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NEDA TOOLKIT for Parents Family Systems Therapy (FST). FST emphasizes family relationships as an important factor in psychological health. Therapy interventions usually focus on relationship patterns and communication rather than on analyzing impulses or early experiences that may have contributed to development of the ED. Family Systems Therapy is different from FBT in that it focuses on the interactions between family members as a way to improve eating disorder behaviors. Psychodynamic Psychotherapy. The psychodynamic approach holds that recovery from an eating disorder requires understanding its root cause. Psychodynamic psychotherapists view behaviors as the result of internal conflicts, motives and unconscious forces, and if behaviors are discontinued without addressing the underlying motives that are driving them, then relapse will occur. Symptoms are viewed as expressions of the patient’s underlying needs and issues and are thought to disappear with the completion of working through these issues. Separated Family Therapy (SFT). In SFT, the adolescent is seen on his or her own and the parents are seen in a separate session by the same therapist. This differs from Conjoint Family Therapy (CFT) where the patient and family are seen together. Both are effective, but the separate parallel sessions in SFT are favored in cases where there is a high degree of hostility or parental criticism. (some definitions adapted from FEAST’s Glossary of Eating Disorders.) It is important to note that while all of these therapies are frequently used to treat individuals with eating disorders, they have varying levels of efficacy and research supporting their use. Many professionals now recommend the use of evidence-based treatment, which is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” In eating disorder therapies, evidence-based treatment usually means that the therapy has been used in a research study and found to be effective in reducing eating disorder symptoms, encouraging weight restoration in underweight patients, and decreasing eating disorder thoughts. Some trials of eating disorder psychotherapies are small and are not necessarily compared to other forms of psychotherapy, which can make it difficult to compare the efficacy of various treatments. Other factors that make testing ED therapies difficult include the relative rarity of eating disorders, high patient drop-out rates, and large costs. Generally speaking, CBT, DBT, ACT, and FBT are currently some of the best-studied commonly- used eating disorder treatments supported by several different studies around the world. It’s important to remember that just because a therapy is classified as “evidence-based” doesn’t mean that it automatically works for everyone; just that it works for many patients. Do some research and evaluate which types of treatments would best target the symptoms and psychological issues being faced by your loved one. Also keep in mind that not all therapists who say they utilize a type of treatment actually use it in all of their sessions. Some CBT therapists, for example, might have a primarily psychodynamic approach and only occasionally use CBT principles. So be sure to ask about how strictly the therapist adheres to treatment guidelines, what a typical session might consist of, how much training the therapist has received in this particular treatment modality, the rough percentage of patients who they treat using this form of psychotherapy, and how current their ED knowledge base is. Selecting a psychotherapist Just as not all psychotherapies are created equal, not all therapists are created equally either. It matters less how long a specific therapist has been practicing and more on how skilled they are at treating eating disorders and how up-to-date their knowledge is. Although there may be exceptions, eating disorder treatment generally addresses the following factors in roughly this order: 1. Correct life-threatening medical and psychiatric symptoms 2. Interrupt eating disorder behaviors (food restriction, excessive exercise, binge eating, purging, etc.) 3. Establish normalized eating and nutritional rehabilitation 4. Challenge unhelpful and unhealthy eating disorder and ED-related thoughts and behaviors 5. Address ongoing medical and mental health issues 6. Establish a plan to prevent relapse Page  | 32