The Psychology of Eating: From Healthy to Disordered Behavior

Treating Eating Disorders 259

removed. If the therapy is being offered as part of a hospital-based trial,

then the therapist will also have had their right to choose patients removed.

Furthermore, if the therapy is part of an outpatient clinic then it is likely

that the room will not always be private, the phone might ring, and

intrusions are likely. Finally, if the patient is still losing weight or at a

low weight, her weight will need to be taken at the start of each therapy

session, which may feel inappropriate to the patient given the therapeutic

emphasis on her relationships and psychological well-being.

• Central to anorexia is a fear of relationships and closeness. Psychoanalytic
  therapy requires a close relationship between therapist and patient. This
  can cause patients to react against their therapist and refuse to engage
  in the therapy session.


• The therapeutic approach requires the patient to be motivated to engage
  with the therapist. Some anorexics have been committed under the Mental
  Health Act, and they have therefore not volunteered for therapy.


• Anorexics see their food refusal and weight loss as the solution to their
  problem. Therapy aimed at food acceptance and weight gain (even if
  this is unstated) can feel more like another problem to the patient than
  like a solution.


• Ending psychoanalytic therapy can be difficult for the patient. If the patient
  has learned to trust the therapist and to believe that closeness need not
  lead to a loss of control, ending the therapy sessions can be perceived by
  the patient as yet another rejection, confirming her beliefs that relation-
  ships cause pain and are not worth engaging in.


• Evaluating the effectiveness of this approach is time-consuming, expens-
  ive, and difficult but a recent trial indicates that it is more effective than
  “routine” nonspecific care for adult anorexics.

In summary, focal psychoanalytic psychotherapy focuses on the role of
family relationships with its emphasis on object relations and the function of
symptoms. In addition, it explores how object relations and symptoms are
expressed and integrated within the context of the therapeutic alliance
between therapist and patient. There is some evidence that it is effective
for adult anorexics, particularly when compared to routine nonspecific care.

Cognitive Behavioral Therapy (CBT)

A cognitive behavioral formulation of eating disorders involves two core
themes. The first is the process of learning via reinforcement, which is