It takes courage for clients to admit that they are starving, gorging themselves, or engaging in various forms of self-inflicted violence to purge the calories they’ve consumed. When they reveal these behaviors to a therapist, it’s understandable that the clinician’s own anxiety kicks in and what follows is a tunnel vision approach and aggressive campaign to extinguish those behaviors as fast as possible. The end result is an ongoing emphasis on food, weight, and the eating disordered symptoms. At the end of the day, it’s not about the food. Yes, it’s true that many people who have chronically engaged in anorexic, bulimic, and bingeing behaviors need nutritional guidance and a re-education about the importance of portion size, the food pyramid, and responding to body cues for hunger and fullness. But treatment that focuses almost obsessively on calories, goal weight, and recordings of food eaten and purged, winds up exacerbating the clients’ existing obsessions about body image, weight gain, weight loss, and food groups.
The treatment of eating disorders must go deeper than that. I believe it’s critically important to identify and de-code the meta-communication of the eating disorder, and to consider that a trauma or pain narrative is being revealed and re-enacted through restricting, purging or bingeing. Imagine where therapy can go when therapists and clients are open to the possibility that starving connects to feelings of invisibility and loss, or a re-enactment of a lack of nurturance in a neglected childhood. There is so much to potentially mine and explore when bingeing becomes a metaphor for “building a protective shield” as a creative way to stave off intimacy, or as the counterbalance to never feeling “seen” in the world. When our vision expands, purging is not just about getting rid of food, but rather symbolically getting rid of a feeling of being “dirty” or “bad” that has been embedded deep within the body because of physical or sexual trauma.
In addition, when eating disorders are reframed as coping strategies and creative vehicles through which a forbidden trauma or pain narrative can be revealed, the sense of guilt and shame, and the self-imposed diagnosis of damaged, weird, or crazy begins to abate. Instead, genuine feelings of compassion and self-forgiveness become a part of the treatment and an important component for healing. This sense of compassion must also come from the therapist in order to counter-balance the counter-transferential feelings of frustration, anger, anxiety or judgment that inadvertently make their way into the therapy room and compromise our ability to be effective. Using creative, right-brain based treatment strategies such as collaging, drawing, sand tray, poetry, and body-based therapies help to unpack the deeper meaning of an eating disorder, access clients’ existing creativity, and bring a newfound sense of hope into the treatment process.
What has been your experience in treating clients with eating disorders? Tell what therapies have worked best for you!