Existential interventions in eating disorders
This study provides the result of a doctorate research into the impact of existential psychotherapeutic interventions with people experiencing chronic eating disorders. The results indicate that positive outcomes are correlated to therapeutic interventions which concentrate on the clients own perception of control and choice over their own eating habits. The research aim was to explore both the effects and the effectiveness of existential therapy in altering the individuals subjective interpretation of their Self when they are deeply immersed in the experience of disordered eating. Interventions went beyond the cognitive-behavioural approaches into the implementation of existential psychotherapy which helped individuals to explore the existential concerns of life, choice, hope, social inclusion and love within the context of their own sense of Being. This focus led to an improvement in all study subjects and a reduction in the use of mental health resources. All individuals entered the study following assessment criteria which included chronicity, lengthy use of mental health services and past therapeutic interventions. Three diagnostic criteria were included, Anorexia Nervosa, Bulimia Nervosa and Morbid Obesity. Data presented in the study supported the original premise that all three eating disorders share underlying similarities and justify the inclusion of the diagnostic criteria of morbid obesity within the study. Therapy was either in closed groups or individual and consisted of a fixed number of one-hour sessions. Therapeutic techniques included cognitive-behavioural therapy and person-centred counselling focusing on self-esteem and self-assertion, as well as an existential focus on dualistic perception of the mind/body, the conscious sense of the present and the affective bond with food itself. A series of therapeutic phases were structured to demonstrate the progress from interventions in self-esteem and self-assertion to existential concerns and principles. Taking therapy beyond cognitive-behavioural techniques involved the application of Yaloms' (1980) and Strasser and Strassers' (1997) Existential Therapy and an exploration of Duker and Slades' (1988) concepts of the fragmentation of the sense of Self in individuals experiencing eating disorders. The research demonstrated important differences between the professional perception of appropriate eating and alteration in weight as successful clinical outcomes, and the clients’ dependency on disordered eating as a source of release from interacting with others. Mental health interventions were perceived by clients as attempts to stop such a release without providing a substitute. A clear sense of loss was presented by all study subjects when eating was controlled by others. In most cases disordered eating was habitual and the emotional effects of raised or lowered glucose levels gave a sense of numbness and nothingness which was actively pursued. This was also attained when disordered eating was combined with other self-harm behaviours. Mental health practitioners inadvertently prevented the attainment of a sense of numbness by their focus on eating and body weight. The encouragement of food regimes causes increased anxiety for all clients leading to poor compliance levels. The research results have the potential to impact on mental health education and clinical services as the data indicates that individuals with disordered eating gain more benefit when the therapeutic focus is less on restoring appropriate eating habits and more on the individuals sense of Self; the importance of food intake as a source of escape from others and escape from the internal awareness of Self.