Seeking Common Threads to Effective Practice
By Abigail Natenshon, MA, LCSW, GCFP

One of the most hotly discussed topics in the field of eating disorder treatment today is defining what sets eating disorder practice and practitioners apart within the field of mental health practice. Research shows that best practice techniques are rarely followed by practitioners, and that best evidence is not always right evidence, depending upon the needs of the patient and the demands of the therapeutic moment. Diverse and integrative disorders require broad based knowledge and a facile use of the therapist's self in approaches to care.

In my view, two aspects of care demand "commonality" among eating disorder practitioners. The first is a deep respect for the diverse and integrative nature of these disorders and the unique needs of each patient, based not only on the nature of the disorder and symptom presentation, but also on the reality that the disorder damages, to one extent or another, the patient's internal strengths, resiliency and resourcefulness so necessary for recovery, a function based on the pre-existing underlying emotional health of the individual. I have found that some of the most extreme cases may have a good prognosis based on the pre-existing and underlying emotional health of individual AND FAMILY.

The second critical commonality among practitioners is, in my opinion, the need for a versatile, empathic and courageous use of the practitioner's OWN SELF vis-a-vis the patient and the demands of the treatment moment. The practitioner's ability to connect with the patient with vibrancy and depth within the therapeutic relationship, once seen as an immeasurable and unteachable art, has recently been elevated to the status of evidence-based science through the work of neuroscientists Drs. Daniel Siegel and Allan Schore who point to attachment theory and brain changes through MRI images which illustrate positive effects of 'right brain to right brain' connection on self-regulation and well-being. Through brain-based research and new technology that measures consciousness and state of mind, the quality of relationship may be considered the most important intervention of all, even within the context of CBT and other manualized practices. Note that the concept of a trusting and workable relationship does not imply the "therapist as friend," as is often the assumption.

The versatile use of self, in my mind, implies the therapist's capacity to recognize and respond to needs with immediacy and spontaneity, calling up diverse resources at will, using the self creatively and with invention, setting secure limits and making demands even while remaining collaborative and loving with the patient. All of this is what sets eating disorder practitioners apart in their capacity to achieve successful outcomes; all of this requires an emotional integration and maturity, both personal and professional, on the part of the clinician.

Lastly, practitioners need to recognize that complete recovery is possible in the vast majority of cases. To accomplish this, clinicians must stand firm, particularly on the very brink of the patient's recovery when heighten anxiety stimulates the need to "negotiation with the enemy." Practitioners mustn't lose sight of the fact that a 93% recovery is not sufficient to overcome an eating disorder; therapy and the intensity of the drive for complete and total recovery must not cease till 100% healing, physically and emotionally, becomes a tangible reality.


Natenshon is the author Doing What Works, an Integrative System for the Treatment of Eating Disorders from Diagnosis to Recovery.
 

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