During treatment at an eating disorder recovery center, a person can expect to engage in several different types of therapy.These may be centered around directly addressing disordered eating behaviors, but they can also be more tangential. Family therapy, group sessions, mindfulness exercises, and various experiential and exposure therapy methods are usually incorporated into a comprehensive care suite at modern eating disorder treatment centers.
Many people who are ready to seek help for an eating disorder are nervous or anxious about going into treatment, especially residential treatment. That’s normal, and you shouldn’t feel bad about having some hesitation before going into treatment. This guide, hopefully, will help to ease your concerns (or your loved one’s) and explain what should be expected.
What Are Eating Disorders?
Before getting into the types of therapy used in treatment, you’ll need to know how to identify an eating disorder. Please note that a true diagnosis can only come from a doctor or psychologist, but you can check out this guide to eating disorder symptoms to get an idea of what to look for.
There are many different types of eating disorders, but three of them are the most common. These include:
A preoccupation with weight and being thin that leads to dramatic caloric reduction and weight loss. Normally, anorexia nervosa includes a distorted body image that leads the individual to believe they are overweight even when they have become severely underweight due to a lack of eating.
Binge Eating Disorder
A repetitive condition in which a person will experience a compulsion to eat a large amount of food in a short period. Usually, this is done in private, and normally it induces feelings of guilt and shame about the behaviors. People with BED often struggle with being overweight and engage in fad diets, experiencing body dissatisfaction.
A person with bulimia nervosa repeatedly and regularly engages in binge eating episodes as with BED, but following these episodes, they purge the calories taken in as a way to prevent weight gain. Most often this is accomplished by self-induced vomiting, but abusing laxatives or diuretics, or compulsively exercising are common as well.
There are variations of these disorders, as well as less common eating disorders like Avoidant/Restrictive Food Intake Disorder (ARFID) and Other Specified Feeding and Eating Disorders (OSFED) which are less common but no less dangerous.
The presence of any of these disorders constitutes a serious mental and physical health risk. If you or a loved one has received an eating disorder diagnosis, it’s time to look into getting help.
Therapy at an Eating Disorder Treatment Center
Treating Underlying Causes
Skilled therapists are trained to use a variety of methods to help people in their care identify the underlying causes of their eating disorders. In most cases, a combination of social pressures, genetic inheritances, and environmental causes are behind the development of an eating disorder.
These underlying causes, as well as any co-occurring conditions (clinical depression, anxiety disorders, and suicidal ideation are all more common in people with eating disorders than the general population), need to be treated as much as the disordered eating behaviors do. If the underlying causes are left alone, it’s like putting a Band-Aid on a broken bone; the root problem is not going away.
Individual and One-On-One Therapy
Individual therapy, a core facet of any eating disorder treatment program, encourages a person-to-person connection to help people overcome disordered behaviors in their lives. In outpatient treatment, this can mean twice-weekly (or more frequent) sessions that last for a month or more. Inpatient or residential treatment usually includes daily individual talk therapy sessions. The total length of time each person remains in an eating disorder residential program highly depends on the individual’s needs but usually starts at a month to 45 days.
At the center of every therapeutic relationship are discretion and confidentiality. You or your loved one should expect complete confidentiality and a feeling of trust and safety with their primary therapist. Without open communication and trust, eating disorders can be difficult to overcome. Over time, you’ll build a professional relationship with your primary therapist – in fact, many successful graduates from eating disorder treatment centers point to this as the best part of their recovery.
Group Therapy with Peers
A common element of residential eating disorder treatment programs is group therapy, where groups of people with similar disorders can commiserate and work together towards understanding their disorders. The group typically gets together every few days to discuss their shared eating disorder experiences and how they are feeling at every stage of their recovery. Group therapists guide the discussion and moderate when things get heated (and they do!).
The group therapy dynamic typically helps those in treatment remember that they aren’t alone, in treatment, or in their experiences with disordered eating or exercise addiction. Quite often, lifelong friendships emerge from these group therapy sessions, and it’s not uncommon for members of the group to continue to support each other after treatment ends. Group therapy sessions are almost always present in residential treatment programs and are usually part of day treatment programs as well.
Family Therapy and Support
Residential eating disorder treatment centers often promote the participation of family members and close friends during an individual’s journey to recovery. There are both sessions where the individual in treatment and their family are in the same room and others which are geared for educating the family without the client present. Therapeutic sessions shared between family members also strengthen their bonds, which allow a “safety net” of committed support after clients leave the residential eating disorder center.
When choosing an eating disorder treatment center, you should prioritize finding one with guaranteed family involvement. In case after case, it’s been seen that continuing family therapy outside of a residential eating disorder recovery center setting helps reinforce the skills in therapy and at the facility. Reacclimating to the “real world” after undergoing residential or even day treatment can be a jarring experience; family support eases that transition in ways that a step-down program can’t. In the months and years after treatment, relapse is always a concern, but it can be mitigated more easily when the people you love are there to lift you up.
Effective and Established Types of Individual, Group, and Family Therapy
Individual, group, and family therapy shouldn’t be the same for each individual – a cookie-cutter approach ignores each individual’s unique needs. For that reason, modern psychotherapy has developed therapeutic techniques that act as a base for personalized therapy. There are many evidence-based therapy methods used at these centers, which have been honed over decades of effective treatment for people with eating disorders. The leading approaches for eating disorders include cognitive behavioral therapy, emotion-focused therapy, and dialectical behavioral therapy.
Cognitive Behavioral Therapy
The cognitive behavioral therapy approach helps people be more aware of their feelings in an objective way, and to identify and isolate their disordered thought patterns and behaviors. There is often a focus on the opportunity to share their formative life experiences, including childhood experiences and past traumas, with their therapist. During this process, the therapist and the client will work together on making a list of disordered thinking patterns. For example, a person with anorexia nervosa might learn to identify their feelings of being “fat” as being disordered and recognize that it’s not objectively true. They can move on from that point to establishing conquerable goals, systematically challenging disordered thoughts, and replacing them with more appropriate ones. Individuals in CBT therapy effectively replace the disordered thoughts and behaviors with objectively constructive ones.
People with strong avoidant behaviors such as those observed in anorexia nervosa can find their eating disorder is harder to overcome without learning to utilize mindfulness. Emotion-focused therapy directly addresses the tendency to avoid food-related situations and ignore emotions when faced with stressors. This therapy was originally developed specifically for eating disorders, and it remains effective in mental health treatment of all kinds. The three-step process halts the negative emotions, restructures the situation, and activates the appropriate emotions. Individuals can work toward creating more positive thought patterns while remaining mindful of their emotions and verifying they are appropriate for the situation.
Dialectical Behavioral Therapy
DBT is based on cognitive behavioral therapy, but it is more focused on a give-and-take between the client and the therapist than the older method. In the application of dialectical behavioral therapy, there is a five-step process whose goal to employ Socratic questioning, in which the therapist asks the client a series of questions that lead them to a desired point of view. They then move on to a five-phase program of recovery
The first part is the training phase, where behavioral skills that can reduce their reliance on maladaptive coping methods are implemented. Individual psychotherapy, normally in conjunction with group and family therapy sessions, comprises the majority of the second phase. The third phase is grounded in in-the-moment coaching where clients learn how to control their responses to everyday triggers. The fourth stage is often optional, though helpful for many working on becoming recovered from eating disorders. This stage focuses on finding meaning in life by exploring the spiritual plane.
You Should Expect a Variety of Treatment Approaches
When used as an important part of a comprehensive eating disorder treatment plan, individual, group, and family therapy all have the power to help patients overcome their disordered behaviors. Therapy acts as a powerful tool that helps reveal the root causes of eating disorders and overcome them.
While at an eating disorder treatment center, people with anorexia nervosa, bulimia nervosa, and other disorders can receive assistance with body acceptance and personal growth to overcome the eating disorder. The ability to accept these newfound perspectives often requires the completion of many different types of individual, group, and family therapy sessions. Professional staff always works toward identifying and treating co-occurring presentations that commonly occur.
As an example, people with a history of trauma and an eating disorder may require treatment for both the eating disorder and post-traumatic stress disorder to achieve their healthy selves. The multi-faceted approach allows for the treatment of these co-occurring disorders and other complex situations.