Don’t Lose Sight of What Works in Eating Disorder Treatment: Part II

The current eating disorder treatment protocol is focused on weight, meal plans, higher level of care and, sadly, liability. People seeking help confront a tricky dynamic in which their health and well being are not always primary.

In addition, the capitalist effect on mental health treatment affects eating disorder treatment too. Various therapy services and even text therapy allow for easily switching therapists and substituting a professional friend for true therapeutic work.

In this climate, the value of the therapeutic relationship is easily lost. Much has been written for decades about the value of a therapeutic relationship with clear boundaries of time, role and intention. The relationship is open and connected but allows for vulnerability and exploration that modern life rarely affords. In this relationship, the openness allows for the type of therapy that is very helpful for recovery.

Eating disorders, especially anorexia, represent a source of safety and comfort for many people. Food restriction often serves as a means of security and certainty in a world that is anything but. Following the food rules, monitoring effects on weight and making decisions based on the eating disorder represents a source of calm, something that often feels impossible to resist.

Early studies into treating people with anorexia focused on developing a therapy relationship that might circumvent and eventually disempower the eating disorder. Finding new sources of calm through relationships and connection, so the theory goes, could begin to compete with the emotional security of the illness.

Much evidence supports this idea, yet the eating disorder treatment community continues to move towards solely cognitive based therapy or reflexive inpatient treatment for people not sick enough to merit that level of care.

The effect of more surface level care combined with unnecessary residential treatment sends people the wrong message. Full recovery doesn’t entail embracing the illness and creating identity through treatment. Instead, being well needs to encompass identity outside of recovery or illness. Identity can come from within and develop through connectedness in the world.

The treatment community can offer a more complete and fulfilling idea of recovery by returning to some of the basics of helping people with eating disorders. Understanding what people with eating disorders need to get well is a necessary part of treating this group of people.