Chapter 15 - Schema Therapy for Eating Disorders

Summary

This chapter illustrates the complex functions that eating disorder behaviour can take, including self-punishment, emotional avoidance, empowerment, mastery, self-regulation, and appeasement of others. The schema therapy approach encourages disaggregating these functions, personifying them, understanding them, and directing dialogues between them. A case study illustrates the way in which the schema mode model can be applied to work with eating disorder symptoms alongside complex trauma. A sufficient level of medical and nutritional stability (as indicated by blood tests and weight) must be reached in order to provide sufficient safety for therapy to proceed. A key component of schema therapy is to understand the unmet needs and schemas that have led to the development of an eating disorder. In schema therapy, the client gradually learns to reconnect with her/his inner child states and needs through extensive therapeutic work – which includes imagery rescripting, chairwork mode dialogues, and somatic, cognitive, and behavioural techniques. Coping modes are not just bypassed, but through imagery and chairwork are actively acknowledged and integrated to form a Healthy Adult ‘team’ that works to prioritise the inner child modes and ultimately meet the client’s nutritional, physiological, and emotional needs.