Eating disorders are life-threatening mental illnesses that can have significant impacts on physiological health, quality of life and psychological functioning. As an eating disorder therapist and researcher, it is imperative to my practice that I stay informed of the latest models of treatment, new findings and ongoing debates in the field.
For two years in a row, I have had the opportunity to attend the International Conference for Eating Disorders in Chicago (2018) and New York City (2019). This conference is held by the Academy for Eating Disorders annually to bring professionals across different disciplines and researchers together to discuss new findings in the field, offer education sessions and have important discussions that foster new thought in this field of interest. Given that I am both a clinician and researcher in eating disorders, this conference is one of my favourite events to attend each year.
Given that approximately half of my work in private-practice involves treating eating disorders, I thought I would share my thought-process on how I decide which treatment models to use with my clients suffering with eating disorders and disordered eating.
What do the experts and researchers say?
Manualized treatment, manualized treatment, manualized treatment! Most experts in the field will agree that using a manual for treatment and keeping to manualized treatment protocol is the most effective way to treat mental illnesses like eating disorders. What is missed here is that researched treatment has to be manualized and standardized in order to effectively measure outcomes of change. The most researched manualized treatment protocol is Cognitive Behavioural Therapy for Eating Disorders developed by Christopher Fairburn and added to by researchers like Glenn Waller, Phillipa Hay and Timothy Walsh. This is a 20-session protocol that works through normalized eating habits and symptom management while also addressing maintaining factors of the eating disorders such as perfectionism, mood and event-related changes, body image distortions and preoccupations with weight.
At these conferences, several manualized treatments were introduced and endorsed as being effective in treating eating disorders. With so many different approaches it is often confusing which is best to use. CBT-E? EFT? DBT?
What are my own findings with this work?
People are not predictable and thus one manualized therapy is not always appropriate. Situations and experiences come up in people’s lives that have to be addressed in an effort to not only keep them on track with recovery but to effectively meet their needs in any given session. Although there are several manualized evidence-based treatment interventions to use, I assess my client’s needs on a session-by-session basis and if there is no response or change with a specific protocol I begin to consider other protocols or interventions that may be more effective. Cognitive Behavioural Therapy is one of the most researched interventions for eating disorders, however, Emotion-Focused Therapy and Dialectical Behavioural Therapy can also be extremely useful when one is presenting with difficult emotions, impulsivity or interpersonal problems.
In addition to manualized treatment, another factor that influences the success of treatment is therapeutic rapport. It is so important that clients feel safe and develop a trusting relationship with their therapist prior to doing work with them. Thus, instead of sticking to a manualized treatment protocol in the beginning, building trust and rapport while assessing the needs of the client is also important in considering the best treatment intervention.
Solution: Finding a middle-path!
The conference provided me with greater knowledge and perspective when treating these challenging disorders. It also provided me with insight that there isn’t one way to “properly treat” an eating disorder. Rather, finding a middle path in establishing a rapport with my clients, assessing their needs and using the most appropriate treatment intervention (manualized or not) is necessary!
Writer: Alyssa Durbin