Talk Therapy for Eating Disorders: To Talk or Not To Talk

Many mental health providers use psychodynamic psychotherapy as their primary treatment method for a whole host of conditions that bring people to therapy. Psychodynamic psychotherapy is often referred to as “talk” therapy. The focus of dynamic therapy is on increasing awareness of how your past experiences impact your life today. The goal is to increase insight and self-knowledge, ultimately leading to more balance and contentment in your life overall.

While psychodynamic interventions are helpful to many, there is currently no strong empirical evidence to support the success of these interventions for conditions like anorexia, bulimia or binge eating disorder. In fact, I would go so far as to say that dynamic therapy and analysis would be counter-therapeutic – even dangerous – for someone with an eating disorder. Why?

Funny You Should Ask Why: With eating disorders, figuring out what caused the disorder in the first place is much less important than doing whatever it takes – immediately – to stabilize eating and weight and reduce symptoms like restricting, binge eating and purging. Early change (within the first 8 weeks of treatment) is the single most potent predictor of a good treatment outcome, so we’re motivated to help people change – fast. There are many factors that contribute to the development of an eating disorder including genetic influence and brain chemistry – so one will never fully establish the true root cause. It’s more important to invest energy in developing skills for coping with your biology and strategies for navigating the world of potential triggers to your disordered eating. So really, the “why” is secondary.

An ED is Not A Choice: Working to build motivation and waiting for someone to “choose” to get better could take time; meanwhile, one’s health can be diminishing rapidly. Effective ED therapists take an active, directive role to guide individuals through treatment. At times, family members may need to intervene (especially with adolescents/kids) to support re-feeding. EDs are serious illnesses with at times, very dangerous consequences. Intervention is needed even when there is ambivalence about – or even full on resistance to – getting better.

The Problem Becomes Physical: Yes, eating disorders are in part, emotional struggles, but the behaviors lead to physical changes that must be addressed directly. The medical consequences of starvation, purging, and driven exercise can be graves. Poor nutrition can lead to changes in the structure and function of the brain, leading to increased depression, anxiety, compulsivity. Weight and nutritional stabilization are key. Consistent, balance nutrition along with maintenance of a healthy weight can in and of themselves resolve many of the mood and behavioral symptoms that you would be addressing in traditional therapy.

Long Term Success & Prognosis: An approach that looks for deeper meaning and suggests that “it’s not about the food,” is not going to be conducive to long-term success. Treatment needs to get right into the food to help the individual relearn how to eat in a more balanced and health-supporting way. ED sufferers need concrete skills for coping and navigating eating throughout the rest of their lifetime.

At Columbus Park we pride ourselves on our dedication to research, development and scientifically informed interventions. To learn more about our intervention strategies and successes click here.