What Patients Need to Know about Eating Disorder Treatment…
By Abigail Natenshon, MA, LCSW
Things you may not know about eating disorder treatment –
If your underlying behavioral and/or emotional issues vaguely resemble or
even roughly approximate those of an eating disorder, or if the
dysfunctional behaviors you observe in your child are similar, though not
precisely as described in the DSMIV diagnostic manual, the treatment
protocol should follow that of the clinical eating disorder.
Eating disordered patients and the professionals treating them must be
careful to distinguish general
psychotherapy from eating disorder therapy; they are not the same thing. The
requirements of eating disorder treatment are unique and must be treated by
professionals who are experienced and expert in this specialty. Generic
psychotherapy tends to overlook the lethal behaviors that underlie these
disorders; strictly behavioral treatment tends to overlook pivotal
underlying emotional issues driving the disorders as well as the power of
the quality therapeutic relationship in bringing about healing.
Should families be involved?
The issue of parental involvement is complex and a function of factors such
as the age of the patient, the stage of recovery, the availability of
families and loved ones, the quality of the family relationships, etc.
Hopefully, the therapist’s competence in treating patients and
families together, in conjoint family treatment, would not preclude that
child’s treatment choices must
be his own, but this does not mean families should be without a voice, even
as (s)he makes his/her own
decisions and determines his/her own course of action.
It is important that you
understand the following basic tenets of eating disorder treatment:
1. An eating disorder is
essentially a device designed to solve problems and insure emotional
survival in the world; though its intentions are noble, its functions are
harmful and potentially deadly. Eating disorder recovery results in more
effective and less harmful ways to accomplish life goals. Eating disorders
are not addictions, though they behave as such;
these disorders are completely curable
with effective treatment in 80% of cases.
2. Eating disorders are
integrative disorders that are best treated by an
integrative and collaborating multi-disciplinary team of experts
specializing in individual and family therapy, nutritional counseling, and
medical and psychopharmacological aspects of care. Patients and parents need
to be collaborating members of the treatment team.
3. The eating disorder
practitioner helps to set and achieve goals that may yet be unknown to the
patient at the start of treatment. The eating disorder treatment and
recovery processes are learning processes. In recovery, weight loss or gain
becomes secondary to the patient’s ability to develop the internal resources
and emotional resiliency he or she needs to nourish oneself healthfully
enough to develop a healthier relationship with food.
A person’s relationship with food
becomes a metaphor for self-care and problem-solving. A discussion of
eating behaviors, as well as the cognitive and emotional issues that reflect
or evoke them, needs to be part of the fabric of every treatment session.
4. If you are currently, or have
been, engaged in treatment that has been less than successful,
your next treatment experience needs
to be different, turning the process around for you. It is up to you to
make sure that this happens. Your treatment goals need to become
change-centered, action-focused and outcome-based; your therapist needs to
be directed and intentional, skilled in cognitive behavioral techniques as
well as in connecting with you within mindful, psychodynamic treatment.
That person needs to give you a sense of confidence and trust, in
himself or herself, in your, and in the treatment process.
Trust your own instincts in your choice of your team. As a consumer
of these services, do not be afraid to get your questions asked and
answered, your concerns addressed.
5. Eating disorder recovery
successes are often camouflaged in
what might appear to be "failures," so don't be discouraged along the
way; just keep moving forward, maintaining realistic expectations for
recovery. Though progress may be slow, expect to experience changes, even if
small, from the very start of treatment and throughout care. Every mistake,
every failed effort, every session should provide fodder for learning and
change and be a source of empowering self-understanding. Expect eating
disorder recovery to feel worse before it feels better; it is
anxiety-provoking for an anorexic person to restore lost weight, but in the
end, re-feeding the malnourished brain is the best “medicine” for reducing
collaborating members of the treatment team, the choice and pace of
recovery belongs to the patient…. unless, of course, he or she is at
physiological risk. Be aware that an eating disorder temporarily strips it
victims of the judgment and capacity for self-care. Under dire
circumstances, eating disordered individuals need to put their care in the
hands of others, until such time as they can resume responsible
7. Everyone with an eating
disorder needs to be under the care of
a medical doctor. Eating disorders are the most lethal of all the mental
health disorders and require careful vigilance.
8. It is up to patients and
parents to hold treating professionals accountable for accurately and fully
diagnosing and medicating co-occurring conditions and mood disorders.
Impulsive behaviors connected with bipolar disorders may typically take on
the appearance of addictions or ADHD. Be aware that to miss an accurate
diagnosis of a mood disorder diminishes the opportunity for a complete
diagnosis and eating disorder recovery and for appropriate medications
capable of greasing the path to healing.
Psychotherapy Is About Making Changes
Change develops out of ferment and signifies the breaking apart of an old
system. A potent diagnostic and treatment tool, change indicates where the
patient has been and where he is going; its rhythm sets the pace of
treatment. The goal of change through eating disorder therapy is not for the
patient to be “right” but to become flexible and emotionally versatile,
developing the wherewithal to more effectively cope with life’s adversities.
The mark of a successful treatment process is change in behaviors and
thinking, whether it takes the form of a bold epiphany or a small
“tweaking,” perceptible only to the patient. All change begins with one
small step. The cumulative impact of small steps may not be apparent at
once, though you and your child should become aware of changes of various
sorts and degrees almost immediately with the start of treatment. Behavioral
changes will generally be easier to discern than those confined to emotional
expression. With patience you will observe your child's small steps grow
into big ones, along with the melding of behavioral and emotional changes in
an integrative wholeness that describes recovery.
Note that even small changes may evoke big anxieties …. minor alterations
will lead to potentially large and sometimes unsettling, consequences. It is
important to stay mindful of the fact that normal eating disorder recovery
progress often takes on the look of failure, so don’t become prematurely
discouraged. Your courage and support through the tough times will be very
much appreciated by your struggling child.