MEDICAL THERAPY FOR EATING DISORDERS: THE ROLE OF THE THERAPIST IN

Much of any therapy’s success depends on the skills and sensitivities of those who administer it. The job description for an eating disorder therapist calls for someone who will take an active role in the process, rather than one who adopts the neutral, interpretive stance of classic psychoanalysis. Since sometimes just learning the truth sets the patient on the right road, a therapist must provide accurate information and advice about eating and nutrition. In more severe cases, being therapeutically active means insisting on hospitalization or devising a plan for gaining weight outside the hospital.

The therapist may need to provide reassurance and support at every step. Eating disorder patients can be highly anxious about their situation. Anorexics, for example, often feel a sense of panic when their weight begins to rise or when menstruation returns. The therapist should anticipate this panic and know how to deal with it. Some anxiety arises because the patient has lost her ability to recognize her inner feelings. One of the greatest services a therapist provides is teaching the patient what her true feelings are and showing her that they are valid.

Properly handled, the relationship between the therapist and the patient provides a context of trust. The patient is gradually able to discuss “bad” feelings more freely and with less fear or shame. In time she begins to trust herself. When she reaches that milestone, she begins to feel she can trust other people as well. Therapy becomes a sort of microcosm of the whole world, and î the patient’s process of growth and maturation within that world.

If you are in treatment, or if you are shopping for a therapist, keep the above points in mind. A health-care professional who lacks these basic skills, or who fails to earn your trust, is less likely to be helpful.

There’s no hard and fast rule stating which type of therapy should be tried first. The choice depends on many factors. In less extreme cases I might hold off using medication until I’ve given other forms of therapy a chance. However, in dealing with a patient who has binged and purged every day for fifteen years but who will only be staying in the hospital for a month, I will be inclined to use every means at my disposal – not just medications but intensive individual, group, and family therapy as well. Some might describe this as a shotgun approach – but if you only have one shot, a shotgun can be pretty effective.