Unless you are in severe danger, the therapist will recommend outpatient therapy for you and likely, also for your loved ones. Outpatient therapy happens in a counselor's office usually once a week. Individual therapy is designed to provide you with education and support. It will be important to talk about how and why the eating disorder developed and what keeps the behavior going. The therapist may also teach you to correct faulty thinking, get in touch with strong emotions, increase poor self-esteem, and process your body image. Homework might also be given. This might include contracting to reduce eating disorder behaviors, tracking your thoughts and behaviors throughout the week, or journaling.
The therapist will also help you develop new coping skills. Introducing or restoring of coping skills might include learning how to self-soothe and calm down without the use of food when upset. It will include communicating feelings and needs effectively to others. You must also learn how to develop a healthy social support system and ask for help when you need it. In addition, you will be taught how to appropriately handle anger, to recognize incorrect feelings of being inadequate, and to appreciate your individual strengths and talents. Those who binge and purge benefit from adding more structure to their eating schedules, learning healthy food choices, and letting go of perfectionistic thoughts.
There are several different approaches that the therapist may use to guide individual therapy. The choice of approach depends on the therapist's expertise and preferred methods, as well as your needs. The most common type of therapy used for eating disorders is Cognitive Behavior Therapy (CBT). CBT has been very thoroughly researched. It has been found in numerous studies to be more effective than other options or no treatment at all. The basis of CBT is that feelings and behaviors are driven by thoughts (cognitions). When thoughts are incorrect, the behaviors and feelings that result tend to be distorted or disturbed as well. The role of the therapist in CBT is to help you identify the incorrect thoughts that are causing your eating disordered behavior.
A CBT therapist is likely to teach many ways to change faulty thinking. For example, those with anorexia will be challenged regarding their rigidly self-imposed expectations and perfectionism. They will be taught to set more realistic goals for themselves and to decrease the importance they place on weight and body image. In recognizing their talents and strengths, their self-esteem benefits from a broader perspective of who they are and what they look like. To do this, a CBT therapist will often point out examples of "black and white thinking." This is a form of faulty thinking in which people see the world in absolutes rather than shades of gray. For example, thinking "I am either completely terrible" or "I am totally wonderful", rather than thinking "I am generally an okay person even though I am not perfect." The therapist will challenge people to monitor these rigid thoughts and to allow more flexibility in their thinking.
For those with bulimia, CBT will look at how they spend too much time comparing themselves to others in unhealthy ways. They will learn:
- to focus on themselves, rather than on external standards
- positive self-talk to start being more kind to themselves
- techniques to stop their obsessive thinking
- to dispute their reasons for binging and purging behaviors
- to view these dangerous behaviors from a more realistic, healthy perspective