Individual therapy is a one-on-one relationship between the patient and a therapist. The time is devoted to exploring the patient’s thoughts and feelings and looking at how she expresses those thoughts and feelings in her actions or her relationships. Individual therapy takes a deeper look at the underlying causes of her behavior, to find out why she uses food to meet her emotional needs.
Ideally, individual therapy provides a safe environment, a kind of shelter in which the patient can explore and express emotions. Therapists support this process. They help the patient to look at problems from another point of view and make connections she may be unable to make on her own.
In fact, the very relationship between the patient and the therapist can be an important tool for change. The patient reveals her characteristic ways of feeling, thinking, and relating in her interactions with the therapist. Together they can look at these patterns and see how they may be affecting her life in the “outside world.”
One key ingredient in their relationship is the development of trust. A person with an eating; disorder often mistrusts her basic feelings. She may misinterpret her hunger and suppress her emotional needs. She can be reluctant to reveal her feelings, especially regarding shape and weight, because she feels ashamed or humiliated. Mistrust of other people is also part of the picture.
Through her relationship with a caring therapist whom she trusts, a woman can reveal her innermost thoughts and feelings. With time, she feels less fear of criticism or judgment. She can then examine those feelings to discover and experiment with other ways of reacting.
In this sense, individual therapy serves as a kind of emotional dress rehearsal for life. A patient can use her therapist as a kind of emotional mirror, by playing out, through the therapist, all of her conflicts with the people in her life. When she sees that the therapist stands by her no matter how ashamed she feels or how disgusting she thinks her behavior is, she feels secure. She trusts herself more and accepts her feelings as valid.
Equipped with a new set of emotional responses, the patient returns to the “real world” relaxed, reinforced, and ready to cope with the pressures that led to her disordered eating. As expressed by Dr. Alan Goodsitt, a psychiatrist from Northwestern University in Chicago and a leading expert in eating disorders: “When one is in touch with inner feelings-what feels good and is enjoyable, what feels bad or is boring, what is satisfying, and what is self-destructive-then one is in a good position to make wise life decisions.”
Individual therapy can be handled by a psychiatrist, a psychologist, or a social worker. Each professional develops his or her own approach.
In my practice I use all the techniques I feel have a chance of working. Usually this means combining elements of cognitive, behavioral, and educational therapy. A psychodynamic approach-exploring the unconscious motivations that underlie her behavior-can often be quite helpful, especially in the later phases of treatment. Through this approach, the patient gains insight into her situation. She sees how in the past she may have had good reasons for reacting as she did to her problems. But she learns that now, in her present-day reality, those characteristic ways of reacting are misguided.
Individual therapy doesn’t replace group or family therapy.
Each strategy supports and contributes to the other.
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