[Integrated psychotherapy for eating disorders].
The various psychotherapeutic strategies for eating disorders (EDs) include psychoanalytic, cognitive-behavioral, family oriented, arts therapy and others. In this paper, the psychodynamism of EDs and their therapy are reexamined and considered holistically from "the separate aspects of eating" point of view. That is the separation of eating regulated by biological appetite and the eating or not eating deriving from the patient's mind, unrelated to appetite. A new therapeutic technique called "formalization", which clarifies the separation of aspects of eating are invented. For integrated psychotherapy of EDs, it is necessary to combine the formalization technique of which clarifies and promotes patients' conflicts, and the integrated psychodynamic therapies that treat the promoted conflicts. The psychodynamism of EDs is the subject of much argument by many therapist. Although these arguments differ, they are similar in two points. Firstly, all of them consider EDs as distinctly separate from biological appetites. Secondly, the behavior of patients with EDs are taken as "false solution" or "substitution" of their essential problem. It is impossible to completely separate the physical action of eating mentally, however there may be a second meaning of eating separate from appetite. Seen in this light, psychotherapies are classified into two groups. One supports and sympathizes with these conflicts and the other is an educational one, telling the patients that a false solution is invalid. The former approach is employed by almost all psychodynamic therapies, such as psychoanalysis, family oriented therapy, arts therapy, self-help groups and the like. These therapies treat patients' conflicts with a non-judgemental approach, transform the psychodynamism, and consequently improve the eating behavior. The latter is applied by behavior therapy. Under strict operant conditioning, adequate behavior is reinforced by reward and inadequate behavior is eliminated by punishment. This way aims to transform the behavior first, change the cognition, and turn off the conflicts. In this sense the eating behavior and its psychological meaning are rated by a fixed value system. It is therefore important to integrate the strong points of these therapies. In other words, the therapeutic approach must be effective in improving behavior, maintaining good therapeutic relationships, radically transforming their psychodynamism. Formalization is a process of clarification of the separate aspects of eating in cases of EDs. At the beginning of treatment it is essential to clarify the double meaning of symptoms. Psychodynamically, there must be a "good" meaning in ED and it is necessary to be appraised.(ABSTRACT TRUNCATED AT 400 WORDS)
Tomizawa
O
O
Department of Psychiatry, Tokyo Medical College.
D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011379:Prognosis; D011613:Psychotherapy / Q000379:methods*