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Cassie Jeng 4

Ms. Mary Jane Sasser


IR-3/ AP 11

An Evolution of Treatment with Eating Disorders

I. How would one approach treatment of a psychological disorder? Mental health is a major

concern for modern medicine as it affects, on average during any one year, 15 percent of

the population (Taylor 196). While there are traditional effective methods for treating

mental health, newer, broader, and non traditional methods of care can widen the

opportunities for health for caregivers. Specifically with patients with eating disorders,

there are benefits to combining classic as well as less traditional treatments. ​Traditional

cognitive therapies encourage patients to rationalize patterns of thought and behavior

through discussion and to challenge these patterns by incorporating an outside

perspective. However, less traditional, more innovative modalities such as dance

movement therapy encourages patients with eating disorders to create stronger

awareness, utilize movement as communication, and reestablish a sense of control in their

life. When the two therapies are used simultaneously, there is higher treatment success

for eating disorders because the approaches combine the best aspects of both to meet the

patients needs and solve obstacles that are introduced when using each individually.

II. Psychological disorders are very prevalent in our modern society, calling for effective
treatment methods to handle the variety of instances threatening lives around the world.
A. Eating disorders are a form of psychological disorder that are characterized by
irregular and damaging eating habits (“Eating Disorders” 1).
1. The most common types of eating disorders are anorexia nervosa, bulimia,
and binge eating.
2. While they primarily focus on body image, weight, and shape, eating
disorders are not just an issue with consuming food.
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a) They “commonly coexist with other conditions, such as anxiety


disorders, substance abuse, or depression” (“Eating Disorders:
Symptoms” 1).
b) Often caused by an additional underlying problem, such as being a
victim in a bullying relationship, eating disorders have both
external motives that are easily recognizable and hidden ones that
form the origin of the illness.
3. Despite popular stereotypes regarding this serious mental health concern,
it is not solely teenage girls who fall victim.
4. It has been publically reported that this illness is “a daily struggle for 10
million females and 1 million males in the United States” alone, and such
variety in the patients demands variety in treatment methods (“Eating
Disorder Statistics” 2).
5. This chart shows the number of Americans in the country with eating
disorders.
a) It provides statistics based on the age groups that suffer the most
from eating disorders, as well as the typical body sizes that lead to
self conscious thoughts of themselves in comparison to the average
American body size.
b) https://www.dropbox.com/s/uk176so31rqtx94/going-to-extremes.g
if?dl=0
B. Every treatment is structured to focus on different characteristics of the disorder
and to ultimately uncover the internal motive for adapted eating habits.
1. Just as some people are visual learners and some are auditory learners,
some patients are more responsive with certain techniques than others.
2. Thus, there must be a variety of different treatment methods, and the
individual therapists must be able to adapt their sessions to the patients so
each can achieve the same treatment satisfaction.
a) A major concept that requires adapting is the type of eating
disorder present.
b) Each type will require different treatment because each is based on
a different way of perceiving the body; “there are different patterns
and behaviors for each type of eating disorder.
c) Anorexia is restrictive, black and white thinking.
d) A bulimic is very impulsive or might look to doing a lot of
exercise…” (Kleinman, Personal Interview 2).
3. Cognitive based therapy (CBT) was developed as a type of therapy that
focuses on thoughts and behavior for problem solving; “the core principles
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of CBT are identifying negative or false beliefs and testing or restructuring


them” (“Psychotherapy” 1).
4. Dance/movement therapy (DMT) was developed as a type of therapy that
focuses on reconnecting the mind and body relationship through dance.
The aspect of physical activity had been proven to help with mental
disorders since the “psychological benefits are improved confidence,
well-being, sexual satisfaction, anxiety reduction, and positive effects on
depressed mood and intellectual functioning” (Taylor 196).
5. Eating disorders do not exhibit the same symptoms; treatment activities
for someone who is bulimic will not be as successful with a different
patient suffering from anorexia nervosa.
6. A variety of therapy choices allows different patients with different
disorders the necessary separate activities to understand the source of their
illness.

III. As one of the most traditional methods regarding eating disorders, cognitive based
therapies work to help with treatment through active discussions between the patients and
the therapists.
A. This type of therapy focuses more on the verbal expression of feelings in order to
access the hidden feelings.
1. Because there is a need to adapt to different styles for different
individuals, there are many different branches off the umbrella concept of
cognitive based therapies (CBT).
2. However, all CBT works to incorporate discussion into the treatment
process for individuals with mental illnesses.
B. Family-based therapy (FBT), a historical cognitive-based therapy type, is still one
of the most common eating disorder treatments today.
1. This style is based off the incorporation of family into treatment sessions
rather than having one on one conversations between the patient and the
therapist and “has proven to be an important element in the treatment of
patients with eating disorders” (The Center 1).
2. Originally introduced as the Maudsley approach by Dr. Christopher Dare
and colleagues at the Maudsley hospital in London, this is a twelve month
outpatient program for individuals suffering anorexia nervosa.
a) The program works “through three clearly defined phases, and is
usually conducted within 15-20 treatment sessions” to ease the
patients into a calm and successful recovery (Le Grange 2).
b) These sessions include the therapist, the patient, and close family
members such as the patient’s parents.
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3. The idea is that family is a key aspect of therapy and will help with
treatment because the patient will have less feelings of being stranded,
alone, or interrogated.
a) It is important to have the family as part of the therapy because it
allows for another support system for the patient and gives a
familiar face to relate to during the sessions.
b) The structure of family-based therapy “considers the parents as a
resource and essential in successful treatment for anorexia
nervosa” (Le Grange 2).
4. Because of the eating disorder ability to skew judgement, it also works to
have someone close and personal with the patient to interpret
conversations or connect outside experiences that the patient themselves
might overlook.
5. It is beneficial since it allows the therapy to travel outside of just the
sessions and impact the patient towards recovery even when they are not
with the therapist directly.
C. Through discussion, cognitive-based therapies like FBT help patients to
rationalize patterns of thought and behavior that are influencing their life and
disorder.
1. Often times, an eating disorder will cause the patient to think or behave in
a certain way that can be dangerous, such as restricting calories so that the
patient has a difficult time maintaining body heat, or in females, the
disappearance of the menstrual cycle.
2. These patterns are generally recognized by the people in the surroundings
that are close with the individual, such as family members.
a) They are then able to show support and “come to discover how
changes in the way they communicate, manage conflict, or tolerate
negative emotions can aid in their loved one’s recovery (The
Center 1).
b) This way, not only is the patient recovering, but the family is
adapting to make it easier and better for the patient and everyone
else around them.
c) It is very beneficial to have the family incorporated in the sessions
to voice their observances and help to work together to progress
the treatment and discussions in a positive direction.
3. The therapist and family members can create a discussion to talk about
hidden thoughts and clear head space from irrational fear or anxieties
formed as a result of the eating disorder.
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a) “Talking therapy could help ‘identify,’ ‘challenge,’ ‘rationalize,’


and ‘break’ these patterns” by having the therapist provide
examples and explanations as for why there should be nothing to
fear or worry (“Talk” 1).
b) For instance, the patient might come up with a fear of being
unpopular, and the therapist can talk to them about how they do
not need to stop eating in order to achieve this desire.
c) This also works to refute “rules” that exist in the individual’s mind
that influence their eating behavior by talking through why the
rules are unnecessary or harmful in the long run (Talk 1).
4. One example of this would be if the patient decided that eating meat was
bad because of its fatty nature.
a) The therapist can talk to the patient about how this diet rule is
unreasonable since meat provides necessary protein for the body
and there are lean meats.
b) For instance, a lot of athletes eat healthy meats as a part of their
three balanced meals a day.
5. When a patient “had developed ‘funny rules’ about food and eating…
CBT helped her to realize how irrational they were” and therefore allow
her to logically revert back to more normal eating habits (“Talk” 1).
6. Family-based therapy and other cognitive therapies work to prove to the
patients that there are better ways of handling themselves and issues other
than the adapted eating habits during the course of their disorder.
D. An important aspect of such cognitive therapy is the incorporation of the outside
perspective offered by the therapist and the family which allows for the refuting
and discussion of patterns.
1. Two sided conversations can provide feedback based on the therapists
opinions and facts: another person’s perspective on the fears and anxieties.
2. Without the incorporation of the other person, it becomes harder for the
patient to fight and overcome their own fears by their own logic.
3. One patient with experience in FBT “gradually realized that anorexic or
bulimic behavior was so time-consuming and so damaging to their state of
mind, that they could prevent people from achieving their goals” through
discussion of their thoughts with the others in their surroundings (“Talk”
1).
E. Cognitive based therapies, like family-based therapy, are able to provide the
patient with the rationalization of patterns needed to overcome their hidden fears
or troubles.
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1. Just by the act of openly discussing the issues surrounding their eating
disorder with people whom they trust and professionals, irrational and
harmful thoughts can be changed to more healthy habits.
2. The outside perspective helps to connect the puzzle pieces and show the
bigger picture to the patient about what is actually happening and the
consequences of their actions (“Talk” 1).
3. This can open a new window to why there is a need for change that the
individual could not view before and allow for a healthy recovery.

IV. In contrast to the more traditional and widely known method, dance/movement therapy,
also known as DMT, is a more recently developed physical and kinesthetic rather than
solely cognitive approach that builds off of the idea that physical activity can be used as
treatment for mental disorders (Scully 112).
A. This type of therapy works with the patient to reconnect the mind and body,
incorporating the body into the actual treatment activities.
1. “DMT is a bottom up approach,” stated Dr. Susan Kleinman, MA,
BC-DMT, NCC, CEDS in a personal interview on the 10th of December
2017, “we attune using movement and pick up what is actually going on
with the person on the body level” (Kleinman, Personal Interview 2).
a) “Bottom up” refers to working from the feet and body, moving up
towards the mind as the last connection (Kleinman, Personal
Interview 2).
b) Dance/movement therapy focuses on the connection to the body
that is necessary to have a positive relationship with oneself and
alleviate feelings of self consciousness.
c) This helps uncover what the body is feeling before the mind can
synthesize its thoughts.
2. There are many ways that dance/movement therapy is specifically
beneficial in eating disorder treatment, including establishing a stronger
awareness for oneself and others and using this to interpret one's
subconscious.
B. The most important building block of a bottom up approach to therapy is the
understanding of one’s self and those around them.
1. Dance/movement therapy works to make the patient more in tune with the
environment around them and aware of how their actions are affecting
others in their surroundings.
a) “By processes such as mirroring, contagion, and differentiation,”
humans are able to build the world around them by observing
others and making differentiations and decisions (Koch 63).
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b) However, they must be connected to the world in order to both


obtain this relationship and use it to improve themselves and
others.
2. The first step is being aware of one’s own body by the process of
kinesthetic awareness;
a) the awareness of oneself and their own body in relation to how and
where they exist.
b) Dance/movement therapy strengthens the patients’ kinesthetic
awareness by interacting directly with the body to become aware
of what they are actually feeling “as dancing requires you to stay
conscious of your whole body” (Ladock 3).
3. The second technique that dance/movement therapy develops is rhythmic
synchrony;
a) the ability to make thoughts and movements in sync with another
person.
b) Because rhythm unites, “by facilitating shared rhythmic body
action, dance/movement therapists foster connection- an
immediate embodied connection that can break through even the
profoundest isolation” (Kleinman, “Movement Dance Therapy” 2).
c) The skill of syncing one’s body with others teaches the patient how
to once against connect with others emotionally, allowing them to
trust and express in a smoother manner, opening the doors to their
souls a little more than before.
4. Finally, the therapists combine these skills with kinesthetic empathy to
connect with others emotionally by understanding their feelings.
a) “It is the attempt to experience someone else’s inner life and
implies knowing what the other one feels,” stated Diana Fischman
(1).
b) In order to relate to the other person and what they are feeling
inside, one must be able to understand their own inner emotions,
otherwise there is no way for them to experience the other person’s
life.
5. Dance/movement therapy facilitates this process to allow a stronger
connection between the patient and the therapist, as well as the outside
world.
6. Since eating disorders are extremely personal, patients are not always able
to openly express with another individual, therefore it is vitally important
that dance/movement therapy allows the patient to reestablish the ability to
connect with others during the treatment process.
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C. While dance/movement therapy is very successful at helping to establish


connections, it is also a way to use these connections to reflect everyday
movement as expressive communication.
1. The dancing activities during sessions works to draw out inner emotions to
understand the source of the anxiety and stress causing the disorder.
2. The direct incorporation of the body and movement in the therapy session
“teaches people with eating disorders how to listen to their body’s needs”
(“Dance/movement” 1).
a) By listening to the body’s needs from the inside, the patient is
better able to understand what is actually going on within them
rather than the surface needs.
b) Attunement to the inner voice of the body through movement
uncovers hidden behaviors since movement is the most primitive
form of communication.
c) Every movement that the body takes is for a distinctive reason,
whether subconscious or conscious, and reveals a part of the
psyche.
3. Dr. Kleinman is faced with these discoveries in her therapy sessions
frequently, with patients like Melanie, where they “discovered that
Melanie repeatedly bypassed a section of her movement sequence”
(Kleinman, “Show Me the Way” 2).
a) Through observing her body movment, they realized that Melanie
was bypassing this certain movement sequence because of a
subconscious feeling of fear that she was unaware existed.
b) By understanding that this feeling actually existed, she uncovered a
new emotion inside her body that was related to the cause of her
eating disorder.
4. It is essential to understand the source of the issue in order to overcome it,
and “the philosophy behind DMT is the body and mind are inseparable
and that body movements reflect emotional states” which therefore can be
used to uncover the hidden source of the issue (Dieterich 40).
D. An advantage to this form of therapy is that is exists as one of the few options that
bypasses language for expression for those who are naturally less verbal.
1. Some individuals struggle naturally with expression of emotions whether
they have an eating disorder or not, therefore discussion based therapy
would not be as advantageous.
a) Dance/movement therapy provides a way to show their feelings
through behavior so they do not have to communicate by talking,
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b) creating a more comfortable surrounding environment for the


treatment.
2. It is vital that the therapist “becomes the necessary relationship within
which new emotional experiences can develop in a safe environment of
respect and trust” (Fischman 8).
3. Without a strong connection, there is no way to understand what the
patient is actually going though.
E. One major mental trauma that individuals with eating disorders suffer is the
feeling of a lack of control in their life (Kleinman, “The Body Speaks” 7).
1. An eating disorder can develop an overpowering control and become the
dominant decision factor in the patient’s life;
a) “by its very nature, an eating disorder blocks patient’s vitality by
shutting down their natural life forces” (Kleinman, “The Body
Speaks” 7).
b) This causes people to often become closed off and distant.
c) Some are unable to express themselves and what they are feeling
because the eating disorder is forcing them to concern themselves
only with eating or lack thereof; others are unable to make
decisions on their own.
2. Dance/movement therapy is able to give back the control over one’s life
that is lost with this overpowering illness.
3. Through dance, the patient is able to be the “choreographer” of their own
life, becoming more in control because they are the ones who plan the
movements to perform.
a) This allows them to reestablish a power over their own body and
actions because it “encourages them to discover their unique,
natural movements that are so integral to the expression and
embodiment of their authentic selves” (Kleinman, “The Body
Speaks” 8).
b) The patient can find their natural movements, influenced by their
own thoughts rather than only the anxieties put in place by the
eating disorder.
4. The person is separated from from their own emotions because of the
overpowering eating disorder that changes their ability to make decisions.
5. Dance/movement therapy allows the patient to reconnect with their
emotions and therefore be able to make their decisions based on these
emotions and connections once again.
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F. Through direct incorporation of body and movement, dance/movement therapy


embraces and builds off the idea of interpersonal connections and expression from
within the soul.
1. The treatment works to bring out what hides deep inside the patient but
still manages to drive all the troubles that arise externally.
2. Through this bottom up approach to eating disorder treatment, a new,
improved positive relationship is reestablished with the body because the
path to the true emotions of the subconscious is put back into the light.
G. These pictures show Susan Kleinman, BC-DMT, BCC, CEDS in the actions of
her sessions with patients.
1. It illustrates some interactions and activities that are used during these
sessions in order to help the patients.
2. https://www.dropbox.com/sh/grvf6pxngs1p93t/AADkRcra5XPw68yDew
WUe6yGa?dl=0

V. Both family based therapy and dance/movement therapy have many benefits as eating
disorder treatments.
A. Each has been very successful in helping patients to recovery through their
individual methods. However, it would be much more successful if the two
therapies were used together for individuals suffering from this mental illness.
1. The cohesion of the two different methods would provide options for
treatment since people learn and improve in different ways.
2. Different treatments work better for different people, and this combination
would serve as another option for people to work towards recovery.
B. Even though it is sometimes difficult to combine ideas because of a difficulty in
compatibility, FBT and DMT would be able to work together because of their
common goals.
1. As both therapies work to uncover the internal source of each issue, “the
vantage point taken therapeutically in both verbal and nonverbal
modalities is the internal experience of the patients- an empathetic
perspective focused on emotions, perceptions, causal explanations, self
and body experience” (Krueger 323).
2. An easy incorporation is to add the FBT talk session following
dance/movement therapy activities.
a) As stated by Dr. Kleinman, dance/movement therapy already
incorporates a discussion time to talk about uncovered patterns as
they “pull things together at the end; that is the integration part,
there is a mix of verbal and nonverbal” (Kleinman, Personal
Interview 2).
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b) However, family based therapy is very popular and successful in


eating disorder treatment in a type of cognitive therapy that is more
than discussion; it incorporates the vital involvement of parents
and close family members.
c) Adding the family-based therapy aspect to dance/movement
therapy might combine the benefits of both, allowing for an even
better and more successful treatment of eating disorders.
C. Meeting the patient’s needs based on their specific symptoms is the basis of
treatment for any mental disorder.
1. It is always the goal to find the best methods to add on to the treatment for
better success and communication.
2. The combination of family-based therapy and dance/movement therapy
would create the opportunity to incorporate the most beneficial aspects of
both into a single therapy method.
3. Cognitive based therapies like FBT are better at introducing and
incorporating the outside perspective and support.
a) Through this type of therapy, the patient can discuss the patterns
and reach verbal solutions and explanations for different behaviors.
b) “When people had been very ill, particularly underweight, they
found that they couldn’t accept that their thought patterns might be
irrational and illogical,” and therefore, talking with another person
whom is close to them can help rationalize their thinking strategies
(“Talk” 2).
4. DMT works better with identifying hidden patterns by using movement to
access the subconscious.
a) The dance/movement therapists are able to analyze the behaviors
that one isn’t thinking about, and
b) “by working at the level of the involuntary physical functions, and
bringing awareness to the unknown or blind spots, we can change
old patterns” (Halprin 58).
5. While there are many other aspects of each of these different therapies,
these characteristics stand out as unique additions to eating disorder
treatment.
6. Using a combination would narrow the focus on the activities that are the
most beneficial in treatment.
D. Another way that combining these two therapies would be advantageous for the
advancements of eating disorder treatment is through the isolation of obstacles
introduced when using each individually.
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1. As with everything in life, not all aspects of each treatment is perfectly


successful in adding to the therapy sessions.
2. Both methods have their own slight disadvantages in comparison to other
existing methods, and thus combining them could work to limit these
obstacles.
3. With family-based therapy, one could worry that the patient is not gaining
the same direct interaction with the body which is very important in the
reestablishment of a positive relationship after the eating disorder.
a) Since eating disorders are largely body image related,
b) without working directly with the body, the patient loses the
opportunity to make those connections and realizations through
feeling their body rather than thinking.
4. With dance/movement therapy alone, the patient is working mostly with
expressive movement, and therefore not focused as much on discussing
what they are relieving.
a) There is a chance that patients might become focused on the
movement or exercise aspect of this type of therapy which can be
dangerous for an individual with an eating disorder type like
anorexia nervosa where the goal is to avoid weight loss and restrict
excess calorie burning from exercise.
b) There have been cases where patients adapted a “‘running
addiction,’ in whom commitment to running assumed a higher
priority than commitments to work, family, interpersonal
relationships, and medical advice” (Taylor 199).
c) This can become an issue because the patient could become more
focused on the exercise and lose sight of the actual treatment
therapy from the session.
5. However, these can be overcome by the better aspects of one another:
DMT introducing the body interaction lacking from FBT, and FBT
allowing for explanations and clarifications as to why to focus not only on
the movement aspects but rather what is it sharing about the body.
a) Working together, the two therapies can create a new method that
could really help add to the effectiveness of eating disorder
treatment.
b) The step towards establishing “a contemporary therapeutic
framework for combining verbal/intellectual, physical, and psycho
emotional means to help us explore and resolve conflicts” (Halprin
57).
E. This chart infographic shows the treatment rate now for eating disorders.
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1. However, it also provides an insight into how the treatment rate is able to
improve in the future.
2. Additional treatment methods would only provide another way for this
treatment success rate to continue to increase, while decreasing the
number of individuals quietly suffering eating disorders in the world.
3. https://www.dropbox.com/s/3d62za8trox7o99/EDstats-infographic.jpg?dl
=0

VI. Therapy is more than countering bad eating habits. Therapy is a way for the individual to

leave in a better state than they entered: more connected with themselves and those

around them. Treatment can be very personal; it requires a strong understanding of what

the individual actually needs to work. Family-based therapy allows the patient to gain the

benefits of talking through their issues with the comfort of a professional and close

family members as support and an outside perspective on what is happening. This not

only allows for a way to talk out feelings, but also a way for the others to help explain

certain behaviors and patterns to the individual, reaching conclusions the individual may

not reach alone. One major part of this style is the patient’s intrapersonal exploration

within the company of family. Dance/movement therapy allows the patient to become

more connected with their own feelings and in sync with the emotional rhythm of the

therapist through kinesthetic movement methods. A better understanding of the

subconscious become obtainable, uprooting the source of the eating disorder by

evaluating the natural movements and patterns expressed during daily actions. Both types

of eating disorder treatments work very well for different situations with different

patients, some are more verbal learners, while others are more attuned to the bottom up

approach. But, both are successful options for treatment.


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However, while these are both amazing options for a patient to consider, there might be

even better responses to eating disorder treatment by opening a new option that could appeal to

even more people. The personal aspect of treatment prevents the use of only a few styles since

everyone is going to need a slightly different way to cope with themselves. Combining

family-based therapy and dance/movement therapy would just provide another opportunity to

have therapy appeal as a successful method for more individuals suffering from an eating

disorder. Sometimes, those with this severe mental illness opt to avoid therapy because they

“don’t know a good therapist and wouldn’t know where to get one,” and this addition would

provide even more of a publicized assistance for patients (“17 Excuses” 2). The goal is to always

find ways to help as many people as possible; reaching out to everyone suffering and providing

the correct treatment. Better responses lead to higher success rates and less individuals that are

living their lives with eating disorders. While it seems like an unattainable goal to erase eating

disorders, with new and original additions to existing collection of treatment methods, there is

the possibility to overcome this common mental battle.


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Jeng 18

Statistics Infographic​.

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