Eating disorders

Talking therapies

When people are diagnosed with an eating disorder they are often offered some type of counselling or therapy. These 'talking therapies' are offered to help people overcome emotional difficulties and change unhelpful patterns of thought and behaviour. Here we use the term "talking therapies” to cover a range of different therapies which could include: 

• Cognitive Behavioural Therapy 
• Psychotherapy
• Generic counselling
• Dialectical Behavioural Therapy
• Family Therapy
• Group therapy
• Art therapy
Young people we spoke with had most commonly received Cognitive Behavioural Therapy (CBT) but all of these treatments could be helpful for people with eating disorders. These treatments are available on the NHS (usually with a waiting list) but some people we spoke with paid for private treatment. Therapies each have a different way of working and where some may help with a particular person or problem, another therapy might not be successful. If one type of therapy does not help a person, they might find it useful to try another type of therapy. Talking therapies can be combined with other forms of support or treatment: for example seeing a dietician (to help with a meal plan and nutritional wellbeing) or occupational therapist (practical help with daily activities) and being prescribed medication for anxiety or depression. 

Finding the right therapist

“I remember thinking, 'Therapy! That’s what American people do. We don’t have therapy in the UK.’” -Eva

People were often quite ill when they started therapy, and often felt that they didn’t want to “lose” their eating disorder. Jasmin worried that a therapist would try to “make me fat”. Some people had had talking therapy before, for anxiety or depression so had an idea what to expect. 

People wanted a knowledgeable therapist who they “clicked” with, could trust and who took them seriously. Some people felt their therapist didn’t “understand” them, didn’t have enough specialist knowledge or kept forgetting things that they previously discussed. Sometimes people just didn’t get on with their therapist and found them false, “irritating” or “patronising”. When talking therapy was successful, people formed supportive long-lasting relationships with their therapist. Rob explained that for him the therapeutic relationship was more beneficial than the therapy itself. 

Benefits of talking therapies

As part of their illness, people had developed deeply held unrealistic patterns of thought and behaviour. Talking therapy could help “identify”, “challenge”, “rationalise” and “break” these patterns – something many people found helpful. 

Elizabeth said that, over the years, she had developed “funny rules” about food and eating and CBT helped her to realise how irrational they were. The therapeutic process in itself could “free up head space” and simply offer a space to express emotions. People gradually realised that anorexic or bulimic behaviour was so time-consuming and the so damaging to their state of mind, that they could prevent people from achieving their goals in life such as having friendships, having a job or a family.

Young people had often felt frustrated that other eating disorder treatments had been focused on their weight and not on the other issues. Talking therapy often worked on the basic issues of self-worth, perfectionism and control and people found this focus useful. Felicity said that it was thanks to therapy that she became much more “psychologically healthy person”. For Nikki, therapy was “the most helpful thing” towards recovery and helped her become more reflective and outward looking. However, Elene wanted to understand more about the deeper causes of her eating disorder which she didn't feel CBT addressed. Roberto had a few therapy sessions but said they weren’t “sufficient” on their own and he would’ve needed other forms of support alongside. 

Some had not seen a therapist face-to-face but had instead read books or done CBT exercises online. Although online exercises weren’t tailored to individual needs, they were readily accessible whenever people wanted.

The limits of talking therapies

People felt that talking therapies worked best when people were motivated and open to it. When people had been very ill, particularly underweight, they found they couldn’t accept that their thought patterns might be irrational and illogical.

Emily said her bulimia had become so deep-rooted that she found it hard to describe her feelings or explain the reasons for her behaviour. CBT could be “hard work”, draining and time consuming; therapy could last for several months or even years. It could be difficult to find the time to keep thought diaries - on the worst days people felt they were continually noting down negative thoughts which could feel like “a chore”. The sessions were often in the daytime and missing school could be hard for those who wanted to do well in school. 

If the person wasn’t motivated or ready to get help, they might feel “pressure to open up” or pretend “to go along with it”, like Georgia described.

Some felt that talking therapies weren’t helpful and would have preferred help with practical issues, such as going to the supermarket or eating out in public.

Family therapy

Family can play an important part in treating eating disorders, especially when people are very young and still living at home. People’s experiences of family therapy varied. For some it didn’t work at all; they described the sessions as awkward and confrontational or felt that involving family was irrelevant because they saw the eating disorder as “their problem”. Katie said the family therapy sessions were unsuccessful and “turned into slanging matches”. Sessions could be very emotional and upsetting; Francesca said sometimes she and her family “would all sit and cry”. Some people never wanted to tell their parents about their eating disorder, let alone be involved in therapy.

For others, it could be an essential step in recovery.

Family therapy can involve one or both parents, as well as siblings, depending on their ages and the family situation. Sarah-May’s family took part in multi-family sessions that involved different families. Sometimes one parent could be reluctant to take part:  Hannah Z’s dad wasn’t keen to come along but when he did, she really “respected” him for it. At first, Francesca’s mum was reluctant to join family therapy. Francesca thought her mum was worried about being blamed but the experience turned out to be very different.

People considered the biggest benefit of family therapy to be the support and insight it offered their parents. Young people had often received help for themselves already and felt fairly well supported and informed but felt their parents had lacked understanding and tools. Francesca also had therapy with her boyfriend, who became an important person in her recovery.

Group therapy

Many of those people who had been treated as an inpatient in hospital attended different types of group therapies in the unit. These included art and drama therapy and workshops on creative writing, yoga, meditation and self-esteem. Different groups offered structure and meaningful activity to hospital days. The groups also helped people to develop coping “tools” to draw on during difficult times and help prevent them from relapsing. 

People felt that group therapy wasn’t always suitable. If the group members were all at different stages of their illness/recovery, this could have a negative impact others. 

Groups were seen as most beneficial when they were between “like minded” people who were at a similar stage of recovery. (For more see ‘Inpatient treatment in hospital).

Counselling at school, college or university

People could access more informal counselling at school or university or with their GPs. This type of counselling was quickly and regularly accessible, with short waiting times and information about other services. However this counselling was often less specialist. Emily felt that school counselling was not appropriate for “in-built chronic eating disorder”. People felt it was more useful to tackle other problems that could be linked to the eating disorder, such as bullying, relationship problems or exam stress.

No counselling

We also spoke to people who had never had any formal therapy or counselling, as they had not engaged with services or had never been offered it. Maria, despite a stay in hospital, refused to take part in talking therapies. She says she managed to recover through her own resources.

Sam has never had counselling but has seen ‘a life coach’. He said it felt like a more productive approach:

“[life coaching helps] to make actions and evaluate as you go. And that kind of works for me I think. Rather than just talking about it ‘cos I think that sits with me”.

Some people who hadn’t found help from the standard therapies had turned to ‘complementary’ therapies, such as hypnotherapy. Katherine found that hypnotherapy helped her gain the will to deal with her unhealthy behaviours.

Last reviewed October 2018.


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