In the past few weeks, I have been speaking about the importance of a multidisciplinary, team approach to eating disorders treatment. As mentioned previously, this approach is associated with the best treatment outcomes and enhanced treatment effectiveness. Today, I would like to spend a few moments with you discussing experiential approaches to ED treatment. These alternative therapies can be integrated into a comprehensive team approach to treatment in order to help patients to increase awareness and expression of feelings and may help to relax patient defenses, given the utilization of non-verbal techniques (Fallon & Wonderlich, 1997). I include a number of links in this post for those of you who would like to pursue this topic further...
Art therapy, music therapy, dance and movement therapy, drama therapy, creative writing, meditation, equine therapy - these are some examples of recent trends in eating disorders treatment. These types of "expressive therapies" can be useful in uncovering feelings, images, and sensations and may permit greater freedom of expression in patients who have difficulty with verbal communication of feelings or for those with impaired cognitive insight. Experiential therapies also allow the therapist, or other healthcare professional, to "be with" patients in a way that reduces shame, fears of exposure, and fears of criticism (Hornyak & Baker, 1989).
The use of these techniques has increased dramatically over the past several decades. Although little empirical research in this area exists, many clinicians firmly believe in the utility of these therapies and find them to be especially well-suited to patients who have a history of trauma (Fallon & Wonderlich, 1997).
Practitioners of these therapies caution that clinicians be careful to maintain a balance between generating affect and providing emotional containment. The sequence, intensity and frequency of experiences will vary for each patient.
Art therapy allows for the expression of somatic concerns and the creation of expression through images when words may fail. According to Lisa Hinz, author of Drawing from within: Using art to treat eating disorders (2006), art can stimulate psychological growth and support healing because of the way people react to the artistic process. Art allows for the expression of a chaotic internal world in a non-verbal and contained manner, yet still allows for a greater range of emotional expression for some patients than verbal means allow. A variety of art therapies can be used both in assessment and treatment of eating disorders.
Likewise, movement therapy allows a patient to connect to his or her body in a creative, non-threatening manner. Dance therapy is based on the premise that body and mind are inter-related and fosters a connection to the body for patients who may have extreme difficulty with body image and who lack interoceptive cues.
Drama Therapy utilizes metaphor and role-play to enhance communication between therapist and patient. It can serve to enhance creativity and growth as well as spontaneous expression of affect.
Story-telling, whether by writing or through verbal means, allows a patient to express his or her journey of change, re-enact key experiences, and re-tell a life narrative in such a way that it can enhance the connections between a patient's experience and their eating disorder, while fostering long term change.
Finally, adventure therapy has been shown to potentially decrease perfectionism in patients with eating disorders, allow for greater emotional connectedness, may reduce body image disturbance, and may assist with weight maintenance in teens.
Meditation, relaxation, and hypnotherapy will be the subjects of future posts in " Treatment Notes".
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Sources: Hinz, L. (2006). Drawing from within: Using art to treat eating disorders. London: Jessica Kingsley Publishers.
Hornyak, L. M., & Baker, E.K. (1989). Experiential therapies for eating disorders. New York: The Guilford Press.
Fallon, P., & Wonderlich, S. A. (1997). Sexual abuse and other forms of trauma. In Garner, D., M., & Garfinkel, P. E. Handbook of treatment for eating disorders (2nd Edition). New York: The Guilford Press.
I am the co-author of a newly released workbook for individuals with disordered eating entitled: FINDING YOUR VOICE THROUGH ART THERAPY: A CREATIVE WORKBOOK FOR DEALING WITH YOUR EATING DISORDER [Jacobson-Levy & Foy-Tornay, 2008]. It an expressive journal that parallels treatment related issues, and may be used in conjunction with various treatment options. The main goal is to promote awareness of how thoughts and feelings often become disguised as disordered behaviors related to food/body image. Our book was released and presented at the Renfrew Center Foundation Annual Conference in November 2008, and recently at the Delaware Valley Art Therapy Conference in January 2009. For more information, go to