Psychoanalytic psychotherapy with a client with bulimia nervosa.

Abstract

This case study presents the progress of one patient with bulimia nervosa who was originally very compromised in psychological domains that are the focus of analytic treatment, and includes in-session therapeutic process and a range of outcomes, for example, eating disorder symptoms, attachment status, and reflective functioning. Nested in a study showing more rapid behavioral improvement in subjects receiving cognitive behavior therapy than in subjects receiving psychoanalytic psychotherapy, the case highlights the importance of supplementing RCTs with single case studies and the need of adapting the therapeutic approach as well as the current therapeutic dialogue to the individual client. (PsycINFO Database Record

Appraising psychotherapy case studies in practice-based evidence: introducing Case Study Evaluation-tool (CaSE)

“…To illustrate the use of CaSE Purpose-based Evaluative Framework for Systematic Case Studies, a case study by Lunn, Daniel, and Poulsen (2016) titled 'Psychoanalytic Psychotherapy With a Client With Bulimia Nervosa' was selected from the Single Case Archive (SCA) and analysed in Table 14. Based on the core questions associated with the six purpose-based systematic case study types in Table 13(1 to 6), the purpose of Lunn et al's (2016) case was identified as critical (testing an existing theoretical suggestion).…”

“…Furthermore, assessing the case against its purpose will let reviewers determine whether the case achieves its set goals (research objectives and aims). The example below shows that Lunn et al's (2016) case is successful in functioning as a critical case as the authors provide relevant, high-quality information about their tested therapeutic conditions.…”

Peer Interaction – Relationships with Friends and People of Similar Age

“…By these patients, binging and purging episodes can be experienced as an undisturbed space or a "comfort zone," leading away from these difficult emotional states (Lunn and Poulsen 2012, p. 50). Additionally, bulimic symptoms, which are often triggered by feelings of abandonment and anger, may serve the function of regulating the wish for an object (being close to another person) and the separation from it (Lunn and Poulsen 2012).…”

Relationship-focused psychotherapies for eating disorders come of age.

“…Finally, Tasca and colleagues (2009) tested a model of attachment insecurity and its relationship to eating disorder symptoms. As noted in the paper by Lunn and colleagues (2016) in this special issue, attachment theory is an important conceptual framework for understanding eating disorders partly because of its focus on describing specific interpersonal styles and affect regulation associated with particular attachment insecurities. For example, attachment avoidance is associated with dismissing relationships and down-regulating of emotions, and attachment anxiety is associated with a preoccupation with relationships and up-regulating of emotions (Mikulincer & Shaver, 2007).…”

“…The Integrative-Dynamic Therapy case presented by Richards, Shingleton, Goldman, Siegel, and Thompson-Brenner (2016) is a novel sequential combination of cognitive–behavioral therapy followed by dynamic psychotherapy for a young adult with bulimia nervosa that likely reflects what most clinicians do in everyday practice. The Psychoanalytic Psychotherapy case presented by Lunn, Poulsen, and Daniel (2016) of a patient with severe personality pathology demonstrates how treatments for eating disorders sometimes must address complex attachment dysfunction, self-organization, and therapist countertransference in order to provide a useful therapeutic experience. Relationship-focused theories and therapies for eating disorders have come a long way over the past decades, thus providing therapists with a wider range of approaches that can be truly personalized to their clients.…”