Relationship-focused psychotherapies for eating disorders come of age.

Abstract

This is a commentary on 3 case studies of relationship-focused therapies for eating disorders. The 3 approaches vary along a number of dimensions, but nevertheless share important similarities especially related to the role played by variables such as interpersonal problems and affect dysregulation. I briefly review research on interpersonal- and attachment-based models of eating disorders that provide the evidence-base for theories of therapy that are relationship-focused. The Interpersonal Psychotherapy case presented by Tanofsky-Kraff, Shomaker, Young, and Wilfley (2016) illustrates how a group context can facilitate change in key role disputes and role transitions in an adolescent at risk of developing an eating disorder later in her life. 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. (PsycINFO Database Record

Implications of Attachment Theory and Neuroscience for the Psychotherapeutic Treatment of Obesity and Overeating

“…Similar to other developing conceptualizations of therapeutic change mechanisms that focus on the role of early relational patterns in adult emotional regulation and dysregulated eating (41,42), I posit that patients with dysregulated eating may benefit from psychotherapeutic approaches that address the underlying regulatory issues that are preverbally embedded in somatic experience and in the implicit relational world of attachment misattunements to facilitate the repair of the developmentally impaired capacity of self-regulatory functioning. The therapeutic aim involves helping patients to regulate impulses, fill the deep emotional void, and move away from the primal call of food to enable the development of more adaptive self-regulatory mechanisms, specifically more self-soothing processes, greater self-efficacy, a more integrated sense of self, enhanced tolerance for intimacy, and a healthier authentic relatedness.…”

Review of attachment interventions in eating disorders: Implications for psychotherapy

“…Several psychotherapeutic method involves the above written attachment-related factors, such as the emotion-focused family therapy ( Robinson Dolhanty, & Greeberg, 2015), and dialectical behavior therapy (Rizvi, Steffel, & Carson-Wong, 2013). Although psychodynamic approaches also contain various attachment-related aspects of psychotherapies such as paternal relationships, transference or emotion-regulation (Tasca, 2016;Thompson-Brenner, 2014), the efficacy of interventions focusing exclusively on patients' attachment-functioning were only recently tested (Illing et al, 2010;Maxwell, Tasca, Ritchie, Balfour, & Bissada, 2014;Tasca et al, 2006). Related efficacy studies showed that the more the patient's attachment functioning improved during the course of the treatment, the better outcomes could be observed (Illing et al, 2010;Maxwell et al, 2014;Tasca et al, 2011Tasca et al, , 2013.…”

“…However, when these attachment-related factors contribute to the maintenance of eating disorder symptoms, they can serve as intervention points in the course of personalized treatments. This implies the usefulness of longer, relationship-focused psychotherapies in eating disorders (Tasca, 2016).…”

Psicanálise no tratamento multidisciplinar e cirúrgico de obesidade severa

“…As mudanças mais notáveis foram sua maior habilidade no funcionamento reflexivo e uma maior coerência em sua narrativa que lhe permitiu ser mais estável emocionalmente, diminuindo os sintomas alimentares. A descrição deste caso é um importante lembrete de que no transtorno alimentar os sintomas não podem ser tratados ignorando a disfunção interpessoal e a incoerência na narrativa do apego (Tasca, 2016).…”

“…Segundo o autor, teoria e pesquisa sobre fatores interpessoais e regulação emocional que determinam os sintomas de transtorno alimentar percorreram um longo caminho nas últimas décadas. As terapias para tratar transtornos alimentares que se baseiam nesta pesquisa, nos domínios interpessoal e de apego, estão amadurecendo e fornecem aos terapeutas uma gama mais ampla de opções terapêuticas que podem ser verdadeiramente personalizadas para seus pacientes (Tasca, 2016).…”