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
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