Eating disorders
Eating disorders are conditions where psychological work is necessary but rarely sufficient on its own. We work together with doctors and we say so plainly.
What this is really about
Eating disorders are rarely “about food”. Restriction, binge eating and weight control usually serve another function: they give a sense of being in control when everything else is uncontrollable, or they are a way of coping with emotions that are otherwise unbearable.
That is why the work is not a matter of drawing up a meal plan. It addresses what lies behind the eating behaviour: perfectionism, self-criticism, emotional regulation, the relationship with the body.
What therapy does
We restore regular eating. The first and often the most effective step: regular meals reduce the likelihood of binge episodes — the mechanism is physiological, not a matter of “willpower”.
We track the cycles. What precedes an episode, which emotions trigger it, what happens afterwards. Specifics matter here, not the general sense of “I keep breaking down”.
We work with rules and beliefs. Rigid food rules (“nothing after six”, “carbohydrates are a failure”) themselves provoke the breach and the episode that follows. We test these rules and loosen them gradually.
We separate self-esteem from weight. This is the core of the work. As long as your worth is measured by a number on the scales, any improvement will be unstable.
We learn to handle emotions differently. Tools from dialectical behaviour therapy provide an alternative to binge eating as a way of coping with distress.
We work with shame. Shame maintains secrecy, and secrecy maintains the disorder. Compassion focused approaches help here.
A condition: a doctor’s involvement
With marked restriction, significant weight loss, compensatory behaviour or menstrual irregularities, medical monitoring is required. We do not provide medical services and do not replace medical supervision.
If the condition requires medical intervention, psychological work is carried out only alongside it. We say this at the first session and we do not take on cases where help without a doctor would be unsafe.
How long it takes
Usually this is long-term work — from several months to a year or more, depending on the condition and how long it has been going on.
The methods we use for this concern
Cognitive behavioural therapy
The most researched approach in psychotherapy. Short, focused, structured work with the connection between thoughts, emotions and behaviour.
Schema therapy
A development of CBT for working with deep, repeating patterns that formed in childhood and go on shaping life.
Dialectical behaviour therapy
An approach created by Marsha Linehan for working with severe emotional instability. Teaching concrete skills instead of talking about feelings.
Compassion focused therapy
Paul Gilbert's approach for working with shame and inner self-criticism — where ordinary cognitive techniques do not work.
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