Types of Therapy in Eating Disorder Treatment

There is a lot of evidence that suggest the imperative use of therapy in eating disorder recovery. Eating disorders are a mental health diagnosis, which suffer severe physical and biological consequences, therefore, therapy is ESSENTIAL to achieve full recovery. Most people understand the role of a dietitian in eating disorder recovery, because it has to do with food, but sometimes the role of therapy can be a little obscure.

This blog post will dive into what is psychotherapist? What is a psychotherapist’s role in ED recovery? And reveal the common types of therapy used to treat individuals with eating disorders, and explain what and how they work with your treatment! By the end of this blog post, you will have a better idea of what to expect coming into your first therapy session with a trained, licensed therapist.

Therapist vs a Psychotherapist?

A therapist is not a protected title, meaning it is not regulated by an organization that protects certain acts and titles. Similarly, to a healthcare worker (not protected title), and a medical doctor (protected title). So essentially, anyone could call themselves a therapist.

Psychotherapists is a protected title as they must be registered with a regulatory body that oversees these mental health professionals. In Ontario, this regulatory body is called the College of Psychotherapists of Ontario. Psychotherapists cannot prescribe medication or provide any formal mental health diagnoses.

The role of a psychotherapist in ED treatment?  

Psychotherapists are an important part of the treatment team. Usually, therapists come into play once the client’s medical instability has been addressed and the client is working towards achieving medical stability.

First and foremost, the role of the psychotherapist is to help the client work towards mental stabilization. So, addressing (if any), higher risk thoughts that are happening, as well as develop tools for navigating their recovery (such as the refeeding process) and coping with the distress of that experience.

Longer term, the role of a psychotherapist is to help address the original cause of the eating disorder. Over time, when the eating disorder becomes unchecked, or develops in a way that’s now maladaptive, it can become very harmful. That’s where we need to learn different strategies to cope. So even though the onset of an eating disorder is typically the brains way of trying to do something that is really helpful and protective, it often doesn’t stay that way for very long. A psychotherapist can help you start building insight into what may have been the factors that lead to this type of thinking and then work to help change the trajectory and develop new, more adaptive ways of coping.

Treatment Setup for Eating Disorder Recovery

It’s important to note that there are various ways that therapy can look like, depending on the setting and access to care.

If there is any acute medical attention required, typically, inpatient care/hospitalization is best. At this stage, there is not a whole lot of therapy provided until the client is medically stable.

Then there are residential treatments, where clients are medically stable but still require 24hr care and hospitalization programs where people go to the hospital during day hours, have meal support for all meals and do therapeutic group sessions to continue with their eating disorder recovery. They get to go home at night and on weekends.

Then we have outpatient treatment, which is what we offer here at The Balanced Practice. This is for folks who are stable enough to be recovering outside of the hospital, but still need to learn to recover and maintain their recovery in “the real world”.

Types of therapy in an Outpatient setting

1.  Cognitive Behavioural Therapy (CBT):

• Works off the assumption that thoughts, emotions and behaviours are interconnected, and that we can work to restructure them to support new, adaptive thoughts and actions. Often, in order for the therapy to be effective, you would have weekly appointments for 20 weeks, so a total of 20 sessions, in an outpatient setting.
• At first, the focus is largely on education, and addressing concerns about the first stages in recovery, usually weight restoration if that needs to occur. Then, with time, we start doing the big bulk of the work, which is where we focus on the processes and the factors in the life of the client that are maintaining the eating disorder or the eating problem. We are going to be talking a lot about weight, shape, eating, and working to enhance the client’s ability to deal with daily triggers and moods, as well as beginning to address any food rigidity/rules. Towards the end of treatment, the focus is primarily future oriented. Guiding the client on how to maintain the changes they have made.

2. Interpersonal Therapy

   • An interpersonal struggle is a struggle between you and another person or multiple people. In this care, we focus mainly on the relationships that actually cause of sustain the eating disorder, as opposed to addressing the eating disorder head on itself. The idea is to explore how some of the challenges and ruptures in your current relationships are based on the eating disorder, and also how these challenges may have led to the development of the eating disorder itself.
   • Once we have identified the interpersonal problems that need to be addressed, we start to build more insight on how to actually make changes and address them. Towards the end of treatment, we work on making sure that the changes we have made are sustainable and minimize risks of relapse.

3. Family Based Therapy (FBT):

   • Generally used for children, young adults and people still living at home with a family around them. The goal is to empower the caregivers of children or teens, to take responsibility for managing the eating disorder symptoms with the goal of restoring the health of their child. This typically includes weekly sessions that involve the whole family, so parents/caregivers, siblings and other important active family members.
   • At first, the caregivers are supported to reestablish normal eating patterns. Generally, with the support of a dietitian, they are the ones taking back full control over food and its trusted that the caregiver understands how to feed their child. Gradually, we work on giving the child/teen an appropriate amount of control back. Some choices may be reintroduced or maybe involvement in food preparation.
   • Finally, as things progress, the therapist works with the child to establish a new identity outside of the eating disorder that aligns with their values for life.

4. Emotion Focused Therapy (EFT):

   • This form of therapy is where individuals learn how to manage their maladaptive emotions, as opposed to trying to control them using eating disorder behaviours. So, the premise of this type of treatment is that what a person eats or doesn’t eat, as well as the behaviours around that may develop as a way of controlling emotions, or as an outlet for those emotions. The goal of this treatment is to assist clients in learning to process unpleasant emotions, while learning to tolerate and regulate them without needing to engage in eating disorder behaviours.
     

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5. Dialectical Behavioural Therapy (DBT):

   • DBT is based on the assumption that self destructive behaviours are caused by the inability to manage and regulate intense, intense emotions. It is a combination of cognitive behavioural techniques and acceptance therapies.
   • There are 4 Pillars that constitute DBT:
     1. Mindfulness: being aware of the present moment without judgement.
     2. Distress Tolerance: Managing intense emotions in the short term
     3. Emotional Regulation: Understanding and reducing our vulnerability to emotions.
     4. Interpersonal effectiveness: learning how to get our needs met, maintaining relationships and increasing our self-respect within relationships

6. Acceptance and Commitment Therapy (ACT):

   • It is designed to increase the psychological flexibility of a client. So, a lot of times, clients with eating disorders, particularly anorexia, will struggle with psychological rigidity. So psychological flexibility means being able to contact the present moment fully as a conscious human being.

7. Internal Family Systems (IFS):

   • This focused on the idea that within our min, there is this inner world à a system.
   • And this system functions with various parts, for example our personality traits.
   • This therapy modality helps clients to separate their eating disorder from their true self. It can help clients learn to challenge those thoughts that maybe aren’t their actual true, authentic thoughts, and then being able to eventually dissipate those thoughts that belong to the eating disorder.

8. Mindfulness based interventions (MBI):

   • This approach has been proved effective for binge eating disorder and is used often as a complementary treatment for other types of eating disorders. It supports clients in reconnecting to their body signals of hunger and fullness, as well as reduce the amount of a judgement experienced during times of eating. It is basically focused on the use of meditations, body scans and mindfulness exercises to increase a focused, purposeful awareness of the present moment, and to relate to their experience in a non-judgmental manner.

9. Compassion focused therapy (CFT):

   • This has been developed to target self-criticism and shame. Clients are taught to view themselves and others through a compassionate lens, including their bodies and their body’s needs. It’s based on the premise of three systems within the brain, so the drive, threat and suit system. It works to address the shame, the pride, self-directed hostility and self-criticism, all of which are factors that maintain the eating disorder.

How to pick a therapist?

There is more and more research that suggests an individual should be looking someone who they will have a strong therapeutic alliance with, and not necessarily the types of treatment they offer. Basically, this means that the relationship between the therapist and the client is the number one predictor of whether your treatment is going to be successful or not.

If you are seeking care for an eating disorder, disordered eating or any other food or body challenges, you should prioritize someone who is informed and trained in this area. This means, you will need to ask questions, because a lot of times on certain websites, such as Psychology Today, some therapist will click that they treat eating disorders, but in reality they only saw one or two clients with eating disorders. So it’s really important to reach out, ask more questions about what therapy for eating disorder recovery might look like and what framework they work from.

Other things to look for in a therapist (and all members of your treatment team, as best as possible):

They are anti-diet

They are Health At Every Size

They are trauma informed

CONCLUSION

I know, this was a lot of information! But I hope you found it helpful to clarify some of the common approaches used to support individuals with eating disorders and disordered eating of all types. If you are hesitant or unsure if therapy is right for you, there is no harm in simply reaching out and connecting with a therapist for a free connection call. This allows you to ask questions in a safe space and see if this therapist will be right for you.

🎙 MORE INFORMATION ON THIS WEEK’S PODCAST🎙

Hear me explore this topic more in depth in this week’s podcast episode with one of our team’s psychotherapists, Kellie! Access it by clicking on any of the icons below!

Need support?👇

The Balanced Practice is a team of professionals specialized in eating disorder outpatient treatment, disordered eating. Our mission is to help as many folks heal their relationship with food and their bodies so they can live happily outside of diet culture!

We strive to provide evidence based counselling to support you, or your loved one, in achieving full recovery. Schedule a connection call now.

Marie-Pier Pitre-D’Iorio, RD, B.Sc.Psychology
Lead Registered Dietitian and Founder of  The Balanced Practice