{"id":39315,"date":"2018-09-01T06:00:27","date_gmt":"2018-09-01T13:00:27","guid":{"rendered":"https:\/\/www.goodtherapy.org\/blog\/?p=39315"},"modified":"2018-09-11T09:22:03","modified_gmt":"2018-09-11T16:22:03","slug":"eating-disorders-and-the-therapeutic-relationship","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/eating-disorders-and-the-therapeutic-relationship-0910184","title":{"rendered":"Eating Disorders and the Therapeutic Relationship"},"content":{"rendered":"<p><a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/eating-disorders\">Eating disorders<\/a>,\u00a0the most lethal of all the mental health disorders, kill and maim 6 to 13% of their victims, 87% of whom are children under the age of 20. &#8220;Best practice&#8221; treatment strategies for patients with <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/anorexia-nervosa\">anorexia nervosa<\/a>, <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/bulimia\">bulimia nervosa<\/a>, and <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/binge-eating\">binge eating<\/a> disorder all too frequently fall short of achieving timely and sustainable recovery outcomes. Beyond eating lifestyle dysfunction, eating disorders represent impairment of the patient\u2019s Self, as seen in the loss of self-trust, self-control, self-regulation, self-care, and emotional resiliency, so necessary in coping with adversity and engaging in confidence-building life opportunities.<\/p>\n<p>The development and recovery of the re-integrated Self in eating disorder treatment is best facilitated through the mindful and versatile use of the therapist\u2019s self within a quality <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/definition-of-therapeutic-relationship\">therapeutic relationship<\/a>, the inclusion of parents and families in the treatment process where appropriate, and an appreciation of the fact that within the context of clinical treatment, healing changes in the patient\u2019s behaviors and attitudes represent healing changes in the patient\u2019s brain.<\/p>\n<h2>Eating Disorders and the Loss of Self<\/h2>\n<p>From infancy to adulthood, self-development occurs primarily within the context of human relationships, be they personal, familial, or professional. The loss of the connection with the eating disordered individual\u2019s authentic Self becomes apparent cognitively, emotionally, physiologically, neurologically, and socially, typically rendering victims resistant to accepting <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/diagnosis\">diagnosis<\/a> and engaging in treatment. Losses of connection can be seen in:<\/p>\n<ul>\n<li>A lack of neurobiological connectivity within brain domains and within the distributed connections between the cranial-based self and the embodied-self.<\/li>\n<li>The loss of the patient\u2019s healthy relationship with food.<\/li>\n<li>The loss of connection to significant others due to social withdrawal.<\/li>\n<li>Attachment dysfunctions in eating disordered individuals, which often exacerbate challenges in treatment engagement and continuity of care.<\/li>\n<li>Experiencing disconnection from feelings and sensation; eating disordered individuals may not recognize eating disorder symptoms as signs of dysfunction, denying the existence of a problem.<\/li>\n<li>Withdrawal from significant others that may result in parents speaking of their eating disordered children as \u201cstrangers.\u201d Where weight and behaviors typically reside on the continuum of normal, eating disorders ironically surface all too rarely in physician\u2019s offices during medical examinations and in laboratory tests. Nondisclosure of dysfunctional behaviors is typical in psychotherapy offices as well, in light of the patient\u2019s fear of <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/stigma\">stigma<\/a>, rejection, or having to face the reality of the need to recover.<\/li>\n<\/ul>\n<p>Self re-integration, a pivotal predictor in the achievement of positive mental health (Siegel, 2006) and a benchmark of full eating disorder recovery, becomes enhanced by treatment modalities that facilitate connections between people, mind-brain-and-body systems, and brain domains.<\/p>\n<p><span class=\"popout-quote-right\" style=\"font-weight: bold; width: 30%; float: right;\">Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship.<\/span><\/p>\n<h2>Parents and Families As Recovery Advocates<\/h2>\n<p>Eating disorders insinuate themselves into relationships between family members. As family system disorders, eating disorders show up everywhere within the context of daily living, side by side with significant others, at kitchen tables, in restaurants, in family bathrooms, at school, and in places of employment. Though generally not responsible for causing eating disorders, which originate in genetic and temperament susceptibilities, parents who participate in their child\u2019s treatment and engage in <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/psychoeducation\">psychoeducation<\/a> enjoy the potential to promote disease prevention and\/or recovery. Becoming knowledgeable about eating disorders, the complex nature of their treatment and recovery, and their own role in their child\u2019s recovery (particularly when the child remains in outpatient care while residing at home), parents can become \u2018most valuable players\u2019 in their child\u2019s treatment team.<\/p>\n<p>Recovering patients, faced with the demands and challenges of eating healthfully throughout each day, average no more than 50 minutes per week in face-to-face contact with helping professionals. Educated parents can become helpful in filling this void. With the understanding that the nature of parental support offered will need to change to align with their child\u2019s changing needs as they progress, family participation in therapy gives both patient and family a voice, and an ear, in expressing and listening to feelings and in resolving conflicts and problems. By reconnecting with their child and learning how to understand, coach, and support their loved one, parents enhance their child\u2019s emotional development and <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/self-care\">self-care<\/a>.<\/p>\n<p>The bonding and trust that develops in <a href=\"https:\/\/www.goodtherapy.org\/family-therapy.html\">family treatment<\/a> greases the path for the patient\u2019s eventual separation and individuation, increasing the child\u2019s capacity for autonomy and healthy self-regulation. Family sessions also diminish the potential for manipulative \u201csplitting\u201d and\/or confidentiality breaches that could otherwise jeopardize a multi-disciplinary team treatment process. If not part of the solution, family members risk becoming part of the problem.<\/p>\n<h2>The Patient\/Therapist Relationship in Research<\/h2>\n<p>Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship. The trust that develops between therapist and patient within the treatment process ultimately re-ignites the patient\u2019s trusting reconnection within their own exiled Self. The mindful therapeutic relationship ideally becomes the prototype for other healthful, quality relationships elsewhere in the patient\u2019s life outside of the treatment system. Dr. Christopher Germer, in <em>Mindfulness and Psychotherapy<\/em> (Germer, 2005), considers <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/types\/mindfulness-based-interventions\">mindfulness<\/a> in therapeutic practice to be the pathway to establishing a healthy, healing treatment relationship. He speaks of the therapeutic relationship as \u201can intervention in itself\u201d with <a href=\"https:\/\/www.goodtherapy.org\/blog\/psychpedia\/empathy\">empathy<\/a> accounting for \u201cas much, and probably more outcome variance than does the specific intervention.\u201d He describes good therapeutic relationships as \u201cthe most potent of all the treatment interventions for healing within a mental health venue,\u201d (Germer) providing the pathway out of an eating disorder.<\/p>\n<p>According to Dr. Allan Schore, it is through the quality of the human relationship that \u201cdeficits in internal working models of the self and the world are gradually repaired\u201d (Schore, 1996). Schore describes a phenomenon that exists between therapist and patient called \u201cempathic resonance\u201d (Schore &amp; Schore, 2008), \u201cwhich results in the patient\u2019s right brain hemisphere becoming neurophysiologically altered in form and function in response to a mindful, quality connection to the functioning of the therapist\u2019s right brain hemisphere. Right-brain to right-brain human attachments through mindful psychotherapeutic connectedness often result in the patient feeling \u2018felt,\u2019 creating a state of neural activation with coherence in the moment that has been shown to improve the patient\u2019s capacity for self regulation\u201d (Siegel, 2006).<\/p>\n<p>A quality patient-therapist connection lays the foundation for the patient\u2019s development of the Self, in addition to the foundation of a complete and lasting eating disorder recovery.<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Germer, C. K., Siegel, R .D., &amp; Fulton, P. R. (2005). <em>Mindfulness and psychotherapy.<\/em> New York, NY: Guilford Press.<\/li>\n<li>National Eating Disorder Association. (n.d.). Retrieved from https:\/\/www.nationaleatingdisorders.org<\/li>\n<li>Schore, J. R. &amp; Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. <em>Clinical Social Work Journal, 36<\/em>(1), 9-20. doi: http:\/\/dx.doi.org\/10.1007\/s10615-007-0111-7<\/li>\n<li>Siegel, D. J. (2006). An interpersonal neurobiology approach to psychotherapy; Awareness, mirror neurons, and neural plasticity in the development of well-being. <em>Psychiatric Annals, 36<\/em>(4), 248-256. Retrieved from https:\/\/www.researchgate.net\/publication\/241200655_An_Interpersonal_Neurobiology_Approach_to_Psychotherapy_Awareness_Mirror_Neurons_and_Neural_Plasticity_in_the_Development_of_Well-Being<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Eating disorders,?the most lethal of all the mental health disorders, kill and maim 6 to 13% of their victims, 87% of whom are children under the age of 20. &#8220;Best practice&#8221; treatment strategies for patients with anorexia nervosa, bulimia nervosa, and binge eating disorder all too frequently fall short of achieving timely and sustainable recovery [&hellip;]<\/p>\n","protected":false},"author":3147,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[628,623],"tags":[1340,1341,230,900,644],"class_list":["post-39315","post","type-post","status-publish","format-standard","hentry","category-general","category-issues-treated","tag-anorexia","tag-bulimia","tag-eating-food-issues","tag-eating-disorder","tag-therapeutic-relationship"],"_links":{"self":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/39315","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/users\/3147"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/comments?post=39315"}],"version-history":[{"count":0,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/39315\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media?parent=39315"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/categories?post=39315"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/tags?post=39315"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}