Current trends in therapy reflect a thought process favored in the general community: mindfulness. Originally coopted from Eastern philosophy and Buddhism, the concept of being present and mindful rails against the Western, and especially American, mentality that striving for the future brings satisfaction and happiness.
An eating disorder thrives on a mind always looking ahead to the next best thing. As long as the attention remains elsewhere, the eating disorder thoughts easily dominate any thoughts in the present and focus on maintaining the obsessive, rigid eating patterns at all costs.
Clinicians who treat people with eating disorders agree that insight into personal emotional struggles and interpersonal dynamics have their place in therapy but will not be the cornerstone of effective recovery. Meaningful sessions can occur for months or years with no appreciable change in the illness.
What is often mistaken for lack of motivation or drive in someone in recovery is in fact a lack of focus on the present. The energy and attention needed to challenge the eating disorder thoughts at every meal and snack and every moment in between are critical but exhausting parts of real recovery. The automatic response to listen to the eating disorder comes with slipping into the illness but, in that moment, also leads to palpable relief.
Present-focused treatment leads to discomfort in two ways. First, the person will be more able to think and feel clearly with better nutrition. For someone used to being disconnected due to starvation, this experience is very challenging. Second, the fears and insecurities that come with facing the aftermath of the eating disorder are emotionally challenging and threaten to push the person back into focusing on the future, thereby returning to the confines of the illness.
The key is to stay in the present despite these experiences and to use therapy to get support managing them rather than use therapy for less necessary insights.
Most therapists agree that the best way a patent can stay in the present is through support. Regular contact with the treatment team combined with support from friends and family who understand the illness work best. It is most helpful when daily interactions reinforce the need to stay in the present and remain focused on the challenges each day, not the goals and changes that may come down the line.