The Role of Counseling in Treating Teens with Eating Disorders

sCounseling is an integral part of an effective treatment program for teens with eating disorders. When used as a part of a multidisciplinary approach, therapy provides the knowledge and tools teens need to become fully recovered from eating disorders. As an adolescent transition out of treatment, they carry that knowledge with them, which helps prevent relapse as they work through everyday stressors.

To help their teens through the journey toward recovery, parents can make it their mission to learn all they can about teenagers and eating disorders —including how counseling can help. Getting started is as easy as browsing through this guide on the role of counseling in treating teens with eating disorders.

Importance of Individual, Group, and Family Counseling

Individual, group and family therapy can help equip teens with the tools, knowledge, and support they need to become and remain recovered. Through the individual and group sessions, counselors focus on helping teens work through their stressors in healthy ways and build a strong toolbox of coping skills.

Family therapy, on the other hand, helps teens build and strengthen their relationships, creating the kind of strong social network they need to become and remain recovered. All types of therapy give teens ample social support and a sense of control over their futures. This aids in their recovery by helping them plan out their journey and follow the steps to becoming recovered from eating disorders.  

Types of Therapy Used for Teens with Eating Disorders

Effective eating disorder treatment programs utilize a variety of therapeutic approaches to helping teens become recovered. They can then not only treat teens’ eating disorders, but also any underlying conditions that may be complicating matters.

The type of therapy used depends on each teens’ unique needs, history, and preferences. Counselors will assess teenagers’ progress through the therapy modules to determine where they should spend their time. As teens move through eating disorder treatment, they will often work within many different therapy models as a result. Here’s a rundown of the eating disorder counseling types they might experience.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) helps people structure their way of thinking about the past, present, and future through talk therapy sessions. This type of eating disorder counseling helps people learn how to manage the stressors that arise in daily life. And it also helps teen process past traumas and present challenges, giving them a path toward peaceful living.

In treating eating disorders, cognitive behavioral therapy sessions start with the identification of underlying factors and challenging situations. Teens work with their counselors to create a plan on how they will change their perceptions, reactions, and behaviors. They will then slowly work on replacing disordered behaviors with healthier alternatives while gauging their reaction to the process.

As teens approach challenging situations, their counselors may prompt them to rate their discomfort with the aim of reducing that score over time. As teens move forward in this process, they experience less and less discomfort while changing their behaviors.

After working through the behavioral phase of therapy, teens will turn their attention to the cognitive phase. This part focuses on restructuring thought patterns to eliminate:

• Low self-worth
• Self-defeating thoughts
• Emotional dysregulation
• Poor body image

In addition to addressing thoughts and behaviors related to the eating disorder and underlying conditions, CBT helps teens handle all the different stressors in life.

To prevent symptoms from returning, cognitive behavioral therapy has a final phase that revolves around reducing triggers and preventing relapse. Through this phase of therapy, teens will learn how to manage their emotions, thoughts, and behaviors after returning to their normal daily lives outside of eating disorder treatment. Counselors will touch on just when to reach out for help and how to acquire relapse prevention assistance during this stage of therapy.

Dialectical Behavior Therapy

While in dialectical behavior therapy (DBT), teens can learn how to discard disordered thoughts and behaviors in favor of adaptive coping methods. This type of counseling moves through four distinct stages that teach teens to pay attention to how they feel and react in a healthy manner. They can work on building up their skills in managing stress, dealing with people, and handling painful emotions throughout this process.

Each of the four stages introduces important skillsets that can help teens recover from eating disorders and better manage their daily lives outside eating disorder counseling. The modules introduce different skill sets that work together to make handling stressors, large and small, much easier. In caring for teens and eating disorders, counselors allow everyone to work at their own pace while going through the following modules.  

Mindfulness

Mindfulness is often introduced first as teenagers need to have a clear view of their innermost thoughts and feelings to become recovered from eating disorders. This module tasks teens with sitting quietly and paying close attention to how they are feeling at the time. They are instructed to allow their thoughts and feelings to pass through their minds without any judgment.

Teens simply have to notice how they are feeling and accept those sensations, which is often easier said than done. As they move through the rest of the DBT modules, teens will also learn how to shift their attention to better support their needs at that moment. Teens with eating disorders will practice mindfulness many times throughout the treatment process to gain awareness and acceptance of themselves.

Distress Tolerance

The distress tolerance module helps teens learn how to manage stressors and handle the emotions that arise. They learn how to accept and sit through distressing feelings without turning to disordered thoughts and behaviors as a way to cope. They can then avoid impulsive and dysfunctional behaviors that may reduce distress at the moment but can make it much worse in the end.

To introduce alternatives to these disordered behaviors, this module introduces many helpful coping methods. They will learn how to effectively use healthy distractions, self-soothing behaviors, and pros and cons lists to get through the moment.

Teens will also learn how to reduce their distress by improving the moment. They may learn to:

• Bring up soothing imagery
• Derive meaning from the situation
• Rely on their religious or spiritual connections
• Relax in the face of stressors
• Focus on a solitary thing to feel less overwhelmed
• Take a small vacation to regroup
• Encourage themselves using positive affirmations

As teens work on building these skills, they develop resilience in dealing with stressful moments that would otherwise leave them in crisis. With healthy coping skills on their side, they can leave maladaptive methods behind as they become and remain recovered from eating disorders.

Emotional Regulation

While distress tolerance teaches teens to handle their emotions well during stressful times, emotional regulation helps prevent unwanted emotions. Throughout this module, teens will use mindfulness and other strategies to notice their emotions and accurately label them.

By taking an assessment of their emotional state, they can identify the emotions they would like to minimize and use strategies to bring in more positive emotions instead. This helps resolve emotional dysregulation and the urge to cope using disordered thoughts and behaviors.

Interpersonal Effectiveness 

Interpersonal effectiveness helps teens build and maintain strong social connections with their friends, family, and community. Healthy relationships greatly benefit teenagers who are working on becoming and remaining recovered from eating disorders. Unfortunately, poor self-esteem, distress tolerance, and other factors can prevent these individuals from maintaining close connections with people.

This module addresses all this by teaching teens important social skills and coping methods. Throughout this process, they learn how to become more assertive and communicate effectively with the people around them.

Since it provides so much insight and introduces many coping methods, dialectical behavior therapy gives teens with the tools and knowledge they need to become recovered from eating disorders. Even after completing eating disorder counseling, they can always return to the learning modules to practice and strengthen their skillsets as needed to handle new daily stressors.

Art and Expressive Therapy

Art and expressive therapy sessions allow teens to explore their thoughts, feelings, and challenges through many different disciplines, including:

• Drawing
• Painting
• Sculpting
• Digital art
• Printing
• Textiles
• Creating music
• Dance
• Acting

Through these activities, teens can express how they are feeling in eating disorder recovery and work through the challenges ahead. They can also use their favorite art disciplines as their main coping skills when healthy distractions are needed.  

Eating disorder counselors may also introduce art-based assessments to obtain an objective measure of teens’ emotional state and journey toward eating disorder recovery. With the results, they can create effective, personalized treatment and therapy plans for the week ahead.

Art and expressive therapy often proves beneficial during eating disorder recovery and beyond. Teens can always return to this form of therapy to cope with the stress that life throws their way. This is especially helpful as they move into adulthood and cope with all the changes that occur over the years.

Additional Eating Disorder Counseling Options

Depending on the needs of each teen in eating disorder treatment, counselors can offer many different types of therapy. Teens can attend counseling centered around:

• Body Image
• Self-Esteem
• Interpersonal Process
• Family and Relationships
• Relapse Prevention

Through these counseling types, teens can overcome their challenges and replace disordered thoughts and behaviors with beneficial alternatives.  

What Teens Can Expect While in Eating Disorder Counseling

As teens go into treatment for eating disorders, counseling will be a part of their daily activities from the start. While in eating disorder counseling, they can expect:

Weekly Therapeutic Assignments

Each week, counselors assess where teens are at in their journey toward becoming recovered and determine how they should spend their time. They will then provide teens with a therapy assignment for that week.

On their schedule, teens will have a combination of group and family counseling sessions centered around the selected therapy models. In addition, they will usually need to meet with their primary therapist twice weekly for individual counseling sessions.

Exposure Therapy Activities

In order to help teens identify and work through their eating disorder triggers, they will complete exposure therapy activities with support from their counselor. This will usually start with weekly food challenges that support the return of beneficial eating habits.

Then, teens will move onto outings to restaurants, grocery stores, and other venues they find challenging to visit. Finally, they will approach activities that these individuals might shy away from as a result of their eating disorder, such as movie nights and group dinners.

Help Building Coping Skills and Strong Relationships

Through every phase of eating disorder counseling, teens learn how to build beneficial coping skills and strong relationships. Each therapy option gives them opportunities to identify their challenges and barriers to becoming recovered. With that info in mind, they can choose the coping skills that will best help them overcome those challenges.

The individual, group, and family therapy sessions also help teens build and strengthen the relationships in their lives. They can learn how to become more effective communicators and maintain close, beneficial relationships with their loved ones. Counselors act as facilitators in every therapy session, helping people come together and heal. This gives teens the support they need to remain recovered after coming to eating disorder counseling.  

Getting Teens into Eating Disorder Counseling

As teens participate in their assigned counseling sessions, they move through experiences that help them prepare to handle all of life’s stresses. They slowly gain the tools and knowledge necessary to remain recovered and avoid relapse as stressors pile up. With their newfound coping skills, teens can better manage their emotional response to stress and tolerate distress with the confidence they can get through it.

In order to help their teens get the care they need, parents should reach out for help at the first sign of a problem. Upon noticing any eating disorder warning signs, parents can call 855-900-2221 to find help for their teens. With a single call, parents will receive help from admissions specialists skilled in setting up the best level of care for teens with eating disorders.

Areas We Serve:

Houston, TX | South Miami, FL | Malibu Lake, CA | Naperville, IL | Portland, OR | Briarcliff Manor, NY | Twin Lakes, VA

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.

Sources