Eating disorders are notoriously difficult to treat due to the deep ambivalence towards recovery that the sufferer will experience. Often eating disorder treatment can be a revolving door of services; therapy, dieticians, recovery coaches, and community teams. What keeps the eating disorder as a viable method of coping is a question I keep coming back to in my work with clients. Garner & Garfinkel, 1987, proposed a model of the development of eating disorders that focused on predisposing, precipitating and perpetuating factors. I use this model as a guide to understand and to inform my overall treatment plan.
Working backwards
Treatment starts with the perpetuating factors and works backwards. A client will need to be monitored physically in order to be able to engage in the deep psychological work needed for long term recovery. Trauma work is inherent in the treatment of eating disorders as it often underlies the illness. Not every client will have a ‘big T’ trauma, but most will have those ‘little t’ traumas that often get overlooked and can cause such a detrimental impact on a person’s sense of worth and self esteem. I often think about 'wounds of invisibility'. What was missing in the clients life, especially their early years, and how are their needs not being met? What does the eating disorder give them that they are not getting from the relationships in their life?
How psychotherapy works in eating disorder recovery
The way I use psychotherapy in treating eating disorders is a personalised process where I incorporate different therapeutic modalities and integrate them to address the unique nature of a person’s difficulties. Psychotherapy is primarily a talking therapy but can encompass different techniques and methods to help a person express their emotional difficulties. My way of practicing is an integrated approach underpinned by psychodynamic theories of attachment, the unconscious and defences. There is also the relational/humanistic and behavioural aspect, which informs the therapeutic alliance. Creating a safe space for the client in which we can develop this alliance where they feel secure, heard, understood and attuned to. In the process of developing this alliance I invite the client to tell me their life story and express their experiences, thoughts and feelings via the use of creative means as well as verbal expression and reflection. This way we can uncover some of the underlying reasons of why the eating disorder may have developed in the first place.
A creative approach to psychotherapy allows the client to explore not just with words, but to safely access their unconscious processes and challenge them in the here and now of the therapeutic relationship. This will ideally help the client make sense of their experiences and be better equipped to form healthier relationships with themselves and with others, vastly improving their quality of life.
A method of coping
An eating disorder can be a way of coping and managing life. If the underlying causes are not addressed, the eating disorder will not be effectively treated, and the sufferer will remain stuck in this cycle.
A typical misconception of an eating disorder is a sole focus on food, when in reality it is often a deeper issue, symbolic of something else. An avoidance of feeling or a hunger for something else, for love, for understanding, a need for control. My psychotherapy asks ‘What is the client saying with their body that they cannot put into words?’ Working psychotherapeutically with individuals that have an eating disorder is with the intention of allowing them an expression of their emotions, and to develop an understanding of themselves, their motivations and to gain insight into their patterns of behaviour. This is with the aim of helping them to develop different ways of being in the world and gaining a more robust way of coping with their difficulties, which do not only rely on food as a coping mechanism. An eating disorder can be an extreme coping strategy, Psychotherapy can offer something different.
Recovery is possible
Healing and recovery is different for each individual person, and it's important to work with what this mean to each client.
Recovery is always possible, but it is hard work for the client, and their loved ones, as well as the therapist.
If you are interested in learning more I run webinars with a more detailed approach. Please look at my Eventbrite Lesleyktherapy to book the next available date.
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