Eating Disorder Treatment
Imagine for a minute that everything you think about yourself is negative and the only way to drown out these “thoughts” is to think about food, eating, and your weight. These thoughts come from a place of complete self-doubt, helplessness, low self-worth and low self-esteem. Someone who is suffering from an eating disorder constantly has to listen to the negative messages that erode their sense of worth and value. These thoughts tell you that you aren’t worthy, that people are always judging you, that you are always wrong and that you will never be good enough unless you are perfect.
If you have never had an eating disorder the best way to explain these thoughts is to think about your own mind and how often you might actually question yourself back and forth in your own head. For someone suffering from an eating disorder the thoughts and voice of the eating disorder is always negative, always degrading, and never forgiving. The eating disorder convinces you that you have no will power and that you are weak and should feel guilty when you have eaten and the only way that you can regain the “control” is to either not eat at all or rid your body of the food. The eating disorder voice convinces you that your own thoughts, your healthy and positive thoughts, are false and your eating disorder is really the only thing in your life you can trust and rely on. It harasses you into feeling guilty for eating and also for having the eating disorder in the first place.
Dealing with this internal battle is so difficult and can be exhausting… learning to not listen to eating disorder thoughts can feel excruciating. The mixed messages can be confusing and scary. One of the essential ingredients to recovery is learning to love you, and the voice of an eating disorder fights hard to keep that from happening. Even though the negative voice of an eating disorder has convinced you that you can’t be happy without it, we know that as treatment providers it is our job to help you recognize all of the wonderful things you deserve: happiness, self-love and recovery.
Your therapeutic relationship with your therapist is one of trust and support and my clients need all of the unconditional positive self-regard, respect and empathy I can give them. It’s my job to help them recognize and learn all of the very special and unique aspects of themselves that their eating disorder tries to make them forget about. It is through understanding, encouragement, positive reinforcement and education that therapy can begin and motivation to recover takes hold. Once you can conquer the voice or voices inside of you that continue to reinforce the negativity, you will find your path to recovery.
When it comes to treatment and eating disorders I take the initial approach of combining different styles of therapy including cognitive behavioral, interpersonal therapy, dialectical therapy specifically mindfulness, and psychodynamic therapy. In many cases I will refer to a dietitian who specializes in working with eating disorders and coordinate our treatment as the nutritional component of treatment is just as significant as the therapy itself. The idea is to address and tackle many different issues over your course of recovery, including self-esteem work, past and present emotional issues, and day-to-day coping strategies. However, as I become to work with my client more I will adjust and modify our goals based upon what appears to work best for them and of course with their collaboration. Cognitive behavioral therapy and interpersonal therapy in addition to learning to be “mindful” can be especially helpful initially with a new client who has never been in therapy and may be struggling with the intensity of his or her feelings, or the constant battle that occurs within the clients had which includes the never ending “thinking about food” and frequent feelings of guilt. The client will begin to learn more about how and why he or she uses his or her eating disorder as way to cope and learns new ways to handle the inner turmoil while working through thoughts and feelings. Typically I prefer this approach first because as we delve deeper into the psychological issues that are at the core it is crucial that the client has the skills necessary to deal with “what comes out of Pandora’s box.”
At the very beginning of therapy I assess each new client and take into consideration the individual’s cognitive and emotional development, psychodynamic concerns, cognitive style, concurrent mental disorders, personal preferences, and family circumstances.
With each client I typically will work with a treatment team which includes a dietitian who specializes in eating disorders, a primary care physician, and psychiatrist if needed. The treatment team collaboration is critical when working with someone who is suffering with an eating disorder and will most often include members of the client’s family as well.
The ultimate goal of your therapy should be to recover! To learn to be more confident in yourself, to make your voice heard through communication, to validate your own emotions, to learn to love yourself, and to learn better ways of coping with anger, sadness and stress (and not rely on your Eating Disorder).
Please note that the reference to the term “hearing voices” is not meant in the same way as hearing voices i.e., auditory hallucinations in schizophrenia.