Living With Food: The Science Supporting Eating Disorder Treatment

By Lucene Wisniewski 

One of the difficult things about treating people with eating disorders is that they’re often motivated to work on some parts of treatment but not others. Many come to treatment thinking, “I want to feel better”, but they often want to feel better without wanting to eat more or to gain weight. And so, when someone first comes into my office, our first conversation is about what he or she wants to be different. Clients often express that they want to have more energy, they want think about food less, they want to feel less depressed, and they want think more clearly. Most of these things, however, cannot improve unless a person is eating adequately. I’ve had countless patients say that they would love to feel better without the problem of eating more!

This conversation often re-emerges mid-way through treatment. Because clients may get stuck on the issue of weight, this translates into a client being willing to eat more and try something new, as long as their weight does not go up too much. In this second phase of motivation and commitment a client has to decide how much of their eating disorder they are willing to give up in order to live the life they want to have.

Sometimes I will hear therapists calling people stuck in this phase “resistant”. In Dialectical Behavioral Therapy we discourage using the word resistant due to its judgmental undertones. Instead, I would say that people have varying degrees of willingness to change particular behaviors. What the patient is motivated and willing to do has to be an ongoing collaborative conversation between the patient and therapist. If you are a clinician and you get to a point in the therapy where what the patient is motivated to work on does not match what you’re willing to do with them then, it may be time for the patient to take a break from therapy. We don’t believe that some therapy is better than no therapy, rather that we aim for effective therapy at all times.

Coming soon: How do you know if you’re motivated enough to do treatment?

Next week: Men, Women, and Eating Disorders

Contributions by Sarah Emerman