Clinical Psychology: A Work Placement in Eating Disorders

Psychological Work Placement || Clementine Clinic (Frankfurt, Germany) || June 2011

· Internship in the psychiatric unit of Clementine Child- and Youth Hospital
· Focus: Eating disorders anorexia nervosa, bulimia nervosa, language disorders, developmental disorders
· Liaising with medical, psychological, psychiatric, and social staff and attending meetings
· Shadowing of all therapeutic activities including individual talking therapy, group therapy, physical activity, nutrition classes, physical rehabilitation, etc

The Clementine Children’s Hospital consists of 4 wards with 75 beds reserved for inpatient treatment and an outpatient day clinic. The clinic adopts a psychoanalytical approach to treat children who suffer physical symptoms and mental health issues as a result of unconscious conflict. The psychodynamic understanding of disease assumes that symptoms are an expression of psychological distress and failed attempts at self-care or -healing. Therefore, the goal of psychotherapeutic treatment is to work with the patient to improve coping and resolve inner conflict in order to eliminate psychosomatic symptoms that impair the person’s development and undermine health, wellbeing and function.

My work placement was mainly based in the psychosomatic ward. Psychosomatic treatment approaches are grounded in the understanding that body (soma) and mind (psyche) are intrinsically linked. This means that psychological suffering, such as anxiety, depression, or isolation can lead to physical symptoms and vice versa. Back pain, headache, chest pain, insomnia or chronic fatigue are common examples of physical symptoms with psychological underpinnings. As an example of vice versa effects, chronic pain due to injury or disability often impacts psychological well being and can lead to hopelessness and depression.

Inpatient treatments on the psychosomatic ward range from two weeks to six months. Patients are treated for different types of eating disorders, anxiety disorders, chronic pain and physical discomfort. Phobic and obsessive.compulsive disorders, bedwetting, encopresis and psychological stress in chronic diseases like asthma, arthritis and diabetes are also treated on the psychosomatic ward.

The psychodynamic treatment approach includes parental involvement and elements of behaviour therapy. As part of the treatment, patients can benefit from individual and group therapy, music therapy, art therapy and body-centred therapy. Group therapy plays a central role in the healing process, as it provides patients with a structured and protective framework that gives children the opportunity to overcome existing problems and develop their own resources.

During my three week work placement, I was mainly deployed in the therapeutic group where I supported carers and nurses. I took part in preparing customized meals for patients and supervised collective meals. I was responsible for entertainment and relaxation in between school lessons and therapy sessions and became a confidant to the children. In the psychotherapeutic setting, I served as a co-therapist and designed excursions, activities and games with co-interns. I was involved in the pedagogical care of patients, took part in school lessons, music therapy and physiotherapy. I was able to participate in admission and anamnesis interviews of children and adolescents with eating-, anxiety- and somatization disorders. In addition, I was involved in family therapy interviews with children with eating disorders, somatization and attachment issues. I was allowed to witness and participate in cross-departmental team meetings and case discussions of the therapy team. Furthermore, I had the opportunity to conduct various intelligence and personality tests such as 20R CFT (Grundintelligenztest Skala 2 in revidierter Fassung, Culture Fair Intelligence Test for 8.5 to 60 year old participants), CFT 1 (Grundintelligenztest Skala 1, Culture Fair Intelligence Test for 5.3 to 9.5 year old participants) and PSSI (Persönlichkeits-Stil und -Störungs Inventar = Personality-Style and -Disorder Inventory).

My work placement report reads:

“Miss Laura von Nordheim showed a keen interest in theoretical attachment theory and the various forms of disruptions and disorders associated with attachment disorders. In practical work, Miss von Nordheim showed very good sensitivity and a high level of empathy, which enabled her to understand the needs of the patients, develop a holistic understanding of adequate psychological care, and use this as a basic auxiliary processing strategy for professional supervision and support of the patient. During her work placement, Miss von Nordheim has consistently showed dedication, initiative, resourcefulness, and therapeutic understanding and was very popular with patients and colleagues.”


Psychological Work Placement || Spessart Clinic (Bad Orb, Germany) || June 2012

· Internship in the child-, youth-, and adult unit for medical, psychiatric and psychosomatic illness and disease
· Focus: eating disorders obesity, binge-eating, depression, stress, burn-out, chronic disease, cardiovascular disease, diabetes
· Liaising with medical, psychological, psychiatric, and social staff and attending meetings
· Delivery of social competency classes, self-esteem workshops, autogenic training, and progressive muscle relaxation
· Shadowing of all therapeutic activities including individual talking therapy, group therapy, physical activity, nutrition classes, physical rehabilitation, etc

The Spessart Clinic has been an established rehabilitation centre for more than 125 years, providing space for over 300 patients in 3 units:

Clinic for Adults 1:
-coronary heart disease
-diabetes mellitus

Clinic for Adults 2:

-stress disorder
-anxiety disorder
-obsessive-compulsive disorder
-personality disorder
-eating disorders related to obesity/adiposity
-psychosomatic disorder
-occupational health: rehabilitation from bullying, stress, burnout

Clinic for Children, Adolescents and Young Adults:

-diabetes mellitus type 1
-asthma bronchiale
-physical disability
-bedwetting, encopresis
-psychosomatic disorder

During my work placement I was able to participate in, and later on lead, a number of psychotherapeutic groups and events including bonding-group, indicative-group, adoposity-group, social competence training, parents’ group, support and advice for parents, smoking cessation group, and relaxation therapy. I was able to witness and conduct individual psychotherapy and participate in interdisciplinary team meetings. Taking part in the wide range of therapies including music therapy, sport therapy and nutrition counselling helped me develop a holistic understanding of the various different approaches to empowering patients in order to combat eating disorders.

My work placement report reads: “During her work placement, Miss Laura von Nordheim has been supervised and instructed by trained and chartered psychologists. We experienced Miss von Nordheim as a highly motivated and interested intern. Due to her open and attentive personality, she easily integrated
herself into our interdisciplinary team and contributed in a constructiveand proactive manner. Miss von Nordheim acquired relaxation techniques ‘Autogenic Training’ for children, adolescents and young adults and ‘Progressive Muscle Relaxation’ for adults with ease and learned to implement these techniques independently.”

Although being situated at opposite ends of the eating disorders spectrum, from not eating at all to eating all the time, I recognised common themes among patients. However, every patient is unique and requires individually tailored support. I learned that food and eating fulfils many more functions than mere energy supply, and I make sure to incorporate the appropriate diligence and awareness into all my work.