Narrative Therapy in the Treatment of Eating Disorders

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Eating disorders are complicated mental illnesses that typically require a multidisciplinary team of professionals to treat. The most common therapeutic interventions for eating disorders are cognitive-based therapies, such as cognitive-behavioral therapy (CBT) or dialectical behavioral therapy (DBT). However, new research suggests narrative therapy could be an effective and positive alternative.

Narrative therapy is a non-pathologizing approach to therapy in which people remain the experts on their own lives. Narrative therapy views problems as separate from people and assumes each person contains the tools within themselves to reduce the impact of problems on their lives.

By applying narrative therapy to the treatment of eating disorders, individuals remain in the driver’s seat of their recovery, identity and personal experience are at top considerations for treatment, and hope is a central component in therapy.

Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder (ARFID), and other specified feeding or eating disorder (OSFED) are all eating disorders recognized in the DSM-5. However, eating disorders typically have a wide spectrum of symptoms and a person may vacillate between diagnoses depending on where they are at in their journey.

Eating disorders can affect any person regardless of their age, gender, racial, or ethnic background. However, research has begun to show that neurodivergent individuals and members of the LGBTQIA+ community could be at an increased risk of developing a problematic relationship with food.

Cognitive-based interventions, such as CBT and DBT, are the most commonly recommended therapies for eating disorders. This may be due to the fact that cognitive-based treatments are widely used in research studies, making them easy to claim as evidence-based interventions. However, the high rates of relapse in individuals with severe eating disorders suggest there is room to explore alternative options for treatment. Narrative therapy could be an empowering therapeutic intervention for individuals with eating disorders as it targets the dominant stories that impact beliefs, behaviors, and emotions. Narrative therapy states that the client is the expert of their own experience, leaving room for the nuanced experiences of the intersectionality of each person’s identity.

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What Is Narrative Therapy?

Narrative therapy is a type of therapeutic intervention that seeks to help clients understand their life philosophies and identify the beliefs that keep them stuck. Narrative therapy focuses on the stories that individuals create throughout their lives. Narrative therapy states that individuals assign meaning to the experiences they go through and that this meaning influences how they see themselves and the world.

Narrative therapy works to be a non-blaming, non-pathological approach to counseling. It centers clients as the expert of their own lives and views problems as separate from people. Narrative therapy assumes each person contains the tools to reduce the impact of problems in their lives.

Key aspects of narrative therapy include:

1. The person, family, or community is invited to map out the effect of the problem on their life, relationships, and identity. This step includes deconstructing the meaning of problematic storylines and externalizing the problem from the person’s identity.
2. Next, therapy focuses on working with the person to reveal identity narratives that have been hidden by the dominant problem. Step two of narrative therapy works to “re-author conversations” in order to identify areas of a person’s identity and values that are absent from the problematic dominant narrative.
3. Last, narrative therapy works to thicken the meaning of the newly uncovered storylines, which have been previously hidden underneath the problem narrative. This step leads to new meanings being extracted from the edits made to old stories.

Narrative Therapy and Eating Disorders

Eating disorders impact the way a person interacts with food and their body. These disorders are centered on problematic narratives surrounding a person’s body shape, desired appearance, the discomfort of physical sensations when eating, or their judgments toward certain foods.

Here are just a few of the ways narrative therapy can assist individuals suffering from eating disorders:

1. Narrative therapy can help people re-story their dominant narratives surrounding food and their body. Re-storying the dominant narrative can help individuals reconnect with parts of their identity that were previously hidden by the problematic storyline.
2. Narrative therapy puts the person in the driver’s seat. Narrative therapy states that each person is the expert on their story and names the therapist as a collaborative rather than an expert. This type of therapy can help a person with an eating disorder regain a sense of empowerment, both in their recovery and in their life.
3. Narrative therapy works to honor each person’s uniqueness, seeing identity as a key component in a person’s ability to heal. Narrative therapy states that each person holds a vast portfolio of stories impacting the way they interact with the world. It makes room for the nuances that exist within the intersectionality of each person’s lived experiences.
4. Narrative therapy brings optimism and hope. Narrative therapy puts people in the driver’s seat of their lives. It states that there exists an endless amount of edits to people’s narratives, leaving open the belief in full recovery and an identity uninhibited by the eating disorder.

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If you or a loved one is suffering from an eating disorder, you may be interested in exploring the option of narrative therapy in treatment. Finding a therapist who specializes in eating disorders and narrative therapy may feel like a daunting task, but online search engines and personal referrals can help make the process more accessible.

To find a therapist, please visit the Psychology Today Therapy Directory.