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:
- 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.
- 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.