Diverse psychotherapeutic modalities exist for the treatment of eating disorders. Often of particular focus at the beginning of treatment, motivational interviewing (MI) is a client-centered conversational intervention that is designed to enhance motivation for change. Cognitive behavior therapy (CBT) and the more recently developed dialectical behavior therapy (DBT) both focus on building a patient’s repertoire of cognitive and behavioral coping strategies for dealing with urges to engage in ED behaviors. Interpersonal psychotherapy (IPT) and psychodynamic psychotherapy focus on identifying unconscious or core meaning and beliefs about the self in relation to others; symptom relief from this perspective arises indirectly through the resolution of core insecure attachment, negative self-image, and negative affect systems. Experientially-based orientations such as internal family systems (IFS) work towards rapid engagement of the core affective states of different parts of the self through role-playing, imaginal exposure, and related psychodrama-based strategies.

While some practitioners focus uniquely on one of the above approaches, many seasoned clinicians work eclectically and integratively with highly symptomatic ED patients. As eating disorders are over-determined in origin (genetics, family environment, cultural influences, abuse history, etc.), it is increasingly common for therapists to maintain multiple and shifting areas of focus over the course of a given treatment. Patients often benefit from a combined focus on these core change processes: 1) motivation for change (MI), 2) insight into the maintaining psychodynamics and meaning of the symptoms (more psychoanalytic and interpersonal approaches), 3) affective exposures (behavior therapy and experiential therapy), and 4) behavioral change strategies (CBT and DBT). Finally, individual outpatient psychotherapy for ED is often most effective when conducted a minimum of twice a week during the symptomatic phases of a patient’s illness.

Patients and families benefit from early awareness of a typical length of treatment and realistic course and prognosis for the disorder. Namely, when treatment is going well, ED recovery is often a lengthy and fluctuating process (change processes trend upwards on average, but slips, lapses, and relapses are a common part of the journey towards long-term remission).

About the author: Licensed psychologist Dr. Abigail McNally maintains a private practice in Harvard Square (Cambridge, MA) where she conducts psychoanalysis, psychodynamic therapy, DBT-informed psychotherapy, and integrative therapy. In addition to a general focus on anxiety and depression, Dr. McNally maintains particular expertise in the treatment of eating disorders, personality disorders, and trauma. She is the former Assistant Director of the Laurel Hill Inn Residential Eating Disorder Treatment Center as well as the former Director of Post-Doctoral Training at Two Brattle Center.