Individual Therapy: Putting The Eating Disorder Out Of A Job

Writing this chapter on individual therapy was different from the rest, since it is impossible to ignore the quantity and quality of information that comes directly from my personal experience. My own battle and subsequent recovery from anorexia nervosa during the ages of fifteen to twenty-one and my experiences as an eating disorder therapist since 1979 add a strong personal influence to this chapter. In treating eating disordered patients I use a very informal approach going by my first name and sharing information about myself and my own recovery. I work from a psychodynamic and cognitive behavioral perspective intermittently and at times simultaneously. I believe that the nature of an eating disorder makes tending to specific behavioral change important, and the attention I give in treatment to this aspect varies in degree depending on how healthy the patient is.

Early on in my career I realized that if treatment were left to typical psychoanalysis, patients could take years explaining their childhoods, how they get along with their parents, their inability to control their anger, or any number of past experiences, all the while continuing to exist on frozen yogurt and salad, or bingeing all day, or purging their dinner every night. Eating disordered patients can starve to death or have heart failure while trying to figure out "why" they are doing this to themselves. Therefore, my individual sessions with patients vary greatly in nature because, along with an ongoing exploration of developmental deficits and underlying issues, I deal directly with thinking patterns, behaviors, and symptom management. The section "Choosing a Therapist" on pages 134–137 should be helpful to patients unsure of where or how to begin this process.

HOW DOES THERAPY CURE?

Every experienced, effective therapist comes to her own understanding of how therapy cures and then works from that understanding, even if she does not consciously recognize it. To do justice in describing, not just the technique but the art of individual therapy with eating disordered patients, I have drawn not only from the literature but also from the knowledge and experience I have gained and utilized with success over the last twenty years. For simplicity's sake, the term patient is used in this chapter to denote an eating disordered individual who is in treatment, and the word therapy is used instead of the more proper term, psychotherapy.

Therapy with eating disordered patients involves providing education, insight, and a corrective emotional experience, allowing the patient to rectify faulty thought patterns, fill in developmental deficits, and internalize missing psychological functions. In individual therapy it is the relationship between the therapist and patient, rather than any certain technique, that is the most curative aspect. In essence, the therapist uses his or her training and the therapeutic relationship to put the eating disorder "out of a job." Until patients can "do it on their own," the therapist lends his ego and self-organization, capacity to anticipate, to delay gratification, to use sound judgment, to relate to another, to regulate tension and moods, and to integrate feelings, thoughts, and behavior. Once patients have internalized these abilities into their self-structure, they no longer need to use substitute or self-destructive measures (eating disorder behaviors) to meet needs or provide important psychological functions.