Anorexia – A Treatment Case Study
Anoerxia nervosa is a serious mental disease with significant medical and physical repercussions. It requires specialist knowledge to recognise the health implications and risks, and to cultivate treatments for clients. Anorexia treatment will normally require ongoing management by a medical practitioner in conjunction with therapy with a professional psychologist or counsellor. It may also require a period of in-patient treatment.
Counsellors, psychologists and therapists utilise a range of approaches toward resolving eating disordered behaviour in anorexics.
Individual Counselling for Anorexia
Counselling is highly recommended as a way to combat anorexia. Counselling involves direct discussion and exercises between a client and counsellor, therapist or psychologist, to help clients understand what anorexia is and how it affects the body physically and emotionally. Individual counselling can also address the client's obsessive desire for control, their perception of social expectations of themselves, as well as their personal expectations surrounding body weight.
Anorexia is an illness that often requires substantial and ongoing counselling support. Most importantly, the physical implications of anorexia must also be managed to ensure that the client’s life is not at risk.
For as far back as she could remember, Tracy had been on a diet. Her mother was extremely body conscious and often spent hours looking at fashion magazines and shopping for the latest clothing they could afford on their budget. Often, her mother would turn to Tracy and say, “when you grow up, you should look like this,” or “there is nothing better than being thin enough to look fabulous.” Even in jest, her mother would poke at Tracy’s little girl tummy and tease her about having baby fat. When she was at school, Tracy only ate what she felt she had to at lunch. (This article is electronically protected - Copyright © Associated Counsellors & Psychologists Sydney PTY LTD)
As Tracy moved into early adolescence, she continued her dieting habits. She would exercise for hours on end in order to make up for a tiny spoonful of peanut butter that she allowed herself to eat at lunch. Although her parents required her to sit down to a family dinner, she became skilled at moving her food around, so that it looked like she was eating, when really all she was doing was rearranging the food on the plate. As soon as she could make a graceful exit, she would hide in the bathroom and make herself vomit anything she had been forced to eat.
One day, when Tracy was almost 17, she fainted while out with her friends. She was surprised when she woke up in the hospital and realised that not only did she have an IV attached to her arm, but that there was a tube down her throat. She was horrified when she heard her parents arguing about a feeding tube forcing her to get enough nutrition to stabilise her weight. She felt oddly detached from her body, but she still felt sufficiently aware to know that she did not want to be force-fed anything that might make her gain any weight.
When she was released from the hospital – 5 kgs heavier – she was not allowed to go home, but instead was sent to a residential treatment centre for anorexia and other eating disorders. Although the psychologists, counsellors and therapists were kind and understanding, she resented being forced to attend a treatment program for something she very clearly did not have a problem with in the first place. (This article is electronically protected - Copyright © Associated Counsellors & Psychologists Sydney PTY LTD)
Daily counselling sessions were required and Tracy was visited by a psychiatrist who prescribed a course of antidepressants for her stay at the treatment center. Tracy expressed concern over the number of calories that would be included in the pills, but she was assured by the doctor that there were no calories in the medications. The doctor even took the time to show her the pamphlet for the medication, which clearly stated that there were no calories in the pills.
Once her weight stabilsed, Tracy was allowed to go home. Her parents insisted that she continue to see a counsellor on a weekly basis. Sometimes Tracy listened and responded to her counsellor’s queries, and occasionally she just tuned out. It did seem odd to Tracy, though, the extent to which her counsellor seemed to ‘get’ her mother’s obsession with looks and the sense that Tracy had held, for a long time she now realised, that she had little control over her life. Her counsellor asked to bring in some photos of herself as a child and now, and she was shocked to recognise, for the first time, just how thin she really was.
As Tracy grew physically stronger and began to understand more about her family and how she needed more and more control over her own life, she began to slowly eat a little more each day. It was hard, but she was beginning to understand that she needed food to live, and she definitely wanted to live. Her relationship with her mother worsened during this period. She felt angry and upset at her mother’s constant concern with fashion and appearance and she started to blame her for what she was slowly beginning to realise was a distorted body image of her own. (This article is electronically protected - Copyright © Associated Counsellors & Psychologists Sydney PTY LTD)
Slowly, but surely, Tracy gained a little weight and began to understand her illness better. She knew that she still had a long way to go, and that she would likely have problems with her weight and body image issues for a long time to come, but she had also begun to develop some control over her eating patterns, and over her life.
How Did Tracy’s Counselling Treatment Help with Anorexia?
Initially, Tracy did not understand at all that she had a problem relationship with food and how strongly she had been influenced by her mother’s attitudes and beliefs about food and body image. In many cases, anorexic clients do not understand or realise when we are young just how much of an influence our parents have on our own attitudes about food and other important aspects of life. Tracy, like most young girls, wanted her mother’s attention and approval, but no matter how hard she tried, she did not feel she had earned it or was worthy of it. She developed an obsession with being thin. In order to achieve maximum results, Tracy monitored every calorie that passed her lips and made sure that the calories were burned off as soon as possible – either by vomiting or through excessive exercise.
It was only when Tracy's body was no longer able to sustain itself and she found herself in hospital, suffering severe malnutrition, that it became clear to everyone, including Tracy, that she had a problem. Until that point, she had been very good at hiding her disordered eating habits from her family and her friends, and to a large degree, from herself. (This article is electronically protected - Copyright © Associated Counsellors & Psychologists Sydney PTY LTD)
When Tracy was placed in a hospital, she was initially resentful. She did not believe she had a problem and she was sure that she didn’t belong in treatment for anorexia or any other eating problem. But as she eventually became receptive to the quiet and compassionate talk of her counsellor, she became aware that she shared many things in common with other clients at the centre who suffered from anorexia. Her counsellor helped her realise that she felt out of control of almost every other aspect of her life; that she had a mother who pressured her about her weight and body size; that she restricted her food intake and felt good about being in control of this; that she got rid of calories in any way possible; that she felt she had to be perfect in order to be loved; and that she felt like she could not stop dieting.
As Tracy became healthier, she was ready to confront her mother and talk to her about her role in the development of her anorexia. With the help of her counsellor, she was able to express herself for what may have been the first time in her life. It was overwhelming, but it felt good to be heard.
Tracy continued to have regular visits with her nutritionalist and GP, to ensure that her weight was monitored. She also continues to see her counsellor to ensure that her emotional needs are supported and she doesn’t let her anorexia reduce her to near-starvation ever again. (This article is electronically protected - Copyright © Associated Counsellors & Psychologists Sydney PTY LTD)
Where Can I Go For Help with Anorexia?
If you or someone you know is suffering from anorexia, you or they will normally require ongoing management by a GP whilst receiving counselling, or may require a period of in-patient treatment. Associated Counsellors & Psychologists offers an eating disorder counseling service. For more information or to schedule an appointment with a counsellor, psychologist or therapist offers anorexia treatment, please contact Associated Counselors & Psychologists Sydney
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