Any discussion of individual psychotherapy for anorexia nervosa should begin with a major caveat: Individual therapy for anorexia, by itself, is not a good solution. It should be accompanied with other treatments.
While individual therapy for those with anorexia is frequently a significant part of a treatment plan, results of analyzing it by itself are not that encouraging. Our understanding of what is effective in treatment of anorexia has a long way to go.
Where We Lack Knowledge About Individual Therapy for Anorexia
Unfortunately, since it is common for study participants to leave treatment (they often don't want treatment in the first place), it is extremely difficult to create a study that lasts long enough to reliably compare the results of various kinds of therapy for anorexia. And studies that have been completed often have involved specific subgroups of those with anorexia -- specifically, those who are of adolescent age and/or have shown symptoms for only a modest amount of time.
That said, a number of treatment methods are available to individuals with anorexia. The important thing is to diligently seek a mode of treatment that works for you. Psychotherapy research has consistently found that the quality of the therapeutic relationship and match between patient and therapist is one of the most important variables in treatment success.
Cognitive-Behavioral Therapy for Anorexia
Cognitive-behavioral therapy (CBT) is perhaps the most well-researched and widely accepted form of psychotherapy available today. CBT has been the most commonly studied type of psychotherapy for a variety of conditions, including anorexia. One reason for this is that it is structured in a way that lends itself to study in a way that is not true of all psychotherapies.
Stated simply, CBT seeks to help clients change irrational thoughts and unhealthy behaviors. Many of our thoughts are so automatic that we don't realize we're thinking them until we examine them closely. Once uncovered, it is possible to challenge destructive (and sometimes untrue) thoughts and even replace them with healthier ones. Unproductive thoughts may lead to unproductive behaviors, and vice versa. In some cases, changing behaviors can lead to the possibility of new thoughts.
One review of research showed that studies comparing CBT to other forms of psychotherapy suggest that CBT does not differ significantly with those therapies in effectiveness. One of these studies compared CBT to behavioral family therapy. Another compared CBT to standard behavioral treatment (SBT) and found few differences, except that CBT clients attended sessions more regularly. Yet another study suggested that CBT was no more effective than basic clinical management.
However, CBT does appear to be a better option than nutritional counseling by itself. So many study participants receiving only nutritional counseling dropped out of some studies that it became impossible to compare the two treatments. Cognitive-behavioral therapy may keep clients engaged in treatment in ways which may be positive in itself.
Psychodynamic/Psychoanalytic Therapy for Anorexia
Traditional psychoanalysis and other psychodynamic therapies do not appear as often in research literature. However, these therapies do offer a different way of addressing behaviors and thoughts.
Psychodynamic therapy emphasizes historical data and how the client and therapist view each other, noting where past events and situations get replayed in the therapeutic relationship. The patient has an opportunity to work on, in an experientially immediate way, some of the psychological dynamics that potentially fuel the eating disorder. A psychodynamic therapist will often offer interpretations of current events and attitudes that can be challenging for the client.
A psychodynamic therapist may view the eating disorder as an expression of conflicts regarding sexuality, competition or separation issues. Another formulation may involve helping a patient understand how the eating disorder may be a way to express unacceptable parts of themselves, such as anger.
Psychodynamic therapy is usually non-directive: The client determines the direction of each session. Because those with anorexia do not often want to emerge from their shells, these forms of therapy can seem slow.
Research results for psychodynamic therapy in eating disorders are relatively scarce. One study found that psychoanalysis performed as well as family therapy and better than a form of cognitive therapy among adults. But psychodynamic treatments beg for much more research to better identify who and why they help.
Interpersonal Psychotherapy
Working with an interpersonal psychotherapist means working on your current relationships in terms of unresolved grief, role disputes, role transitions and more, and how these challenges contribute to distress.
While there is merit to the thinking behind applying interpersonal psychotherapy to anorexia (after all, a support system with good relationships seems to be key in recovery), little research is available on the subject.
