Psychoanalysis is a therapeutic practice that is sometimes used in the treatment of eating disorders. As with other eating disorder therapies, it is best to receive psychoanalysis in addition to getting support from a nutritionist.
Sigmund Freud, an Austrian neurologist, is the founder of psychoanalysis. He coined the term and developed this theory of how the mind works and approach to treating mental health conditions by talking about them in the late 1800s. He believed there were three parts of a person’s personality, the id, superego, and ego. He proposed there are unconscious thoughts, feelings, urges, and memories of childhood experiences that people are unaware of. These primitive instincts and impulses are part of what he called the “id.” He believed these forces drive behavior, sometimes in negative ways, and cause psychological distress, or conflict.
Freud believed this conflict resulted from a clash of the id and what he called the “superego,” or a person’s morals or conscience, which Freud believed came from a person’s parents. He helped patients bring these unconscious drives into conscious awareness. Slips of the tongue–Freudian slips, mannerisms, and dreams are ways the unconscious can manifest. Then he helped his patients address this distress–such as anxiety, depression, and what he called neuroses, and resolve the negative behaviors.
This is where his concept of “ego” comes in. He believed the ego represents a person’s reality and identity and helps resolve conflicts between the id’s impulses and the superego’s morals.
While Freud’s theory and approach are controversial, some concepts have endured and evolved, paving the way for the many modalities of psychotherapy that exist today.
Psychoanalysis sessions usually last a little under an hour and can occur up to five times per week. During the session, the patient is usually lying on a couch, and the therapist is not within the view of the patient, although this is not as common today. The patient talks about childhood memories, thoughts, dreams, and fantasies. These may lead to other ideas, called free associations, and talk about them, too. The patient and therapist then discuss how these result in certain emotions, actions, and behaviors, then work toward changing these patterns.
Psychoanalysis practitioners are often medical doctors that specialize in psychiatry, and their rates are higher than other types of psychotherapy practitioners. They may prescribe medications, such as antidepressants or antipsychotics. Traditionally, a minimum of 50 sessions is required.
Psychoanalysis is sometimes used as part of a treatment plan for those who have eating disorders when there is a history of disturbances in early relationships, (1) when an individual has a hard time being authentic when others are present, and when there are co-occurring personality disorders.
As with any eating disorder, the objective of therapy for someone with anorexia nervosa is to understand their psychological struggles and gain insight, so change will occur and the person can have a healthy relationship with themselves, eating, and food. (2)
Some questions the therapist may ask include:
Modern psychotherapy does not generally adhere to classical psychoanalytic methods. For example, sessions may not go on for years and years. Therapists may interact more with their patients and face them directly. They may focus more on what’s happening currently in the patient’s life instead of what happened in early childhood.
Many different “talk therapy” approaches have evolved. They include cognitive behavioral therapy (CBT), cognitive emotional behavioral therapy (CEBT), dialectical behavioral therapy (DBT), emotionally focused therapy (EFT), and internal family systems therapy (IFS).
Cognitive behavioral therapy is one of the more popular approaches used today. (3) CBT analyzes the connection between beliefs, thoughts, and feelings,which often originate from childhood experiences, and how these relate to behavior.
There are many benefits of psychoanalysis: (4)
Psychoanalysis does have limitations, including:
Nonetheless, psychoanalysis can be effective in treating eating disorders. One major research review on psychoanalysis and eating disorders analyzed 64 studies on psychoanalysis. The review concluded that psychodynamic therapies are effective to help patients suffering from eating disorders and personality disorders. (9) When developing a comprehensive eating disorder treatment plan, it’s essential to tailor the plan to each individual.
At this time, Within Health does not use psychoanalysis for the treatment of eating disorders, but our clinicians do apply some psychodynamic ideas when thinking about how they conceptualize cases, clients, and their history. If you’d like to learn more about our treatment practices for eating disorders, or the first steps in starting treatment, call our team now.
