Treatment Philosophy And Approaches

This chapter provides a very simplistic summary of three main philosophical approaches to the treatment of eating disorders. These approaches are used alone or in combination with one another according to the treating professional's knowledge and preference as well as the needs of the individual receiving care. Medical treatment and treatment with drugs that are used to affect mental functioning are both discussed in other chapters and not included here. However, it is important to note that medication, medical stabilization, and ongoing medical monitoring and treatment are necessary in conjunction with all approaches. Depending on how clinicians view the nature of eating disorders, they will most likely approach treatment from one or more of the following perspectives:

• Psychodynamic
• Cognitive behavioral
• Disease/addiction

It is important when choosing a therapist that patients and significant others understand that there are different theories and treatment approaches. Admittedly, patients may not know whether a certain theory or treatment approach is suitable for them, and they may need to rely on instinct when choosing a therapist. Many patients know when a certain approach is not appropriate for them. For example, I often have patients elect to go into individual treatment with me or choose my treatment program over others because they have previously tried and do not want a Twelve Step or addiction- based approach. Getting a referral from a trustworthy individual is one way to find an appropriate professional or treatment program.

PSYCHODYNAMIC MODEL

A psychodynamic view of behavior emphasizes internal conflicts, motives, and unconscious forces. Within the psychodynamic realm there are many theories on the development of psychological disorders in general and on the sources and origins of eating disorders in particular. Describing each psychodynamic theory and the resulting treatment approach, such as object relations or self-psychology, is beyond the scope of this book.

The common feature of all psychodynamic theories is the belief that without addressing and resolving the underlying cause for disordered behaviors, they may subside for a time but will all too often return. The early pioneering and still relevant work of Hilde Bruch on treating eating disorders made it clear that using behavior modification techniques to get people to gain weight may accomplish short-term improvement but not much in the long run. Like Bruch, therapists with a psychodynamic perspective believe that the essential treatment for full recovery from an eating disorder involves understanding and treating the cause, adaptive function, or purpose that the eating disorder serves. Please note that this does not necessarily mean "analysis," or going back in time to uncover past events, although some clinicians take this approach.

My own psychodynamic view holds that in human development when needs are not met, adaptive functions arise. These adaptive functions serve as substitutes for developmental deficits that protect against the resulting anger, frustration, and pain. The problem is that the adaptive functions can never be internalized. They can never fully replace what was originally needed and furthermore they have consequences that threaten long-term health and functioning. For example, an individual who never learned the ability to self-soothe may use food as a means of comfort and thus binge eat when she is upset. Binge eating will never help her internalize the ability to soothe herself and will most likely lead to negative consequences such as weight gain or social withdrawal. Understanding and working through the adaptive functions of eating disorder behaviors is important in helping patients internalize the ability to attain and maintain recovery.