A Note from the Author and Introduction to this E-book
Therapist’s Unique Use of Self in Empowering an
Integrative Eating Disorder Recovery
Natenshon, MA, LCSW, GCFP
Guiding a path to recovery
Like a path of breadcrumbs through the woods, the eating
disorder recovery process is, by nature, an inconstant process, easily
derailed. Mental health practitioners who practice within this specialty
understand that even the most tried-and-true treatment choices will at
times fail to produce effective outcomes facilitating timely, complete
and sustainable recoveries.
As a virtual “GPS” for therapists, this Recovery Handbook defines a
clear direction for clinicians who may occasionally find themselves lost
within the maze of diverse treatment methods, modes and approaches.
This is a resource designed to
help therapists get back on track, so that they can do the same for
their patients. Keeping in
mind that any singular problem-solution will not represent the
only practicable solution, the
case examples provided here are intended to confirm your current
practice techniques, at the same time providing tools and strategies to
augment your options for anticipating, fielding and resolving recovery
An integrative healing process
I have found that in offering information to health
professionals about eating disorder diagnosis, treatment and recovery at
conferences or in the classroom, invariably there will be one or two
clinicians who express disappointment in my not having been more
“specific” in offering instructions that describe
exactly what to do and say.
Seeking such definitive or
formulaic information bespeaks a failure to consider the vastly
integrative and diverse nature of these complex disorders and the
distinctively unique quality of each recovery. Typically accompanied by
dual diagnoses, there is nothing predictable about eating disorders or
their healing; both defy reduction to any singular, boiler plate,
one-size-fits-all methodology purported to pertain to all cases.
[Note, however, that the strictly
manualized protocols for the practice of CBT (cognitive behavioral
therapy) and FBT (Family based treatment) have been known to offer some
degree of success with very specific patient populations within the
eating disorder community.]
It is the responsibility of every therapist to conceptualize
and communicate to patients an
integrative view of what eating disorders are, and how they heal… as
well as an affirmation of their optimistic potential for complete
The unique nature of each eating disorder recovery
The nature of the recovery work will be embedded in the unique
footprint of each individual disorder and the biology that has given
rise to it within an emotionally, biologically and developmentally
diverse patient population; in the patient’s inborn resiliency and
capacity to grow and change; in the patient’s and family’s capacity to
meet each others needs which evolve throughout the recovery process; and
in the unique and ever-changing requirements of the therapeutic moment.
Most importantly, the nature of the recovery process is determined by
and enhanced through a facile use of the professional’s self in
establishing a quality therapeutic attachment and relationship.
This type of professional facility is the most critical
factor in the healing process, along with professional skill mastery and
an integrative orientation.
As therapists, we navigate the same waters as do our patients
and their parents and families, in our need to field and comfortably
tolerate ambiguity, unpredictability and the unknown in helping patients
re-create and renew an effectively functioning Self (previously exiled
by the disorder.) Most therapists
already have acquired the skills and tools they need.
They simply need to learn which ones to use, when, why and
how…all while using themselves effectively in the process. It is for our
patients and their families to determine if we are up to the task.
Making order out of chaos
The tools and resources available to us are many and diverse.
Similar to astronauts who learn to navigate by recognizing stellar
constellations, as therapists, we too need to organize our
conceptualizations and treatment tools into meaningful and practicable
constellations capable of creating order out of the chaos of an eating
disorder; then we need to communicate them.
The ideas presented here will become increasingly meaningful and
lucid to clinicians as they gather professional experience in treating
these complex disorders.
The importance of family involvement in eating disorder
My emphasis on family involvement in eating disorder recovery
stems from the significant role parents and siblings need to play in the
eating disorder healing process, particularly in cases where the
identified patient is a young child or young adult living at home.
Eating disorders reside not only within the individual, but within the
family system; both the patient and his or her family require education
and healing throughout the recovery process. Eating disorder clinicians
need not only to understand
family systems, but to muster the courage and wherewithal to function
within them to heal the child
and family, while eradicating the disorder. In so doing, therapists
empower parents and loved ones to become Most Valuable Players on the
professional .treatment team.
In an effort to sustain the fabric of an integrated recovery
process, it is preferable for the therapist who treats the identified
patient to treat the family as well.
For additional case examples that illustrate specific examples
of treatment responses and strategies as they relate to various
approaches to treatment, see Chapter 13 of
Doing What Works: an Integrative
System for the Treatment of Eating Disorders from Diagnosis to Recovery.
(Natenshon, NASW Press)
Abigail Natenshon, MA, LCSW, GCFP