The Therapist’s Unique Use of Self in Empowering an Integrative Eating Disorder Recovery

By Abigail 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 conundrums.

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 healing.

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 recovery

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

www.AbigailNatenshon.com