What exactly happens when you go to therapy to heal from an eating disorder? What is therapy anyway?

This is the first of a series about different levels of treatment.

Unfortunately, most people who suffer from eating disorders don’t get treatment, either because they don’t have the money, the time or they feel that they should be able to heal from eating disorders all on their own, or that their particular issue isn’t severe enough to warrant treatment. What is important to remember is that it’s always okay to get help. Your eating disorder thrives in isolation and reaching out and getting help is what will heal it. Trying to work through it alone often perpetuates the issue. It doesn’t have to get to the point of totally unmanageable before you ask for support. You don’t have to hit bottom. You don’t have to be vomiting all day long, or starving yourself down to nothing or eating constantly all day to get help. It’s really common for someone to come in and feel embarrassed that they’re asking for help because they feel that they’re “not sick enough” or even “not skinny enough” to qualify for an eating disorder. If food feels hard for you, if you find that you’re simply overthinking eating, if you’re uncomfortable in your body, or you just want someone to talk to in order to suss out your situation  and figure out if you even need help and what kind of help you need, it’s okay to call someone. Going to therapy or to treatment doesn’t mean you’re crazy or that you “need help.” Therapy is a place for you to take care of yourself. It gives you time and space to think about your needs and to act on them. It’s a way to take care of yourself.

You can choose to see a Psychologist (Psydoc), a Licensed Social Worker, (LCSW), a Licensed Marriage & Family Therapist, (MFT) or a Licensed Mental Health Professional (LPC) or a Psychiatrist (MD).  Psychiatrists are the only ones who can prescribe medication, but many psychiatrists don’t do counseling. If you need meds, your therapist will usually consult with your psychiatrist, so that you are getting med management one place and therapy elsewhere.

Before a therapist becomes licensed, she or he must see patients a certain amount of hours (usually 3000) and then take some exams in order to be licensed in their state. This process can take anywhere from 3-6 years after finishing from graduate schools. Before getting licensed, these interns are supervised by licensed professionals while seeing clients. If you would like to see an intern, they usually charge much less than those who are licensed.

When you go in for eating disorder treatment with a therapist, they will often want to treat you along with a nutritionist and sometimes a psychiatrist.

So what happens in therapy? That’s difficult to say. First off, a therapist will not fix you. Therapy isn’t a magic cure, but it’s an open space that gives you the opportunity to think about your situation and strategize ways to improve it. There are a million different ways that therapists work to heal eating disorders. My own personal brand of therapy is eclectic integrative, which means I draw from many different modalities of psychotherapy to create  my own brand. I most often utilize a mixture of psychodynamic therapy  – which is more of the classic Freudian approach- where we discuss your family dynamics and past events in your life and how they have contributed to your current ways of existing in the world. This is incredibly helpful because it makes the unconscious conscious. It allows you to understand why you are behaving in ways that you’re behaving rather than purely reacting as you always have. It gives you some perspective and the ability to step outside of yourself so that you can make better choices about your behaviors. This goes well with cognitive behavioral therapy– which then takes your unconscious that you have now made conscious and enables you to make a choice by giving you options of different ways to think about your situation and react toward your situation. I also utilize somatic therapy and mindfulness which both make you more aware of the feelings that you are holding in your body so that you can work with the actual feelings that you are having rather than hiding from them by acting out with food. I also utilize hypnotherapy which is another way of increasing mindfulness and making you aware of your behaviors and the choices you have.

When you start with a therapist you will begin by education your therapist about your specific eating issues, how long you’ve been suffering, what your behaviors are and the severity of them. They might take your weight and find out how many times a day, week, or month you’re bingeing or bingeing and purging. Understanding the severity of your eating disorder is key to understanding what kind of treatment you will need. You might need weekly therapy sessions as well as sessions with a nutritionist and/or group therapy and a psychiatrist, or weekly sessions might be enough. It’s also possible that  you might need a higher level of care, such as an IOP, a PHP, residential treatment or hospitalization. But your therapist can help you to assess that. Sometimes, if you don’t seem to be on track with your healing, you might need a higher level of care as therapy goes on.  With eating disorder treatment, the first course of action is working to reduce the behaviors, as those decrease, you then begin to work on the feelings or the issues that trigger the behaviors. Often, as the symptoms decrease, challenging feelings increase.  I personally believe that it’s very helpful to stay in therapy after the symptoms (eating disorder behaviors) end in order to work deeply on the underlaying issues. This helps to prevent relapse and also helps you to continue moving forward in your life and achieve the things that you couldn’t before because your eating disorder was taking over.

To find a therapist who treats eating disorders, you can look on ED referral, Something Fishy, or  NEDA.

You can also search on Good Therapy or Psychology Today. Look for someone who specializes in treating eating disorders.

It is possible to find low-fee therapy. You might want to call a University near you that probably has students and interns in counseling centers. You might call a local hospital or mental health agency. If that fails, call a local therapist who probably knows where to refer you go.

Next up: IOP (intensive outpatient treatment)