Before treatment can begin, anorexic clients must undergo assessments that ensure they are physically capable of outpatient treatment. If these individuals are not ready for outpatient treatment, they must undergo hospitalization to stabilize their condition. For those clients who pass medical examinations, and are good candidates for outpatient care, it remains necessary for a physician and dietitian to be involved with treatment (Bowers, 2002). This ensures the client is cared for in a holistic manner by addressing “nutritional rehabilitation, possibly medical stabilization, and psychological interventions” (Bowers, 2002, p. 249). This multidimensional approach ensures the client’s physical wellbeing is addressed, in addition to the psychological aspects of the disorder.
The treatment of anorexia begins with creating a sense of rapport and collaboration between the client and therapist. The relationship between client and therapist is especially important with anorexic patients because changing their eating behavior produces great levels of anxiety. In order to facilitate the relationship the therapist expresses respect for the client’s fears, reminds the client about the cost of their behavior, and encourages the client to look forward to acquiring new coping skills (Kleinfield et al., 1996). By addressing the fear involved with change, the therapist helps to normalize these feelings and encourages them to look forward to learning how to cope more effectively. When the client’s fears are decreased, it strengthens the therapeutic relationship and helps the client learn to collaborate with the therapist. Once a strong alliance has been established, the client begins to trust the therapist. This lays the foundation for changing faulty beliefs and anorexic behavior (Kleinfield et al., 1996).
In addition to creating a collaborative relationship, the early stages of treatment focus on psychoeducation (Stein, 2001). The inclusion of education allows the individual to learn about the importance of proper nutrition and how restricting food intake affects the body. Once the client receives education, the therapist employs motivational interviewing to help the client evaluate the costs and benefits of his or her behavior (Stein, 2001). This then leads to challenging faulty cognitions and beliefs about body weight.
In order to help an individual with anorexia begin to change their core beliefs about weight and body image, it is vital for the therapist to understand the individual’s schemas. It is through these schemas that the individual understands the world and makes decisions. Bowers (2002), cites previous research that suggests these schemas are the foundation of cognitive rigidity, which is the “fundamental psychopathology of eating disorders” (p. 249). In other words, it is vitally important to help the individual change their rigid cognitions because these cognitions are the foundation of their illness....