Intensive Psychotherapy of Former Anorexic Individuals (original) (raw)
Related papers
Individual psychotherapy for anorexia nervosa
Journal of Psychiatric Research, 1985
and the Toronto General Hospital THE careful observations and wisdom of a few modern pioneers are apparent from a review of the extensive literature on individual psychotherapy for anorexia nervosa. Although there have been other notable contributors who have shaped clinical thinking over the past decade, Bruch, Crisp and Russell have been most consistent with their penetrating formulations regarding the essential psychopathology of anorexia nervosa and have continued to provide valuable insights into the conduct of individual psychotherapy for these patients. Many of the developments over the last 10 yr have been recapitulations or refinements of their earlier observations. In describing unique psychopathological features in anorexia nervosa, they have deviated from earlier theorists who largely generalized to anorexia nervosa from constructs originally derived from another context. First this review will briefly highlight the precedence established by Bruch, Crisp and Russell and then selectively review other contributions which appear to this author to have had a recent impact on the practice of individual psychotherapy with anorexia nervosa. BRUCH (1962, 1978, 1982a) has captured the phenomenology of anorexia nervosa in which the self-starvation represents a struggle for autonomy, competence, control and selfrespect. According to this view, the mother's early failure to recognize and confirm the child's expression of independent needs has resulted in the anorexic-to-be experiencing inner confusion. Bruch has proposed a "fact finding" psychotherapy aimed at correcting specific conceptual deficits and distortions which have evolved out of faulty developmental experiences. Therapy is aimed at helping the patient discover her "genuine self"' by encouraging and confirming authentic expressions of her thoughts or feelings. Rather than exploring the symbolic significance of symptoms, experiences are re-evaluated in order to understand how conceptual disturbances, largely derived from previous relationships, have interfered with the development of autonomy and self-confidence. CRISP (1%7,1980) has provided a compelling developmental model which presumes that the central psychopathology of anorexianervosa is rooted in the biological and psychological experiences which accompany the attainment of an adult weight. According to this view, anorexia nervosa is an attempt to cope with fears and conflicts associated with psychobiological maturity. The dieting and consequent starvation become the mechanisms by which the patient regresses to a prepubertal shape, hormonal status and experience (CRISP, 1980). Crisp has repeatedly emphasized the meaning of the sub-pubertal weight in developmental terms. This model has had distinct implications for the conduct of individual psychotherapy. Renourishment evokes the developmental concerns which have been arrested by weight loss and individual therapy is directed toward creating alternative strategies for coping. RUSSELL (1970) has recognized the variable presentation of anorexia nervosa and has emphasized the morbid fear of fatness as pathonomonic. He has stressed the importance of
Anorexia and Adolescence a delusion embedded in the body
Anorexia nervosa is, unfortunately, a very difficult test bed for the psychotherapist: it is in every way a borderline syndrome, in other words, a form between the psychosis (the rupture of the reality principle, the absence of the consciousness of the illness) and the neurosis. Since the young anorexic is substantially phantasmatically closed in her maternal-foetal involucre, above all, the contact and the opening phases are a difficult task, which requires experience, neutrality and patient waiting by the therapist: every attempt to force the situation, will be lived by the patient as a repetition of an englobing threat which endangers her untouchable Uniqueness.
Humanistic approaches to the understanding and treatment of anorexia nervosa
Journal of Adolescence, 1987
Research and tre; to anorexia nervosa are primarily based on behaviourist review summarizes some attempts " understand the causes and ~ ~ :tments of ~he condition from .e view~ints of psychoanalyl , family, existential and feminist psycholo~'. These perspectives~ which focus on the individua| experience of the anorexic, leave many questions unanswered, but provide fresh frameworks from which to inv¢~tigate and treat the condition.
Effective Treatment of Anorexia Nervosa: The Recovered Patient's View
Transactional Analysis Journal, 1985
The existing outcome research on the efficacy of treatment of anorexia nervosa yields minimal insight regarding the nature of the recovery process and the quality of life pursuant to recovery. A primary problem is the omission of direct inquiry of recovered patients. This study, utilizing intensive interviewing of 25 recovered anorexics, finds that few who received formal treatment believe it was essential to their recovery. Many experience the therapeutic experience as duplicating the dynamics and problems leading to the illness. Citing insufficient attention to eating behavior, body image, and family dynamics, the interviews alsoreveal that factors essential to a therapeutic relationship are more often found in relationships outside of treatment. Recovery occurs over time as the anorexic accepts and adapts to the problems in the systems around her and in turn accepts herself. Findings validate the need for an existential, systems-oriented approach in the treatment of anorexic patients. Recovery from anorexia nervosa, a complex biopsychosocial disorder characterized by lifethreatening deficits in interoceptive awareness, necessitates dramatic changes in selfawareness, cognition, and perception. Because this disorder may lead to death or to severe physical sequelae, treatment is often multimodal, with many interventions (medical, psychotherapeutic, nutritional, behavioral), initiated at the same time. Smith, Glass, and Miller (1980) point out that delaying treatment or utilizing controlled comparative studies of treatment effects is inconceivable and unethical. Thus, assessment of the value of various treatment effects is difficult as combinations of factors inside and outside of treatment may be 48
Frontiers in Psychology, 2019
In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a 'lost sense of emotional self.' We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of 'emotional self.' Further, we discuss how, once established, AN becomes 'self-perpetuating' and the 'lost sense of emotional self' relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an 'emotional self' which can be flexibly and adaptively used to direct an individual's needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.
Psychodynamic Self Psychology in the Treatment of Anorexia and Bulimia
2020
This book presents an implementation of psychodynamic self psychology in the treatment of anorexia nervosa and bulimia nervosa, using a theoretical and therapeutic approach to examine the way that patients turn to food consumption or avoidance to supply needs they do not believe can be provided by human beings. The book starts with an overview of self psychology, presenting both the theory of self psychology and its specific application for the etiology and treatment of eating disorders. Featuring contributions from eating disorder professionals, the book then integrates this theory with 16 compelling case studies to explore how the eating-disordered patient is scared to take up space in a society that encourages precisely that. Professionals in the field of psychotherapy for eating disorders, as well as the entire community of psychotherapists, will benefit from the empirical capability of the theory to predict the development as well as remission from eating disorders.
A conceptual history of Anorexia Nervosa: specificity of the psychopathological perspectives
Dialogues in Philosophy, Mental and Neuro Sciences, 2021
Purpose. To show the contribution of different psychopathological stances in shaping the concept of anorexia nervosa through history. Methods. Description of the most relevant observations of clinical cases, from XVIII to early XX century. Results. The clinical descriptions were shaped by the clinical questions the physicians wanted to investigate. We found medical and psychopathological questions. The former focused on somatic differential diagnosis, measurement of bodily signs and symptoms, organic etiologic explanations, and medical (also behavioral) remedies. The latter studied the psychic phenomena in detail, tried to understand the link between symptoms, settled explanatory hypotheses about the individual, familial, experiential and situational factors leading to eating disturbances, and illustrated various strategies of "moral", behavioral, and psychological treatment. Within the psychopathological approach there were at least three stances, based on the main nosographical constructs operating as "psychopathological attractors": Hysteria
From Knowing to Discovering: Some Suggestions for Work with Anorexic Patients
In this article I offer some technical suggestions for psychoanalytic work with anorexic patients. Although focused on an outpatient setting, certain parts of the article will also have utility for inpatient work. As an outpatient therapist working with an anorexic patient, especially in the acute stages of the illness, there are case management demands that need immediate attention. The setting up the particular frame is required to augment the therapeutic work. The most urgent pressure felt by the clinician is the precariousness of the patient's physical health. This can be experienced as if there is a gun to the head of the therapist. This deathly force must be carefully and constantly grappled with, and particularly so in the most symptomatic stages of the illness. The clinician must work with a patient who might die at any time, yet an anorexic patient cannot be managed the way a suicidal patient would be. The question of technique in this situation is a complex one. Above all, the patient must be met where s/he is. Notwithstanding the uniqueness of each patient there are some specific themes that often arise in the acute stage of the illness. Certain technical suggestions are offered.