Unless you are in grave danger, the mental health clinician will recommend outpatient therapy for you and (very likely also) for your loved ones. Outpatient therapy is conducted in a counselor's office, typically on a weekly basis. Individual outpatient therapy is designed to provide you with education, insight, and support. It will be important in therapy to address how and why the eating disorder developed and what continues to contribute to the disordered behavior. A mental health provider may also teach you to rectify faulty thinking, get in touch with strong emotions, increase poor self-esteem, and process body image. Homework (e.g., behavior contracts designed to reduce your disordered behaviors, monitoring sheets for tracking thoughts and behavior, and journaling to increase understanding, etc.) might also be required.
The role of the therapist also involves helping you develop new coping skills. Introduction and restoration of coping skills might include learning how to self-soothe and calm down without the use of food when upset, as well as communicating feelings and needs effectively. You must also learn how to develop a healthy social support system and ask for help when you need it. In addition, teaching the appropriate expression of anger, the recognition of faulty perceptions of inadequacy, and the appreciation of individual strengths and talents as safe alternatives to self-punishment are important. Furthermore, those who binge and purge benefit from adding more structure to their eating schedules, learning healthy food choices, and restructuring perfectionistic thoughts.
There are several philosophical and theoretical approaches that the clinician may use to guide individual therapy. The choice of approach is dependent on the clinician's expertise and preference, as well as your needs. The most common type of therapy used for eating disorders is Cognitive Behavior Therapy (CBT). CBT is an empirically valid intervention, which means that the techniques have been vigorously researched and found in numerous studies to be more effective than other interventions or no intervention. Aaron Beck originally developed Cognitive Behavior Therapy in the 1970's. The premise of his therapy is that feelings and behaviors are driven by thoughts (cognitions). When thoughts are inaccurate, the behaviors and feelings that follow tend to be distorted or disturbed as well. The role of the therapist in CBT is to help you identify your cognitive distortions that are causing your eating disordered behavior. For more information on Cognitive Behavior Therapy, visit our Cognitive Restructuring Article.
To treat destructive eating disordered behaviors, a CBT therapist is likely to teach a variety of cognitive restructuring techniques. For example, anorexics are challenged regarding their rigidly self-imposed expectations and perfectionism. They are helped to set more realistic goals for themselves and to decrease the importance they place on weight and body image. In recognizing their talents and strengths, their self-esteem benefits from a broader perspective of who they are and what they look like. In order to do this, a CBT therapist will often point out examples of their "black and white thinking," a form of cognitive distortion in which people see the world in absolutes rather than shades of gray; for example, thinking I am either completely terrible or totally wonderful, rather than thinking I am generally an okay person even though I am not perfect. The therapist will challenge people to monitor these rigid cognitions and rethink them in a manner allowing for more flexibility and ambiguity.
For bulimics, CBT addresses their over-reliance on attributions of other people as an unhealthy means of comparison. Individuals with bulimia learn to focus on themselves, rather than on external standards. Bulimics also learn positive self-talk to start being more kind to themselves, as well as thought-distracting techniques to escape obsessions. Furthermore, they learn to dispute their justifications for binging and purging behaviors so as to view these dangerous behaviors from a more realistic, healthy perspective.