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Psychotherapy is valuable, and probably essential, for returning to healthy eating habits in the process of recovery from an eating disorder. Here are five things you can expect with regard to psychotherapy for eating disorder.

Most people who live with eating disorders benefit from psychotherapy, especially during the early stages of their recovery, but periodically for the rest of their lives. Psychotherapy is a highly individual process. Different types of psychotherapy work better for different people, and the kind of psychotherapy that works best during one stage of recovery may not be the kind of psychotherapy that works best during another stage of recovery.

Here are five things to know about psychotherapy for eating disorders.

Certain kinds of issues are usually treated with short-term therapy

Interpersonal therapy (IPT) is one of the most common forms of psychotherapy offered to people who live with eating disorders. It isn't intended to reshape the personality. It's only intended to build interpersonal skills and to improve one or two areas of life skills that are especially important to changing dysfunctional eating and exercise habits. The goal of IPT is rapid improvement. The most common approach to IPT is cognitive behavioral therapy (CBT). This kind of therapy focuses on correcting dysfunctional attitudes and distorted beliefs about weight, shape, and self-image.

Even "deep" psychological issues are sometimes addressed with short-term therapy

Psychodynamic psychotherapy seeks to uncover and resolve the underlying emotional injuries that lead to injurious eating and exercise habits. Getting to the bottom of emotional issues usually requires confronting painful secrets that may not be consciously accessible. Progress may be slow, and treatment may take years.

Most people in recovery from eating disorders go in and out of psychotherapy as needed

Participation in psychotherapy isn't an all-or-nothing process. Some people make good progress with their therapist, and then run into issues that require additional help. It's important to remain open to therapy as needed, and to maintain channels of communication with potential therapists (as well as the ability, usually insurance, to pay them).

Signs that help from a therapist is needed include:

  • You had a problem with underweight and you've started losing weight again. Or you had a problem with excessive eating and you have started gaining weight again. Medical problems have to be ruled out. But once they are, it's important to get back on track in recovery from your eating disorder. It's usually a good idea to seek help when your weight changes by three percent, higher or lower.
  • You had issues with excessive exercise and you find yourself exercising more than an hour a day without a specific reason, for instance, you became a professional athlete. Or you have had a series of activity-related injuries and you can't stop working out every day long enough to recover from them.
  • You feel guilt about eating or exercising. If you feel like something is wrong, let a therapist help you identify what it is so you can feel better. And if you don't want to feel better, that's a very important reason to see a therapist.
Anytime feelings of hopelessness or preoccupation with death or suicide occur, seek mental health help immediately.

Families of people who live with eating disorders need therapy, too

There's an old saying that it's usually the least affected (that's not quite the word used in the saying, but we will be nice) member of the family that spends the most time in therapy. It's not at all unusual for siblings of children and teens who have eating disorders to develop their own serious issues around feelings of neglect, that all the family's attention and resources are flowing to their brother or sister. They may project their anger by bullying the sibling with the eating disorder, making the eating disorder worse, so that it requires even more attention. These patterns may become life-long even after the sibling with the eating disorder achieves recovery.

It's also not unusual for married partners of people living with eating disorders to develop their own emotional issues. Usually the partner who has the eating disorder is ashamed of it and secretive about it. Even so, they may expect sympathy and support from their partner who is not quite sure what is going on. The partner in turn is puzzled and not quite sure what to do, experiencing his or her own anxiety about their partner's condition. 

Psychotherapy for children who have eating disorders always requires addressing family dynamics. Psychotherapy for partnered adults with eating disorders always requires a consideration of the marital relationship.

Psychotherapy is available over the Internet

Both psychotherapy through Skype and online chat rooms and recorded video sessions with counselors are available over the Internet. This format is more popular with teenagers than with adults and more popular with males than with females. Researchers have found that where teenagers first learn about Internet counseling makes a difference. If Internet counseling is suggested by their schools, they are less likely to participate. If they learn about Internet counseling from online search or printed materials, they are more likely to participate and seek help with more difficult issues.

  • [No authors listed] Psychological interventions for eating disorders. Drug Ther Bull. 2016 Dec. 54(12):141-144. doi: 10.1136/dtb.2016.12.0445.
  • Grenon R, Schwartze D, Hammond N, Ivanova I, Mcquaid N, Proulx G, Tasca GA. Group psychotherapy for eating disorders: A meta-analysis. Int J Eat Disord. 2017 Sep. 50(9):997-1013. doi: 10.1002/eat.22744. Epub 2017 Aug 3. Review. PMID: 28771758.
  • Photo courtesy of SteadyHealth

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