Types of Treatment
There are a wide variety of different treatment options available to you; it is important to choose the ones that work best for you.
// group therapy // types of therapy // individual // IP/OP // maudsley method // dieticians // 12-step //
Group Therapy
Group or support therapy can take place within an inpatient program,
an outpatient program, a therapist's practice, or as an independent support
group such as OA (Overeaters Anonymous). Different groups often have varying
objectives so it is important to research what the group is about. Is it spiritually
based? Does it address eating disorders specifically or as part of a larger
picture? Is it meant to be a support for the individual sufferer, or does
it incorporate families into the process?
Groups are often facillitated by a licensed therapist. Support groups may be run by therapists or counselors, recovered person, family or friend of someone with an eating disorder, or someone else who may be looking to help others (or themselves) recover.
It is very important with group therapy that you can feel comfortable with the facillitator and other group members. If you can, sit in on a few sessions and see if it is the group that would work best for you. Choose the group that appeals most to you and which you believe can best help you work through recovery.
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Types of Therapy
There are many types of professionals who can help you with your recovery.
Most of them should have some sort of degree or certification for the education
and training they have received; whether or not it is important for them to
have such papers is up to you. There are many counselors and social workers
who are not licensed but may be able to provide you excellent support, just
as there are those who are licensed but may not be what you need. What is
most important is that he or she is someone who makes you feel that you are
in a safe, comfortable environment where you can be counseled effectively.
Psychiatrists (PhD) are usually more expensive and tend to focus on medication, diagnoses, admissions, and medication. Some provide psychotherapy and others do not. For example, my first psychiatrist was a pill pusher, but the one I have at Residential is a great counselor who doesn't force medication. Not all psychiatrists are trained in psychotherapy unless they have gone through post-graduate education.
Psychologists (PsyD or PhD) are the ones who are trained in psychotherapy.
Marriage, Family, and Child Counselor (MFCC), Marriage and Family Therapist (MFT), and Licensed Marriage and Family Therapists (LMFT) are not that different from psychologists depending on the licensing requirements of the state. Most can provide the same level of counseling as a psychologist.
Marriage, Family and Child Interns (MFCI) or Marriage and Family Therapist Interns (MFTI) are working in clinical practice to fulfill requirements they need to be licensed. They can see clients and all work is usually supervised by someone already in a licensed position.
Licensed Clinical Social Worker (LCW) has a degree in social work with a strong clinical focus. They can make very good therapists because of the strong focus on psychoanalytic and pyschodynamic theories in their education.
Licensed Professional Counselor (LPC) in some states, is equivalent to a MFCC or LMFT, and is trained in counseling.
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The ultimate goal of your therapy should be to recover! To learn to be more confident in yourself, to make your voice heard through communication, to validate your own emotions, to learn to love yourself, and to learn better ways of coping with anger, sadness and stress (and not rely on your Eating Disorder). You will spend many hours talking to your therapist about your childhood, your experiences, and your day-to-day life, and all of this is important to your recovery. There are many ways a therapist can work with you individually, and different therapists have different methods. The name of the approach is not as important as the methods used, so it will be important for you to discuss with your therapist your goals in working towards recovery.
Psychoanalytic: This is a clinical approach through interpretation, dream analysis, free association, analysis of resistance and transference. This all assists the client in gaining access to their subconscious, to the internal conflicts they may not be aware of, and in gaining new insights. There is a strong focus on repressed conflicts and less focus on social, cultural and interpersonal factors.
Nonpsychoanalytic (Jungian) Therapy: Self realization and learning to accept yourself as an individual, and to BE an individual is part of what this type of therapy is all about. It incorporates the idea of spirituality as an important role in discovering who you are. Generally, this approach is about making connections with your feelings and motivations and learning who you are. There is more a focus on the "big picture" and less of a focus on each day-to-day problem.
Cognitive-Behavior Therapy: This type of therapy works on the premise that thinking, questioning and doing (with practice) leads to the changes needed for recovery. Learning to change the way you think about yourself will result in changing the way you treat yourself. There is an eclectic combination of cognitive, behavioral and emotional techniques: changing negative thoughts to positive, and pessimistic words to optomistic words. Using humor, role playing, and homework and word-work in attacking shameful feelings and feelings of guilt are combined with the effort to make changes in thinking and behaviors. The focus with cognitive-behavior therapy is that it is a "move-forward" approach and often lacks exploration of the deeper emotional issues that led to negative behaviors and thoughts in the first place. There can also be Behavior Modification Therapy on it's own where as the client focuses on changing behaviors through practice.
Eclectic Approach - Combining All Theories: This is my personal favorite because it combines many aspects of all the above theories. A therapist that uses this approach will be able to attack many different issues over your course of recovery, including self-esteem work, past and present emotional issues, and day-to-day coping strategies. This is also the most commonly used approach in practice today by therapists.
Marriage and/or Family Counseling may also play a role in your recovery depending on how important it is overall to involve your loved-ones. Some level of counseling can help you all learn to communicate with one another so that you will feel heard, and to be able to express your emotions to each other in a safe environment. Once you have started your own therapy you may wish to discuss these options with your therapist and whether or not you both feel it will be important.
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Inpatient and Outpatient Facilities
Inpatient: - When a person is "inpatient" it means that they will be living at the facility for a certain period of time. This can range from a couple of weeks to several months. The facility usually has medical doctors, registered nurses, therapists, dieticians and volunteers on staff to work with the people in recovery on a daily basis. It is intended to provide a safe environment in which to recovery from an Eating Disorder. Depending on the facility, the routine can vary, but it may include the following: group sessions, one-on-one therapy, medical evaluations, weigh-ins, nutritional counseling, art therapy, medication administration, spiritual exploration and prayer, meal times, and social or leisure activities. You make have weekly sessions with nurses, medical doctors, social workers, case managers and/or nutritionists. There may be involvement in projects, or times alloted for continuing education. Some programs may be more restrictive than others in their allowances for free time, and some may focus very highly on individual care (as opposed to a group approach). You will have to get information from each treatment center to find what works for you. Most programs will expect you to be somewhat medically stable before entering, meaning that if your health is extremely poor, you may require hospitalization before admittance.
Outpatient: - "Outpatient" means that the patient does not live at the facility. Outpatient programs are sometimes run by centers that do inpatient care, but can also be offered at Eating Disorders Clinics or Mental Health Clinics. Again, there is often a "team approach" with medical doctors, therapists, and dieticians on staff, with scheduled daily or weekly sessions depending on each individual's needs. One-on-one therapy and group sessions, daily activities and classes, art therapy, medication and medical evaluation, and weigh-ins may all be part of your schedule depending on the facility. You will have to get information from each treatment center to find what works for you.
Residential Housing: - The focus of residential care is usually to help with integration back into daily life. There is usually a required weekly time to meet with a therapist, social worker and/or case-manager, and for group sessions. There may be time alloted for schedule appointments with a dietician. Some programs offer the ability to get involved with volunteer projects and part-time jobs. The ultimate goal of residential housing is to help make the transition back into day-to-day life a little easier for those in recovery.
Generally, these types of facilities are meant to address treatment from a broad approach... not only teaching sufferers how to eat healthfully, but to address corresponding self-esteem issues, psychological diagnoses, coping mechanisms, behaviors, issues, and emotions. The way each facility does so, and their own treatment philosophy can vary, so it's important to ask a lot of questions and review as much information as you can about each program you are considering.
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The first phase (Sessions 1-10) puts the parents in charge of the eating behaviour of the AN adolescent, making food the medicine to be administered to a patient. The first two sessions engage the family to determine their eating habits and assemble a picture of the AN impact on all family members. The therapist externalizes the illness by presenting the eating disorder as controlling the patient, freeing parents and patient from blame. The therapist then encourages the parents to find their own method to control the adolescent eating behaviours without using force or punishment, but rather through a system of creative measures that include functional rewards, such as "I cannot let you get your driving licence while you are too weak."
The second phase (Sessions 11-16) transfers the control of the feeding process back to the adolescent, and addresses related family problems.
The third and final phase of the treatment focuses on encouraging the processes of adolescent development that unfold as the AN wanes, and establishing new family relationships disentangled from the eating disorder.
Used appropriately, and as intended, the Maudsley Method is based on the foundation that where an Eating Disorder started matters little in it's treatment. This isn't to belittle the issues a sufferer may feel in relation to their [possibly dysfunctional] family... This is to stop playing the blame game, and instead, for all members of the family to accept responsibility in "fixing what is broken."
When sufferers often feel "invisible" in their families, this type of intense involvement may suddenly act as a psychological facilitator in improving the overall relationship. It may help to make the sufferer feel seen, to feel cared about and loved.
While it seems on the surface that the focus of the Maudsley Method is to treat just the symptoms of the disease (behaviors/eating), you could make a lot of arguments that the impact of such involvement in teen treatment carries many hidden psychological messages. Getting family members (ie., parents) this inherently involved in their child's treatment obviously carries many hidden psychological messages and lessons.
Theoretically, Anorexia caught in an early stage (during developmental teen years), in a manner such as this, that [slowly] establishes appropriate boundaries, shows an immense concern from the family, provides proper nutrition, emphasizes that there is no need for shame (from either family or patient), teaches appropriate control, and reestablishes positive family relationships (in phase 2 and 3), responds well to this treatment for a variety of reasons, and does encompass many of the aspects of what more "traditional" treatments try to (and do).
As stated, this treatment is meant for dependent teens. It is important to determine if this is the right treatment for your child. It is important to consider your entire family dynamic when making this decision.
Without sounding like it's appropriate to put the "blame" on anyone, I often hear from sufferers things like my parents don't care, my family doesn't get it, they don't understand, they get so mad about my anorexia -- the Maudsley approach puts patient and parents into a mutual place -- one to battle the Eating Disorder together -- in an understanding, caring, nurturing way that does address issues (again, phase 2 and 3). That isn't to say that this specific approach is for everyone. One simple example... a child with a particularly controlling parent may resent this type of treatment all the more.
"The treatment is not for everyone. Abusive parents are excluded from family therapy. The treatment is suitable only for minors living at home, where some degree of parental control is assumed. 'For young adult anorexics, individual therapy seems to work best,' says Dr. Loeb, an advocate of the method." (source: Columbia University)
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Dieticians (also called nutritionists or dietary/nutrition counselors) are can be an essential part of the recovery process. Their role is to help patients uncover their issues with food - in general and with specific foods - in order to overcome them. It is important to ask yourself if you would rather be on a meal/calorie/portion plan or if a more intuitive approach would be more helpful. Some dieticians will specifically work with one form or another, but many are willing to work out either approach depending on the individual's specific needs.
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Twelve-Step programs, such as Alcoholics Anonymous or Overeaters Anonymous, are based on twelve "quotes" that are accepted and believed in moving towards recovery. The groups are typically spiritually based in nature and follow a tradition of finding "sponsors" who work as support-towards-recovery mentors. It is a group atmosphere that may meet once or more per week.
The Twelve Steps are (this is a generalization): 1. admitting powerlessness - that life is unmanagable; 2. believing that a greater power could restore sanity; 3. deciding to turn will and life over to the care of God; 4. making a searching and fearless moral inventory or self; 5. admitting to god, self, and another human being the nature of our wrongs; 6. being ready to have God remove all these defects of character; 7. humbly asking God to remove our shortcomings; 8. making a list of persons harmed and being willing to make amends with them; 9. making amends with people hurt except when doing so would hurt them or others; 10. continuing to take personal inventory and admitting our wrongs; 11. improving the relationship with God through meditation and prayer and praying for knowledge of the will to carry out the power of His knowledge; 12. having a spiritual awakening as a result of these steps, and carrying the message to other addicts to practice these principles.
Twelve-Step groups are help all over the world, for all different types of addictions. A twelve-step program may or may not be for you... as with anything else, it's not for everyone.