body dissatisfaction, and to create a therapeutic environment free from weight stigma so that clients feel comfortable disclosing their concerns in these domains.
The second key piece of advice is that all clinicians should educate themselves about the Health At Every Size Approach. It’s essential that clinicians not fall into the trap of equating weight and health (see the excellent work of Jeff Hunger and Janet Tomiyama if this area is new to you!) and that we work towards social justice by helping clients in all types of bodies meaningfully pursue a flexible, sustainable path towards mental and physical health. If clients are stuck in a cycle of talking about weight loss as a goal, help them understand the reasons for that goal and work directly towards the outcomes they are seeking through weight loss rather than focusing on weight.
Beyond that, I’d say that getting some basic education in the treatment of binge eating disorder is useful for all clinicians. Binge eating is more prevalent than bulimia and anorexia combined, and most people with BED are presenting to general mental health services rather than specialty eating disorder treatment programs. Being able to effectively intervene in the cycle of binge eating will have a huge impact on most people’s practice. Christopher Fairburn has done excellent work adapting CBT for eating disorders and has written some clinician-friendly materials. Of course, I think clinicians can also get a lot of valuable tools by reading our book, and even working through it alongside clients. We draw from multiple theoretical orientations including CBT, ACT, IPT, and DBT, so most clinicians will find some tools that feel familiar and some that may be new or presented in a new way.
6. What would be a main takeaway you want readers to get from your book?
The most important takeaway is that there are highly effective treatments for binge eating; it does not have to be a lifelong sentence. Outcomes from both clinician-delivered treatments and self-help books are good, so people should seek support in whatever way makes sense to them. The other main takeaway would be that the solution isn’t more willpower, more restriction, or more self-punishment. Most people with binge eating have already tried those strategies to no avail, and both the research and my clinical experience show that they tend to make the problem worse instead of better.
7. Do you have any other upcoming projects you’d like to talk about?
Yes! I’m planning on recording a CE course with Simple Practice Learning this summer for any psychologists or social workers who are interested in learning more about how to help clients who struggle with binge eating.