Eating Disorders
Eating Disorders and How We Treat Them

When treating eating disorders, our practice embraces a gestalt conceptualization, or the deconstruction of the whole situation into its elements. We believe disordered eating patterns originate as an unconscious attempt to solve – often also unconscious – problems. Subsequently, secondary – but now conscious – problems arise: those associated with the symptoms of the eating disorder.

In effect, the eating disorder illuminates a problem – just not the original one. Since food and the eating relationship are often representative of life and interpersonal relationships (i.e., what we do with life, we do with food), fundamental to recovery is the work of decoding metaphors disguised in eating behaviors and thoughts.

Our practice pays balanced attention to the dual nature of the eating disorder recovery process by incorporating two components:

  1. What’s underneath it all:
    We work with you to develop insights into the underlying issues, precipitating factors, and historical material that fertilized the soil for an eating disorder to grow. We strive to recognize how the eating disordered symptoms have served on an emotional level and what keeps them alive in your life.   We work to bring the unconscious into consciousness and we explore metaphors (particularly those hidden in the eating relationship) to extract their deeper meanings.
  2. What’s is the struggle like NOW and how do we make it better:
    We work to establish an emotionally safe environment from which to explore often secretive thoughts and behaviors regarding food, weight, and body image. We identify risk factors and establish safety measures. We talk about decreasing judgement, shame, and isolation, and we strategize and support the practice of new, more effective coping behaviors that promote better functioning, health, mood, and genuine resolution of problems. This component includes tools and techniques to increase self-compassion, mind-body awareness, mindfulness, self-care, restoration of capacity for attention to hunger and satiety cues, and creative practices targeted to individualized needs.

We believe that successful recovery from eating disorders is absolutely possible and may require a network of professionals for each individual. Some options when considering a team approach and available levels of care are outlined below.

Nutrition Therapy for Eating Disorders

When choosing a nutritionist, it is crucial to work with specialists in the field of disordered eating. Working with these qualified nutritionists who support your work in counseling can facilitate recovery in numerous ways, including but not limited to:

  • Providing a separate “safe place” to discuss details of weight. Sometimes in eating disorder treatment, weight is an issue that must be addressed. Keeping the scale out of the psychotherapy room can be a helpful ingredient to maintaining the emotional safety necessary to do the therapy work.
  • Freeing up time and attention in the psychotherapy room to address underlying issues that may be driving the eating disorder. When food, body image, and weight become an obsession, one’s every waking thought can be permeated by its torment. This relentless distraction is required to perpetuate the disorder, and can also serve as a compelling distraction in the psychotherapy room. Nevertheless, it is important for the recovering individual to also be able to focus on the details of food, whether that food has been avoided, consumed, binged, purged, or “merely” obsessed about. The skilled nutritionist can “hold” these concrete preoccupations, clearing a space in the psychotherapy room for the inner work to take place.
  • Establish a landing strip for “food metaphors.” What we do with food, we do with life. Thus, having a point person to share the details of your relationship with food can uncover rich material to further digest in psychotherapy. When nutritionist and therapist confer (with the patient’s written content), parallels are often drawn between unconscious emotional and relational issues and the metaphors expressed in the relationship with food.
Levels of Care in Eating Disorder Treatment

Sometimes it is useful to jump start recovery with an immersive level of care and then transition to an outpatient setting. There are several options in eating disorders treatment.

  • Inpatient Treatment (Hospital Based Programs) – This is most commonly a specialized eating disorder unit (EDU) within a hospital. Sometimes the EDU will have its own space, but at times, these programs are housed within inpatient psychiatric or medical units. Some group therapy is offered in these settings, and stays range from a few days to months. This level of care is most useful when re-feeding is essential for safety and cannot be achieved without 24-hour medically trained supervision.
  • Residential Treatment – This is similar to inpatient treatment in that it involves overnight stays, however, it is usually housed in a non-hospital setting. Residential treatment provides significantly more intensive group and individual psychotherapy, nutrition, and expressive therapies (art and movement, etc.). Stays are typically 30 to 90 days; however, longer stays can be most helpful for integrating recovery, practicing new skills, and preventing relapse.
  • Partial Hospitalization Programs (PHP) – Also known as Day Treatment, PHPs are typically held Monday-Friday, though some include weekends. They begin before breakfast and end in the afternoon or early evening. They involve meal support, numerous therapy groups, individual psychotherapy, nutrition therapy, and psychiatry. Some also include a family component for therapy and shared meals. The length of stay ranges between 30 and 90 days.
  • Intensive Outpatient Treatment (IOP) – These programs are typically held in the evening, 3-4 times per week. IOPs offer a variety of therapy groups and dinners with meal support. Participants in an IOP continue treatment with their individual psychotherapist, psychiatrist, and/or nutritionist. Lengths of stay can range from a few weeks to a few months.
Psychotherapy

While drawing on a diverse study of approaches, the psychotherapy process aims to support in the development, exploration, and restoration of the authentic, core Self. Treatment is attuned to the individual rather than wedded to a particular model. Accordingly, each person is treated with respect for their unique needs, values, goals, challenges, and inherent strengths.

Some of the terms you see sprinkled throughout our site or mentioned as we begin working together may be new to you. Here is a little more information if you would like to learn what guides our thinking and training.

Our clinical orientation begins with the recognition of the “continuity of being” – a concept rooted in Object Relations Theory, though also embraced and expressed in many therapeutic models, some of which are described below:

Object Relations Theory
A theory of relationships between people, in particular within a family and especially between the mother and her child. A basic tenet is that we are driven to form relationships with others and that a lack of successful early relationships leads to later problems. According to theorist Donald Winnicott, “the first ego organization comes from the experience of threats of annihilation which do not lead to annihilation and from which, repeatedly, there is recovery.” This safe environment allows the child to experience individuality and eventually develop a “continuity of being.”
Ego Psychology
Rooted in the Sigmund Freud’s structural id-ego-superego model of the mind, ego psychology focuses on the narrating portion of human consciousness that reflects on one’s thoughts, feelings, and actions. Ego in this sense is very similar to what we commonly think of as identity. A healthy ego is shored up by things such as insight into self; agency and self-directedness; self-esteem, acceptance, and compassion; empathy; an element of purpose; and philosophical and moral development.
Gestalt Therapy
This form of therapy recognizes that context affects experience, and a person cannot be fully understood without understanding his or her context. Gestalt therapy emphasizes awareness of the present moment and context. Through exploration of the present, people can discover feelings that may have been suppressed or masked by other feelings and eventually begin to trust their emotions.
Analytical Psychology
From the school of psychology that originated with Carl Jung, this type of therapy emphasizes the importance of the individual psyche and the personal quest for wholeness. This frequently involves looking at the way that past experiences have affected the individual and the way they continue to prevent us from living fulfilled lives. Analytical therapy is about “removing obstacles.”
Cognitive-Behavioral Therapy
CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in thinking, behavior, and emotional regulation. CBT is problem-focused and action-oriented, meaning that new information-processing skills and coping mechanisms are introduced to reach identified goals and decrease unwanted behaviors.
Family Systems Theory
It is the nature of a family that its members are intensely connected emotionally. While there will be differences in degree, interdependence is always present in a family unit. When utilizing this theory, we will consider the family as an emotional unit and apply systems thinking to analyze the complex interactions that make up that unit.
Feminist Psychoanalytical Theory
Women and other oppressed groups may be at risk for mental health issues due to psychological distress caused by societal obstacles such as victimization and violence, unrealistic depiction in the media, limited economic resources or opportunities, and work inequities. Therapy focuses on supporting the client as they work to overcome limitations and restrictions. Gender roles, socialization, identity development, and self-concept are all explored in order to promote empowerment.
Relational Psychotherapy
This form of therapy is based on the principle that emotional well-being depends on having a satisfying mutual relationship with others. Individuals who find it difficult to maintain supportive and healthy relationships may experience a sense of disconnection in addition to feelings of diminished self-worth and general distress. In sessions, the therapist and client work together to forge a secure relationship that can serve as a model for future relationships the client wishes to develop.
Expressive Arts Therapy
Expressive arts therapy may incorporate writing, drama, dance, movement, painting, and/or music. Emphasis is placed on the process of creation rather than the final product, as imagination and self-expression can often form a road to healing.
Somatic (body-oriented) approaches
This is a holistic therapy that studies the relationship between the mind and the body in regard to psychological past. Sensations associated with past trauma may become trapped within the body and reflected in facial expressions, posture, muscular pain, or other forms of body language. Somatic therapy explores this mind-body connection, assuming that awareness and healing practices for both mind and body will continue to strengthen each other.
Mindfulness Therapy
The goal of mindfulness is to help individuals learn how to recognize their sense of being and see themselves as separate from their thoughts and moods. This disconnecting can allow people to become liberated from thought patterns in which the same negative messages may be replayed over and over. Certain meditation techniques – breathing meditations, sitting meditations, body scan meditations, walking meditations, and yoga – may help to improve a person’s mindfulness.
Dialectical Behavior Therapy
A specific type of Cognitive Behavioral Therapy, DBT emphasizes the psychosocial aspects of treatment. For people who are prone to react in a more intense manner toward emotional situations – especially those found in romantic, family, and friend relationships – DBT focuses on teaching skills that help individuals maintain more baseline emotional states.
Motivational Interviewing
MI is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence, or a person’s desire for change.
Existential Therapy
This type of therapy is based on the fundamental belief that each individual experiences internal conflict due to his or her interactions with certain conditions in human existence, such as responsibility, death, isolation, and meaninglessness. The key to existential therapy is to develop tools that strike a balance, helping the client to recognize that each of these things happen for all humans without becoming overwhelmed by that fact.
Humanistic Psychology
With an emphasis on the study of the whole person, humanism is a psychological approach that believes people are inherently good and will experience growth if provided with suitable conditions. Each person and each experience is unique, so therapists work with the client to understand experiences and work toward self-actualization (reaching maximum potential).
Books, Links, Podcasts
Some of Our Favorite Books

Eat, Drink, and be Mindful by Susan Albers, Psy.D.

Breaking Free from Emotional Eating by Geneen Roth

Feeding the Hungry Heart by Geneen Roth, accompanied by the workbook Why Weight?

The Craggy Hole in My Heart and the Cat Who Fixed It by Geneen Roth

When You Eat at the Refrigerator, Pull Up a Chair by Geneen Roth

When Women Stop Hating Their Bodies by Carol H. Munter & Jane R. Hirschman

Fat is a Feminist Issue by Susie Orbach

Take the Fight Out of Food by Donna Fish, MS, LCSW

Life Without Ed by Jenni Schaefer

Intuitive Eating by Evelyn Tribole and Elyse Resch

Eating in the Light of the Moon by Anita Johnston, PhD

8 Keys to Trauma Recovery: Take Charge Strategies to Empower Your Healing by Babette Rothschild

The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment by Babette Rothschild

The Courage to Heal by Ellen Bass & Laura Davis

Healing the Divided Self by Maggie Phillips & Claire Frederick

Peace is Every Step by Thich Nhat Hanh

Broken Open – How Difficult Times Can Help Us Grow by Elizabeth Lesser

What You Feel You Can Heal by John Gray, PhD

The Artist’s Way by Julia Cameron

Harold and the Purple Crayon by Crokett Johnson

The Little Prince by Antoine de Saint-Exupéry

The Woman’s Comfort Book by Jennifer Louden