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Eating disorders: A journey through psychotherapy and recovery

Updated: Jul 12, 2023

Psychoanalytic Therapy and the Treatment of Eating Disorders

My psychotherapy room. A safe place for a long journey .
My psychotherapy room. A safe place for a long journey .

Hello again,

In my introductory post, I shared some information about my professional background and approach as a clinical psychologist working with individuals grappling with eating disorders. Today, I'd like to delve deeper into a specific aspect of my practice: psychoanalytic psychotherapy. But first, it would be beneficial to understand the broader context of therapeutic approaches used for treating eating disorders.

A wide array of therapeutic strategies are utilised to address eating disorders, each with its unique focus and approach. For example, Cognitive Behavioural Therapy (CBT) is a popular method that emphasises the identification and alteration of harmful thought patterns and behaviours. It's often structured, goal-oriented, and relatively short-term. Conversely, techniques such as narrative therapy concentrate on the stories individuals construct about their lives, whilst biofeedback and behavioural interventions focus on managing physiological responses and modifying troubling behaviours.

These interventions have their strengths and can prove effective in specific contexts. However, they often concentrate primarily on the symptoms – the behaviours associated with eating disorders – without probing deeply enough to address the root causes. If you'd like- one can describe many of the techniques mentioned above as a surface solution- a plaster placed on the skin to prevent bleeding- but the source of the bleeding when it comes to eating disorders might be, and usually is, very deep. The plaster, I believe, is very important. It is needed while more in-depth work is taking place to extinguish the source of the bleeding. In some cases, it is a "first-aid" must to give some relief and save lives. And from time to time, you'll need to refresh this plaster. I believe that some form of more structured, guided and solution-focused intervention is always needed at different stages of treating eating disorders*. However, without going beyond the symptom itself, without looking at the person struggling and really understanding what has led to this breakdown- it is left unsolved. And I have met many people who felt they were not given enough time, space, and an in-depth understanding, to enable them to create change. This is where psychoanalytic psychotherapy comes into its own.

What makes psychoanalytic psychotherapy unique, and why do I find it so valuable in treating eating disorders? The answer lies in its capacity to explore beneath the surface to uncover the underlying issues driving the behaviours associated with these disorders.

Eating disorders are complex; they're not merely about food or weight. They often serve as coping mechanisms for dealing with emotions, traumatic experiences, or perceptions of self. Here, the psychoanalytic approach proves invaluable. Facilitating a deep exploration of a person's mind helps unearth these often hidden aspects and triggers, leading to a more comprehensive understanding of the eating disorder and its roots.

A key advantage of psychoanalytic psychotherapy is its focus on the therapeutic relationship. In this treatment modality, the bond between the therapist and patient becomes a critical tool. It provides a safe and non-judgmental space where individuals can feel genuinely heard and understood, often for the first time. This relationship catalyses change, enabling patients to explore their feelings, thoughts, and behaviours openly.

To my understanding and from observing my patients over the many years of treating eating disorders, the breakdown that comes with the eating disorder takes away from the ability to think. This is a crucial point, making psychoanalytic intervention a lifeline for treating eating disorders. The eating disorder robs people of their ability to think. To mentalise about their selves and their lives. Psychoanalytic treatment recovers precisely that, or in some cases, it builds the ability to think for the first time. In future posts, I will write more about mentalisation and psychotherapy, as these are crucial in understanding psychotherapy in general and psychotherapy with eating-disordered clients in particular.

If you are offered a quick fix to an eating disorder, I would be concerned and careful. As tempting as it is to want this painful and frightening state to go away, the way is long. And if rushed- if not given time to understand what is lacking and slowly rebuild it- something will collapse somewhere else. Eating disorders are severe mental health conditions, and the way to recovery is long. Psychoanalytic psychotherapy is not a quick fix. It's a journey – a journey that respects the individual's pace and readiness for change. It recognises that recovery from an eating disorder is not just about changing eating habits; it's about altering one's relationship with oneself and others. This process takes time, patience, and commitment.

Psychoanalytic psychotherapy can lead to profound and lasting recovery by prioritising depth of understanding and long-term change. It enables individuals to understand their patterns, develop healthier coping mechanisms, and enhance their overall quality of life.

In future posts, I will delve further into the techniques and principles of psychoanalytic psychotherapy. I'll also share insights about how this approach interacts with other therapeutic techniques and how it all comes together in the recovery process.

As always, remember that no matter where you are in your journey – whether you're just starting out, facing a hurdle, or looking for a new direction – there's always room for understanding, growth, and recovery.


* This is why an initial assessment, as well as an ongoing one, will always be part of the treatment process, to allow me to decide when to suggest that to my clients as an additional tool, either by me or by a colleague. But I'll expand more on the specific way in which I construct my work in future posts.

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