Choosing a therapist these days can be like ordering a drink from Starbucks:
I’ll have a grande CBT lite DBT Gestalt-free psychotherapy with two shots of psychoanalysis and breve IPT.
This image came to mind have after dinner with a friend last night. She’s been in therapy for several years, and has decided to switch to someone with “a little more of a CBT focus… who still integrates interpersonal therapy but spends less time talking about family.” Hmm… good luck with that search, Rach.
The reality of it is, there are so many types of therapy out there. Just to give you an idea of how many:
- Art therapy
- Cognitive-behavior therapy (CBT)
- Dialectical-behavior therapy (DBT)
- Exposure therapy
- Family therapy
- Gestalt therapy
- Group therapy
- Integrative psychotherapy
- Interpersonal therapy
- Hypno-therapy
- Marriage counseling
- Music therapy
- Narrative therapy
- Play therapy
- Psycho drama
- Psychoanalysis
- Psychodynamic psychotherapy
- Psychoeducation
… and on and on and on. Granted, some of these are much more common than others, and you could probably lump a lot of them together, but you see my point — what therapy is right for you?
No one therapy has been proven to be the best choice with eating disorders (especially anorexia), so your perception of recovery and ED etiology will be largely influenced by your first therapist. I think very few people have much information on all of the available types of treatment (not to mention the different kinds of therapists, psychiatrists, social workers, doctors, nutritionists, counselors, etc.). And even if they did… how do you know which therapy to try? And what exactly is the focus of therapy supposed to be? What is the interaction between you and your therapist supposed to be like? How are you supposed to feel when walking out of therapy?
There are so many beliefs in the psych field right now, that maybe you do need to customize your treatment like you would your Starbucks drink. And beyond that, maybe you’ll need to just around between types of treatment… not necessarily because you chose wrong in the first place (although that’s common), but because you have different needs at different times in your life and stages of your disorder.
Where this gets tricky, though, is with the concept of “bad therapy” — and if you’ve read my other posts, you’ll know that I believe that there is bad therapy. Maybe the kind of therapy that you gravitate towards is appealing is because it allows you to perpetuate your disorder or to ignore some issue. You can draw pictures forever in art therapy and never change any eating behaviors. Or, you can talk about your meal plan every single week with a nutritionist and never bring up a bad relationship that you’re in. So, I guess what I’m asking… is to what extent is therapy supposed to be comfortable? Is it no pain, no gain?
Any input would be appreciated…
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Tags: Anorexia, art therapy, bad therapy, bulimia, cognitive behavioral therapy, dialectical behavioral therapy, eating disorders, exposure therapy, family therapy, gestalt therapy, group therapy, interpersonal therapy, nutritionist, psychoanalysis, psychotherapy, Starbucks, therapist, therapy, treatment
June 19, 2008 at 5:08 am
I have my first appointment for ed treatment next week, I presume we’ll discuss the different types of therapy they offer, I wonder which one it will be! Maybe like Starbucks it’s worth trying new flavours.
Vx
June 19, 2008 at 7:20 am
Here’s my opinion. Thinking about someone’s mode of therapy, while important, is a little like reading the back and front covers of a book. It will highly influence your decision about whether to take on this therapist or not… but once you accept the therapy, if the therapist is GOOD, there will be so much more than you ever expected or predicted within that book. Much more depth, a lot of work, a lot of growth and change.
I really also believe that, if the therapist is good and you really bond with him or her, the “mode” of therapy can be almost superficial. What will matter more, later on, is the connection you have with the therapist, and how this connection in combination with the therapeutic techniques helps to both heal the mental illness and strengthen you as a person.
Honestly, therapy is mostly an art. Every person is different, and is going to need different things from the therapeutic relationship. Bad therapists are the ones who blanketly apply CBT, then blink in confusion when it doesn’t work for you. Good therapists are the ones who see what techniques work and don’t work, and carry further with the ones that do work, and ask you about YOU, and, yes, dig deeper into your personal life so that they’re actually dealing with the real issues and not the superficial outsides.
Sorry about the novel, also!
June 19, 2008 at 1:07 pm
Actually, for adolescents who have been sick for less than three years, family-based therapy has absolutely been proven to be the treatment of choice for anorexia. Long-term outcomes are between 80 and 90 percent recovery, compared with recovery rates of between 30 and 50 percent for all those other kinds of therapy.
For more information on FBT, check out http://www.maudsleyparents.org.
June 19, 2008 at 10:05 pm
Harriet –
I’m not sure exactly which studies you’re referring to… but I doubt that you’re comparing apples to apples. The criteria for using FBT seems pretty stringent — you need supportive family, they need to be available, your home environment needs to be a safe place, monitoring all meals must somehow be possible, and the ED individual must be young enough that the family member can exert control. What if your parents has a serious addiction? They can’t always be responsible. What if your family has no interest in participating in treatment? Or, since the genetic component of EDs is so strong, what if your mother is still really struggling with an eating disorder herself?
I’m not arguing that FBT isn’t effective; just that the participants in all the other studies probably don’t have the continuous support system and other advantages as do those in your FBT study.
One more question… what defines “long-term”? 1 year? 5 years? 20?
(P.S. – As always, I appreciate your contributing your perspective).
March 31, 2009 at 12:55 pm
Actually, FBT has been looked at in randomized controlled trials, which are specifically designed for “apples to apples” comparisons. The exclusion criteria for these studies was not especially stringent. No active suicidality, medically stable enough for OP treatment, no parental abuse. That’s it. You might want to take a look at the research yourself before you criticize the methodology.
http://maudsleyparents.org/bibliography.html
Excluding families that have struggles seems like a really bad idea to me. These families are especially likely to benefit from good family treatment IMO. Parents should be aware of treatment choices and make their decisions, rather than let someone else decide for them whether they’re “good enough” or not. Once in a while I hear the opinion that FBT isn’t suitable for single parent families, but single-parent families were just as successful as intact families in helping kids with BN using FBT.