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Over 35 Years of Eating Disorder Specialty Practice
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Eating Disorder Specialist

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Healing the Eating Disordered Self
through the Power of Loving Relationships

Abigail H. Natenshon, MA, LCSW, GCFP


Anorexia and bulimia, the most lethal of all the mental health disorders, kill and maim from 6 to 13 percent of their victims, 87 percent of whom are children under the age of 20.  It is a little known fact that afflicted individuals also include men and women in their 30’s, 40’s and 50’s who are coming forward in increasing numbers to reveal these previously well-kept secrets, breaking silences that some have kept for decades. The ever-expanding community of patients, their loved ones, and their professional care-takers continue to seek better ways to comprehend and conquer these pervasive and life-altering diseases. For the past four decades, clinicians and researchers in the eating disorder field have sought solutions to these problems through various treatment approaches and combination of approaches in an attempt to optimize recovery outcomes. Yet, cure remains tantalizingly out of reach for far too many sufferers; even evidence-based cognitive behavioral techniques which have been shown to be the “best practice” treatment modality for bulimia nervosa, when offered by themselves, typically fall short of achieving consistent, timely and sustained outcomes in all too many cases.  Eating disorders are integrative disorders and effective healing needs to be similarly integrative in nature.  Effective treatment incorporates a multiple focus on nutrition, physical health, cognitive-behavioral skills, family and social systems, emotional issues, mood dysfunctions and pharmacological interventions, and last but not least, the quality and versatility of the treatment relationship.


Eating disorders represent dysfunction within human connections
Be they revealed or undisclosed, diagnosed or undiagnosed, eating disorders insinuate themselves into the very fabric of life and human relationships. As the cornerstone of human connections, these diseases function as the interface between patient and significant others, as the third point in what becomes relational “triangles” between children and parents, husbands and wives, therapists and patients. Taking up residence within a person’s core, eating disorders dominate the inner life, robbing their host of the most precious of all relationships…that being the individual’s relationship with his or her own Self. By displacing and replacing the core personality, anorexia and bulimia wrest control over life functions, holding the patient hostage, depriving him or her of the emotional resiliency required to solve life problems, cope with adversity, engage in confidence-building life opportunities, and make healthy lifestyle choices. Children who fail to recover in their youth are destined to carry their disorder with them into their adult years, further decreasing their odds of ever finding and developing healthy, gratifying, and ultimately, healing personal relationships.


Eating disorders are family diseases
As family system diseases, eating disorders show up within the context of daily living, side by side with family and loved ones, at kitchen tables and in family bathrooms, (and all too rarely in the doctor’s office) Recovery, too, takes place day to day in the course of life. Patients average 50 minutes per week face-to-face with health professionals, yet spend “24/7” living out their lives and recoveries alongside loved ones at home, at school, at places of employment.  It is for family members to pick up the gauntlet of opportunity for involvement in their child’s or spouse’s cure and by so doing, to optimize it. Though not responsible for causing these diseases, parents, partners and siblings enjoy the potential to become primary forces in preventing and/or healing them. With eating disorders, the stakes are high. If not part of the solution, family members risk becoming part of the problem.

The pathway to healing is in healthy connections

Through family therapy and the reconnection of patients with families, parents are offered a second chance to fill in emotional and developmental voids that have deprive the afflicted individual of mature functioning, effective problem-solving and self-care.  Healthy family bonding also greases the path for the patient’s healthier separation and increased capacity for autonomy and self-determination, even while avoiding the potential for “splitting” and confidentiality breaches. Timely and sustainable recoveries generally remain elusive in cases where the patient’s treatment excludes some forms of family participation at appropriate points in treatment.

Because eating disorders are principally disorders of relationship…with the patient’s self, food, and with others… the healing energy within the success of any treatment methodology occurs within and through the context and interface of the treatment relationship. The eating disorder therapist fosters authentic and proactive human connections between self and patient, between patients and families, and therapist and families, all of which ultimately reclaim the connection to the patient’s lost or exiled Self.  The trust that develops between the therapist and patient…and in the treatment process, and in the patient’s capacity to achieve healing, ultimately re-ignites the patient’s trusting reconnection with her core self.  The versatile and healing therapeutic relationship ideally becomes the prototype for healthful, quality relationships elsewhere in the patient’s life, both within and outside of the treatment system. 


The importance to recovery of the quality and versatility of the patient’s relationship with the therapist is seen in the advent of brain scanning technology and evidence-based brain research which has shown the patient’s right brain hemisphere to actually change in form and function in response to a quality therapeutic connection with the therapist’s right brain hemisphere.  Simulating the pivotal connection between mother and infant in attachment theory, this connection lays the foundation for the patient’s development of self-regulation, self-trust, and self-determination, forming the very basis of ED recovery. Christopher Germer, in his book, Mindfulness and Psychotherapy, (2005) speaks of the therapeutic relationship as an “intervention” in itself… as the most potent of all the treatment interventions for healing within a mental health venue. He describes mindfulness in therapeutic practice as the pathway to establishing a healthy, healing treatment relationship.  What we learn is that good relationships provide the pathway out of an eating disorder. Disorders of human connectivity, eating disorder recovery lays in creating healing connections to therapist, the patient’s self, and to significant others.


Healthy connectivity in nourishing relationships…with self, with others, with nature, or a Higher Being is a major source for the developing sense of spirituality. Soulful connectivity gives ordinary life depth and value, elevating a person to a sense of integrity, peace and radical acceptance of life and self. Mindfulness as a process both within and outside of the context of psychotherapy, by evoking self-awareness and connectivity with other and self, provides a healing unity for mind, brain and body that marks eating disorder recovery.

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