Anorexia nervosa is an eating disorder, characterised by being underweight and by a fear and refusal around maintaining a normal, healthy weight for your age and height. Anorexia nervosa involves a preoccupation with body image, shape and weight; excessive weighing and body measuring; distorted eating and weight loss behaviours; and a lack of regard for the consequences of being underweight.
The National Institute for Health and Care Excellence (NICE) recommends psychodynamic therapy as one of the most effective treatments for anorexia. One of RSCPP's eating disorder experts, Chartered Psychologist Beverley Marais, explains what psychodynamic therapy is and how it can be used to treat anorexia.
Psychodynamic therapy focuses on your relationships both inside and outside of the therapeutic encounter. This therapeutic model allows for unconscious and conscious processes to develop. This means that the therapist would listen and respond to both conscious and unconscious material in the room. The lack of an overt perceived structure to the sessions may feel overwhelming or even unbearable for many clients, however this space is necessary for treatment to happen. One of the ways this would happen is through the therapist's use of transference (the thoughts and feelings you transfer from outside the therapy room on to your therapist) to modify and repair your internalised relationships. The therapist would comment and make interpretations of the current therapeutic relationship while, at the same time, being aware of the underlying unconscious anxieties this may provoke. Ultimately, in psychodynamic therapy, the view is that the underlying problems or causes need to be understood before there can be an improvement in symptoms.
Psychodynamic therapy for eating disorders explores your symptoms as representing disturbances in your relationships. One example of this dynamic would be to view yourself as fearful of your own greed, which results in rigidly limiting your food intake, thereby illustrating a lack of greediness. There would usually be a similar pattern within your relationships, wherein you may be fearful of your own dependent feelings. Often anorexic individuals view dependency as a sign of weakness. You may therefore try to illustrate to yourself and others that you are not dependent on food or any relationship for sustenance. When your focus is on controlling your body and food intake, relationships with others appear to become less important, so you create a sense of being emotionally and physically self-sufficient.
Clients who are vulnerable generally benefit from frequent therapy sessions. This could be weekly and, in some cases, twice weekly or more often, depending on the levels of intensity required for the individual. Because each client is different and unique, time and space is required to understand what has caused disturbances for you personally. For this reason, treatment may take many months and in some cases, years.
While the symptoms of anorexia may be similar in individuals, the treatment is an individualised and unique experience for each person. In addition, there is no treatment model for anorexia that is unequivocally effective in all cases, and it is therefore not possible to generalise on individual outcomes. Many clients are successfully treated on an outpatient basis, however those more seriously ill would be treated in specialist eating disorder units. Effective psychodynamic therapy with the client would result in a reduction in eating disorders symptoms and behaviours. Some people may gain greater understanding of the functions of their eating disorder, as well as awareness of some unmet needs in relationships. Ultimately, clients are invited to explore the very real possibilities around change and growth, the themes that impede their development, and begin to think about themselves and their relationships in a different way. Not all clients value the experience of psychodynamic therapy and, therefore, alternative models may better meet their needs.
All therapists on rscpp.co.uk are accredited, registered or chartered by a UK professional body. Therapists who offer psychodynamic therapy will in addition have completed a course in psychodynamic practice. You can also search specifically for therapists who have experience working with anorexia.