The Importance of Goal Setting in Eating Disorder Therapy

​Helping clients to develop insight into the cause of their eating disorder is great. However, it’s not enough when it comes to truly helping people to recover from eating disorders.
 
Unfortunately, I still see therapists whose primary treatment approach for helping those with eating disorders is psychodynamic psychotherapy. Psychodynamic therapy is an insight-oriented therapy that focuses on helping a client to understand the influence of the past on present behavior.
 
Now, I’m certainly not saying that psychodynamic therapy is “bad,” or that it’s not important to explore with clients the influences of their past in terms of the eating disorder. The problem is that when you stop there, or when your entire focus of treatment is to understand “why” someone is turning to their eating disorder behaviors-it’s going to be really hard for someone to recover.
 
While it’s interesting and can sometimes be helpful in terms of having a broader understanding, you don’t actually need to know “why” someone developed their eating disorder in order to successfully treat them.
 
It’s kind of like if someone went to a doctor with a broken arm. You don’t actually need to know why they broke their arm, in order to put it in a cast and proceed with the necessary treatment.
 
The Importance of Setting Behavioral Goals
 
As a therapist, I tailor treatment to each client. I use a blend of treatment that includes elements of cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and acceptance and commitment therapy (ACT), and sometimes FBT-informed.
 
I could write a whole book on the key elements of eating disorder treatment, as there are many and treatment is multifaceted.
 
However, today I want to focus on the importance of setting behavioral goals and really “getting into it,” when it comes to the client’s behaviors, thoughts, and feelings around food and their body.
 
Eating disorders are about the food and they also aren’t about the food.
 
We need to address the disordered behaviors and unhelpful thoughts around food, exercise, and weight-and also look at the functions that these behaviors are currently serving in the person’s life.
 
Setting specific goals that challenge the client’s eating disorder behaviors is so important, and needs to be incorporated into treatment.
 
It’s kind of like if someone had a phobia of driving. We could sit in therapy and talk about where their fear stemmed from, but until we actually set goals around getting in the car-it’s unlikely that the person will be able to get better.

Goal Setting Around Eating Disorder Thoughts/Behaviors
 
For homework, I typically assign my clients to list out all of their specific eating disorder behaviors, that way we can gradually start to challenge them-in a way that feels uncomfortable but not unsafe.
 
The same way that I wouldn’t take someone with a phobia of driving and put them right onto the highway, we often start by addressing the lower level sources of anxiety and then working our way up.
 
Another element of treatment that can be helpful, is eating with clients. I’ve gotten a lot of questions about how I incorporate this into my treatment approach. Some clients really benefit from directly challenging their food rules/fears in session. Right now, I do lunch with clients about 4-5 times a week and I also will sometimes do “challenge snacks” with clients in session.
 
Also, if a client comes in and has not eaten very much, it’s unlikely that our session will be very effective when their brain is so malnourished. So, I always have a few drawers of snacks on-hand in my office.
 
I also will set goals with clients (and practice in session) around speaking back to their “eating disorder self” from their “healthy self,” which I’ve found to be so incredibly helpful for many clients.
 
What Are You Working Towards?
 
If you don’t set goals or have a vision for what you want to life to look like when you are recovered, it’s going to be harder to work towards this.
 
That’s why it’s so crucial to have a therapist and registered dietitian who are actively setting goals with you and helping you to envision what you are actually working towards.
 
My approach to therapy is compassionate, yet firm. I am empathetic and understanding and I also set goals with clients and hold them accountable.

As clients are making progress in their recovery, we can also start to explore the function of the behaviors in their life. Often eating disorder behaviors are a way that someone is trying to regulate uncomfortable emotions, cope with past-trauma, or deal with feelings of low self-worth.

Through therapy, clients can learn healthier ways to cope with intense emotions, and we also can look at strategies for addressing the underlying issues. However, we need to be doing this in tandem (or often after) addressing the specific eating disorder thoughts and behaviors. 
 
If you are struggling with an eating disorder, please seek help. Seeking treatment is a sign of true courage, not weakness. Make sure that you are setting goals for your recovery and that your treatment team is holding you accountable. If your therapist is not setting goals with you, give them feedback or look for someone who can better support you in your recovery.

​Often big changes happen-one small goal at a time. 

Jennifer Rollin, MSW, LCSW-C: is an eating disorder therapist in private practice in Rockville, Maryland. Jennifer specializes in helping teens and adults struggling with anorexia, binge eating disorder, and bulimia, and body image issues. Jennifer provides eating disorder therapy in Rockville, MD, easily accessible to individuals in Potomac, North Potomac, Bethesda, Olney, Germantown, and Washington D.C. Connect with Jennifer through her website: www.jenniferrollin.com

Check out Jennifer's on-demand eating disorder trainings here!