Eating Disorders: A Treatment Apart. The Unique Use of the Therapist's Self in the Treatment of Eating Disorders
Treatment skills that serve general mental health practice, though applicable to eating disorder care, by themselves will not suffice to meet the uniquely pressing demands and requirements of treating these life‐threatening disorders. Eating disorders adversely influence every aspect of human functioning, demanding a comprehensive and integrative approach to care. Because eating disorders disrupt the patient's relationship with self and others, the quality of the therapist's versatile and integrative use of self within the therapeutic relationship can become the single most significant intervention in achieving successful healing outcomes. The intensity of professional challenges within the treatment process reflects the urgency behind the patient's need to heal. Treatment efficacy is achieved through the therapist's commitment to a timely, intentional, and practicable fulfillment of clearly established goals, uniquely tailored to each patient and eating disorder. The self‐integrated psychotherapist, as case manager, is required to manage a complex landscape of pathology and strengths, regression and healing, diverse professional and familial resources, transference and countertransference phenomena and, with skillful proficiency, traditional as well as nontraditional (neurophysiological) treatment interventions and approaches to care. This chapter highlights key elements in the therapist’s V.I.A.B.L.E. (Versatile, Integrative, Action-oriented, outcome-Based, Loving, and Educative) use of self in facilitating the healing of the eating disordered patient and malnourished brain.
Part of the book: Eating Disorders
Neurobiology and the Changing Face of Eating Disorder Treatment: Healing the Eating Disordered Brain
By recognizing eating disorders (EDs) as disruptions in brain circuitry, neuroscience has begun to shed light on how people make changes in psychotherapy. The clinician who treats the eating disordered patient also treats the eating disordered brain. It is time for practitioners to become better acquainted with the organ they treat, and to apply neuroplasticity research findings to clinical practice. Eating disorders and body image disturbances signify the loss of integrity of the core self. Twenty-first century research and technology has validated the age‐old notion that healthy neuronal connectivity within, and between, mind(s), brain(s), and body(s) reintegrates and defines the healthy self. The concept of the “self” as embodied (grounded in somatic reality) expands the scope of effective healing practices. Neurophysiological (somatosensory education and mindful psychotherapeutic attachments) interventions that support the emergence of embodied mindfulness and sensory awareness facilitate the reintegration of the eating disordered brain, and of the fragmented core self. Both lie at the heart of eating disorder recovery. Nowhere in the field of mental health are the concepts of the embedded self and embodied healing as significant as in the treatment of eating disorders and body image disturbances. This article discusses the healing impact of neurophysiological connections, intrapersonal and interpersonal, that foster recovery of the self.
Part of the book: Eating Disorders
Reclaiming the Lost Self in the Treatment of Bulimia Nervosa: A Neurobiological Approach to Recovery That Integrates Mind, Brain, and Body
The pathology of bulimia nervosa reflects the ‘dis-integration’ of the structure of the self within the distributed nervous system, resulting in the patient’s impaired sense of self and incapacity to sense self-experience. The twenty-first century definition of self as ‘an embodied, sensory-based process grounded in kinesthetic experience’ not only refutes the long-held myth of mind-body dualism, but also sheds light on the influence of neurobiological factors in disease onset and on how people make recovery changes within psychotherapy. The capacity to create, or reinstate, self-integration is built into the nervous system through the neuroplastic brain’s ability to change its structure and function in response to thought, sensation, feeling, and motor activity. The introduction of neurophysiological (sensorimotor) and neurobiological (interpersonal, attachment-based) interventions into mainstream clinical treatment for bulimia nervosa increases exposure to embodied experience, fostering mind, brain, and body connectivity. By stimulating integrative neuronal firing and synaptic activity, top-down and bottom-up transactions enhance acuity in self-sensing, self-perception, and body image coherence, supporting the unification of the disparate self. The current focus of mainstream clinical eating disorder treatment on symptom reduction alone neglects the neurological underpinnings of the disease. This chapter describes a range of treatment options for bulimia nervosa designed to support sustainable changes at the brain level.
Part of the book: Anorexia and Bulimia Nervosa
Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis and Treatment of Disordered Eating and Clinical Eating Disorders
Eating disorders, the most lethal of all the psychiatric disorders, are frequently misdiagnosed as benign weight management problems, which contribute to their being underdiagnosed and under-reported. Though eating disorders are typically first identified through easily discernible weight change, their unseen origins lie in genetic propensities, neurobiology, environmental and family influences, inborn temperament, and trauma. Non-integrative, behaviorally based weight management solutions that call for dieting and meal plans alone, by ignoring the psychological underpinnings and neurobiological origins of dysfunctions driving these disorders, can potentially lead to loss of life and/or life quality. Conversely, generic psychotherapy protocols typically fail to address and enforce the behavioral prerequisite to re-feed the malnourished eating disordered brain and body, which is required to optimize therapy outcomes. It is for the intuitive and skillful diagnostician to determine whether the patient’s desire for weight change is based on healthful autonomous discretion or on the dictates of compulsions based in life-threatening pathology, thus informing treatment. Eating disorders are disorders of the core Self of self-regulation, self-perception, self-esteem and self-care, affecting life spheres far exceeding eating-lifestyle and weight management. Healing weight management problems requires integrative diagnosis and care, re-establishing one’s healthy relationship with food, weight, and eating, as well as with one’s re-integrated core self.
Part of the book: Weight Management