A Straight Line Is Not Always The Most Direct Path

Treatment for eating disorders often takes a circuitous route.

The straight line would dictate: get patients to eat appropriately, talk with them about their disorder and the thoughts underlying them, replace harmful behaviors with healthy ones and — voila! — fixed.

Except it doesn’t work that way. The direct path can frighten clients with eating disorders and set them back in their recovery. For example, talk therapy can be frightening for patients who are emotionally cut off, whose bodies are under constant stress, who are starving or eating themselves to death. Sometimes, the most effective treatment starts with an oblique approach such as experiential therapy.

Experiential therapy activities may include an onsite work with horses (equine therapy), tai chi, yoga, meditation, low ropes course, canine therapy, journaling, drumming, team building, psychodrama, art, and music therapy. When undertaken with the guidance of a trained specialist, these activities help people with eating disorders begin to do critical therapeutic work within the framework of enjoyable actions, movements and activities. With the patient focused on the goal or task at hand, the therapist can frequently help the patient identify and address subconscious issues that he or she might otherwise not discuss.

In addition, experiential therapies can help individuals with eating disorders recognize the sensations of their body as they complete specific activities, and then begin to rebuild an overall awareness of their bodies and their emotions. Many patients experience alexithymia, a physiological and emotional disconnection from their bodies, often precipitated by trauma.

Some therapies, such as tai chi and yoga, directly address this disconnect. When they engage in physical activities, they build awareness of how their bodies feel, start to notice sensations, then identify emotions that may accompany those sensations and, finally, learn how to manage their emotions and appreciate their bodies.

Each type of experiential therapy affects a different part of the brain and hits a different part of the recovery process. Yoga, meditation and tai chi work on body recognition, control and breathing. Art activates the hippocampus and the right brain. Ropes courses develop strength, balance and spatial sense.

The ability to develop a positive relationship with another being such as horse or dog provides a critical first step for those who cannot connect with other people because of trauma or abandonment issues. With other creatures, they can begin to reestablish trust, experience a sense of mastery and find hope.

The Equine-Assisted Growth and Learning Association (EAGALA) model of equine therapy brings together the patient, therapist, certified horse professional and a horse to facilitate emotional growth and learning. Structured techniques keep all participants on the ground and leave the patient free to engage with the horse to creatively solve problems and take risks while working on identified therapeutic issues.

The more physical activities teach patients to trust themselves and to rely on and value their bodies, while the group settings begin to build relationships and connections among individuals in therapy who are combating the same disorder. The groups provide support, motivation and hope and create a sense of safety for all members, so each individual can achieve more than they would on their own.

The value of group participation can be seen clearly in psychodrama. The format enables patients to set up a visual representation of their eating disorder and explore what it has done to them. They may ask one group member to play the eating disorder, another to be the negative self-talk that says, “You’re no good” or “starvation” or “worthlessness.” Then they interact with the people playing those roles and discuss what that feels like. Externalizing their thoughts and the disorder helps them confront them as separate from themselves and provides insight that would often take much longer or be impossible to achieve in talk therapy.

Art and music may give eating-disordered patients a nonverbal way to express their emotional pain before they have the words to describe it and sometimes before they are even aware that they feel it. Music and art provide patients the freedom to convey their feelings, perceptions and perspectives safely, without fear of judgment.

As patients engage in experiential therapies, therapists address important clinical issues that often accompany eating disorders, such as self-awareness, self-worth, individuality, personal boundaries, impulse regulation, body image, and relationships with others. The combination of movement and talking has been found to be the most effective way to treat anyone with an eating disorder by building self-confidence, trust, and expressive tools.

Eating disorders are complex, and effective treatment requires a variety of approaches administered by a multidisciplinary team. Experiential therapies provide valuable ways for therapists to reach these patients where they are at the start of treatment and begin the healing process.