Eating and the Self: Focal Psychodynamic Therapy Modules

When I became the senior program director of Western Psychiatric Hospital of UPMC's inpatient eating disorder program, patients wanted more alternatives to DBT. As a psychodynamically oriented integrative therapist, Focal Psychodynamic Therapy (FPT) was an immediate interest. While cognitive behavioral manuals tend to be very tangible, specific and circumscribed, psychodynamic ones don't lean on behavioral or paper-and-pencil interventions and consequently set guidelines for verbal interventions or the experience of therapy instead. Eating and the Self aims to split the difference.

Eating and The Self - a Focal Dynamic Manual

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The Eating and the Self treatment guide provides a structured (integrative cognitive behavioral components) approach to psychodynamic content (informed primarily by FPT). This offers a hugely unique experience for patients to explore who they are, how others have treated or related to them, how they relate to others in both dyadic and triadic matrices, and how intrapsychic and interpersonal relationships are symbolized or repeated in the relationship to food. Experiences begin to make sense, and consequently can be verbalized rather than repressed beyond the consciousness barrier only to resurface as acted-out eating behaviors and somatic symptoms.

The result of this is agency and increased free-will (new ways to respond to emotions and interpersonal situations). The relationship with the treatment team improved - often the dietitian/nutritionist and psychiatrists in the acute eating disorder programs as split and seen as mean and controlling, but conversations became more peaceful.

In the outpatient setting, many clients have enjoyed completing 1 module per week and discussing it as part of the next session (some clients have gone through the whole manual the week they get it).

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Conclusion

Despite working with eating disorders for many years, I still find there are times when it is helpful to have a workbook model, and structured paper-and-pencil experiences for certain clients. Even if you don't typically work with clients who have eating disorders, these concerns are common and will come up with other clients. While at times it may make sense to refer out or seek consultation, many aspects of our relationship to food can be address without referring, and having a structured guide to lean on can be helpful for therapist and client alike.