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Eating Disorder Professional Treatment - Individual Psychotherapy Continued

Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Bingers are taught to find reinforcement and comfort in activities other than eating. Through journaling and charting, they are taught to identify, and replace negative, destructive thinking that precedes binging episodes. Bingers also develop skills to replace destructive behaviors with another activity that is reinforcing and healthy. Bingers must also be confronted regarding their minimization of the dangerousness of destructive behaviors.

Studies indicate that CBT has a 60% or higher success rate for treating general or overall psychological conditions, including eating disorders. It is important to note, however, that "successful treatment" means only that patients are no longer jeopardizing their lives and can return to daily functioning. It does not mean that they are symptom free. Because there is no cure for or complete recovery from anorexia, bulimia or binge eating disorder, you may have to work the rest of your life to prevent your relapse into a negative cycle of disordered eating behaviors. This sounds depressing, we know, but truly, with the help and support of friends, family and therapists (as needed), and through the exercise of your newly acquired coping skills, you can expect to enjoy a happier and safer life.

Other forms of individual therapy, which are not as effective as CBT in research trials, may still be useful for some people with eating disorders. These include more relationship-oriented therapies, such as various forms of psychodynamic theory and humanistic theory. Psychodynamic therapies use the relationship built between client and therapist to create insight and behavior change via a technique called transference. In transference, the therapy relationship is used as a laboratory in which troubling emotions found in other relationships (such as with family members) can be safely expressed ("transferred") toward the therapist who acts as a surrogate receptacle for those emotions. For example, the patient may become angry at the therapist in place of being angry towards a parent, say, treating the therapist as a sort of surrogate parent for a time. The therapist can recognize this anger as being aimed at the patient's parent, and reflect upon this to the patient, who can become more aware of and thus more in control of her actual feelings towards her parent. The therapist accepts feelings from the patient freely, allowing the patient to explore new coping styles, while backing out of unhealthy and destructive coping styles. This process can be very beneficial when combined with the teaching of coping techniques for future relationships, such as assertiveness training. Some of these therapies may be especially helpful in the treatment of co-morbid conditions, such as depression and perfectionism.

The premise of treating an eating disorder from a psychodynamic perspective is that the symptoms of the disorder are expressions of a struggling inner self that uses these behaviors as a way of communicating or expressing underlying issues. The underlying issues are developmental deficits and/or unresolved feelings and needs that if not addressed, will continue to be expressed as dysfunctional behaviors. These issues cannot be confronted directly, as the person will use defensive coping skills to protectively maintain behaviors that feel comfortable and safe. The essential goal, therefore, is to help people understand the connections between their behavior and their relationships, and how these interact to create and maintain their eating disorder.