Association of Professionals Treating Eating Disorders (APTED)
3195 California Street, Suite #E
San Francisco, CA 94115
Website: www.AptedSF.org
Email: AptedSF@aol.com
(clinic referrals) 415-931-6090  (off) 415-771-3068 
(cell) 415-608-6307
Types of Psychotherapy
Information Sheet #1: Individual Therapy
APTED believes that recovery from an eating disorder involves recovery on several levels: body, spirit, mind
and emotions, as well as relationships. There are many modalities of treatment, and many approaches, so as
to “meet” as much as possible of a person’s body, mind, and spirit. (In choosing a practitioner to see, feel
free to ask each person about their approach, ask details about their experience treating eating disorders,
and ask how they understand what maximizes one’s chances of recovery.) (Also see: http://www.somethingfishy.org/reach/treatmenttypes.php#individual.)
Types of individual psychotherapeutic approaches include (but are not limited to):
ACT (Acceptance and Commitment Therapy):
Also see below, under Cognitive-Behavioral Therapies. Acceptance and Commitment Therapy (ACT) is a type
of psychotherapy that helps you accept the difficulties that come with life. ACT has been around for a long
time, but seems to be gaining media attention lately. Categorically speaking, ACT is a form of mindfulness
based therapy, theorizing that greater well-being can be attained by overcoming negative thoughts and feelings.
Essentially, ACT looks at your character traits and behaviors to assist you in reducing avoidant coping styles.
ACT also addresses your commitment to making changes, and what to do about it when you can't stick to your
goals. ACT focuses on 3 areas: Accept your reactions and be present; Choose a valued direction; Take action.
(See also: http://www.get.gg/act.htm.)
Body Oriented therapies:
Body-oriented psychotherapy or Body Psychotherapy is also known as Somatic Psychology, especially in the
US. There are many very different psychotherapeutic approaches. They generally focus on the link between the
mind and the body and try to access deeper levels of the psyche through greater awareness of the physical body
and the emotions which gave rise to the various body-oriented based psychotherapeutic approaches, such as
Reichian (Wilhelm Reich) Character-Analytic therapy; neo-Reichian Alexander Lowen's Bioenergetic analysis;
Peter Levine's Somatic Experiencing; Jack Rosenberg's Integrative body psychotherapy; Ron Kurtz's Hakomi
psychotherapy; Pat Ogden's sensorimotor psychotherapy; David Boadella's Biosynthesis psychotherapy; Gerda
Boyesen's Biodynamic psychotherapy; etc. (See also: http://www.inner-healing.com/somatic.htm.)
These body-oriented psychotherapies are not to be confused with alternative medicine body-work or bodytherapies that seek primarily to improve physical health through direct work (touch and manipulation) on the
body because, despite the fact that bodywork techniques (for example Alexander Technique, Rolfing, and the
Feldenkrais Method) can also affect the emotions, these techniques are not designed to work on psychological
issues, neither are their practitioners so trained.
APTED
Types of Psychotherapy - Information Sheet #1: Individual Therapy
CBT (Cognitive-Behavioral Therapy):
Cognitive behavioral therapy refers to a range of techniques, which focus on the construction and reconstruction of people's cognitions, emotions and behaviors. Generally in CBT, the therapist, through a wide
array of modalities, helps clients assess, recognize and deal with problematic and dysfunctional ways of
thinking, emoting and behaving. (See also: http://www.nacbt.org/whatiscbt.htm.)
Behavior therapy focuses on modifying overt behavior and helping clients to achieve goals. This approach is
built on the principles of learning theory including operant and respondent conditioning, which makes up the
area of applied behavior analysis or behavior modification. This approach includes ACT (Acceptance and
Commitment Therapy), and (DBT) Dialectical Behavior Therapy. Sometimes it is integrated with cognitive
therapy to make cognitive behavior therapy. By nature, behavioral therapies are empirical (data-driven),
contextual (focused on the environment and context), functional (interested in the effect or consequence a
behavior ultimately has), probabilistic (viewing behavior as statistically predictable), monistic (rejecting mindbody dualism and treating the person as a unit), and relational (analyzing bidirectional interactions).
Control-Master Theory:
Control-Master Theory assumes that the patient's problems are rooted in the grim, constricting pathogenic
beliefs that the patient acquires in the traumatic experiences of childhood. The driving force behind the
psychotherapeutic process is the patient's conscious and unconscious desire to recover the capacity to pursue
life goals by gaining control and mastering self-destructive patterns of thoughts and behaviors. (See also:
www.sfprg.org/control_mastery/)
(DBT) Dialectical Behavioral Therapy:
(DBT) Dialectical Behavioral Therapy is a well researched and comprehensive treatment approach designed to
help people who have difficulty in regulating their emotions. This often results in a high degree of impulsive
reactivity, self-destructive behaviors, and volatile relationships with others in their lives. DBT works by
teaching participants to become more aware of their particular sensitivity to negative emotions such as anger
and anxiety. At the same time, it provides the skills necessary to tolerate these feeling and then begin to regulate
them. DBT also teaches assertiveness skills to enable participants to effectively begin asking for what they want
from others and saying no to things they don't want. (See also: www.sfdbt.com/)
Expressive Arts Therapy:
Expressive Arts Therapy is a form of therapy that utilizes artistic expression as its core means of treating clients.
Expressive therapists use the different disciplines of the creative arts as therapeutic interventions. This includes
the modalities of dance therapy, drama therapy, art therapy, music therapy, and writing therapy, among others.
Expressive therapists believe that often the most effective way of treating a client is through the expression of
imagination in a creative work and integrating and processing what issues are raised in the act.
More full excerpts abut these three modalities appear in the Appendix at the end of the document:
•
•
•
Arts Therapy
Dance Movement
Drama Therapy
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APTED
Types of Psychotherapy - Information Sheet #1: Individual Therapy
Health at Every Size Approach:
Health at Every Size is based on the simple premise that the best way to improve health is to honor your body. It
supports people in adopting health habits for the sake of health and well-being (rather than weight control).
Health at Every Size encourages:
•
•
•
Accepting and respecting the natural diversity of body sizes and shapes.
Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
Finding the joy in moving one’s body and becoming more physically vital.
(See also: http://www.haescommunity.org/; http://amihungry.com/)
(See also: http://www.bodypositive.com/)
(See also: https://www.sizediversityandhealth.org/)
Interpersonal psychotherapy (IPT)
Interpersonal psychotherapy (IPT) is a time-limited psychotherapy that focuses on the interpersonal context and
on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to
psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on
interpersonal processes rather than intra-psychic processes. IPT aims to change a person's interpersonal
behavior by fostering adaptation to current interpersonal roles and situations.
(See also: www.interpersonalpsychotherapy.org/)
Narrative therapy:
Narrative therapy is a respectful and collaborative approach to counselling and community work. It focuses on
the stories of people’s lives and is based on the idea that problems are manufactured in social, cultural and
political contexts. Each person produces the meaning of their life from the stories that are available in these
contexts. A wider meaning of narrative therapy relates significantly to a relatively recent way of thinking about
the nature of human life and knowledge which has come to be known as ‘postmodernism’ – which believes
there is no one objective ‘truth’ and that there are many multiple possible interpretations of any event. Thus
within a narrative approach, our lives are seen as multi-storied vs. single-storied.
(See also: http://www.narrativetherapycentre.com.)
Psychodynamic Psychotherapy
Psychodynamic Psychotherapy is a form of depth psychology, whose primary focus is to reveal the unconscious
content of a client's psyche in an effort to alleviate psychic tension. Although its roots are in psychoanalysis,
psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis. Psychodynamic
therapies take into account issues of attachment theory, how our earliest relationships affects things like selfesteem and self-regulation, and issues of self-object theory (how our early family relationships developed
patterns for later kinds of interacting in the world and with others).
Psychodynamic and insight therapies aim to help clients become aware of and experience their vulnerable
feelings which have been pushed out of conscious awareness. The Psychodynamic approach states that
everyone has an unconscious, which holds and harbors painful and vulnerable feelings, which are too difficult
for the person to be consciously aware of. In order to keep painful feelings, memories, and experiences in the
unconscious, people tend to develop defense mechanisms, such as denial, repression, rationalization, and others.
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Types of Psychotherapy - Information Sheet #1: Individual Therapy
Psychodynamic Psychotherapy: Continued
According to Psychodynamic theory, these defenses cause more harm than good and this theory holds that once
the vulnerable or painful feelings are processed, the defense mechanisms reduce or resolve.
Psychodynamic theorists (and well as self-psychologists, see below) understand eating disorders as stemming
from maladaptive ways people developed in order to try to deal with overwhelming emotions and situations
from childhood and/or adolescence. (See also: http://www.goodtherapy.org/Psychodynamic.html.)
Self-Psychology:
Heinz Kohut developed Self Psychology on the theoretical foundation that empathy be the primary tool for
examining and understanding human development and psychoanalytic transformation. Kohut’s views varied
greatly from Freud’s, as he did not believe that the human psyche was reactive primarily to sexual triggers.
Psychotherapy and psychoanalysis have been dramatically changed by the self-psychology movement and have
woven empathy and fundamental human fulfillment together to create an effective outcome for the client. This
technique strives to encompass all of the basic needs for healthy human development, and in particular relates to
issues of self-regulation of moods, affect states, and self-esteem – issues typically quite pertinent to patients in
recovery from eating disorders and other addictive disorders.
(See also: www.selfpsychology.com/.)
Transpersonal therapy:
The field of Transpersonal Psychology is concerned with expanding the frontiers of psychology and spirituality
for the betterment of humanity and the sustainability of the planet. Transpersonal Psychology addresses the
client in the context of a spiritual understanding of consciousness.
Traditional psychology is interested in a continuum of human experience and behavior ranging from severe
dysfunction, mental and emotional illness at one end, to what is generally considered "normal", healthy
behavior at the other end and various degrees of normal and maladjustment in between. While an exact
definition of Transpersonal Psychology is the subject of debate, Transpersonal Psychology is a full spectrum
psychology that encompasses all of this and then goes beyond it by adding a serious scholarly interest in the
immanent and transcendent dimensions of human experience: exceptional human functioning, experiences,
performances and achievements, true genius, the nature and meaning of deep religious and mystical
experiences, non-ordinary states of consciousness, and how we might foster the fulfillment of our highest
potentials as human beings. (See also: http://www.sofia.edu/about/transpersonal.php.)
Beyond those described above, other individual psychotherapeutic modalities may include:
(This list drawn from: http://www.something-fishy.org/reach/treatmenttypes.)
Spiritual Guidance:
This can be anything from counseling with a priest or pastor or exploring your beliefs with the help of someone
versed in your spiritual area of interest. Spiritual Therapy assists you in this process of inner healing and
spiritual growth. It leads you on the path from self-doubt to self-empowerment. It involved your beliefs
surrounding the meaning of life, a higher-power and your own faith.
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Sensory Integration:
The senses work together. Each sense works with the others to form a composite picture of who we are
physically, where we are, and what is going on around us. Sensory integration is the critical function of the
brain that is responsible for producing this composite picture. It is the organization of sensory information for
on-going use. Sensory Integration Therapy seeks to encourage the nervous system to process and integrate
sensory input in more organized and meaningful ways, which will ultimately enhance the ability of the nervous
system to function with more efficiency. Each adaptive response, as it provides feedback into the nervous
system, encourages maturation and organization of the nervous system at increasingly higher levels. Ultimately
the individual is able to interact with his/her environment in more successful and adaptive manners.
Reiki Healing:
Healing is not the popular conception of removal of symptoms. Healing is full and complete resolution of the
causes of the disease. Healing is returning to a state of alignment with your Higher Self or true way of being. In
its simplest form using Reiki is simply the practitioner placing their hands on the recipient with the intent of
bringing healing, and willing for Reiki energy to flow. There is a set of hand positions traditionally taught
which give good coverage over the recipient’s entire body. It is not necessary to follow those positions, they are
merely taught as a starting position from which the practitioner can learn. If there is a specific area of concern
the practitioner can keep his/her hands right there for as long as necessary.
Meditation:
Meditation Therapy is a bold approach to finding lasting solutions to our deepest problems and concerns.
Combining the power of deep meditation practice with the insights of psychology, Meditation Therapy will help
you to experience healing transformation in powerful and lasting ways. Genuine healing occurs only when we
are willing to examine the deepest parts of ourselves and create positive new patterns of responding to life. You
will learn how to transform your mental attitudes and activate your own innate healing power.
EMDR (Eye Movement Desensitization and Reprocessing):
It is an innovative clinical treatment that has successfully helped over a million individuals who have survived
trauma, including sexual abuse, domestic violence, combat, crime, and those suffering from a number of other
complaints including depressions, addictions, phobias and a variety of self-esteem issues. EMDR is a complex
approach to psychotherapy that integrates many of the successful elements of a range of therapeutic approaches
in combination with eye movements or other forms of rhythmical stimulation in ways that stimulate the brain’s
information processing system. With EMDR therapy it is unnecessary to delve into decades-old psychological
material, but rather, by activating the information-processing system of the brain, people can achieve their
therapeutic goals at a rapid rate, with recognizable changes that don’t disappear over time.
Life Coaching:
A Life Coach listens to you when you most need it and will give you non-judgmental support and the tools to
guide you to achieve the following: Change your lifestyle, Love the life you are living, Find your unique
purpose in life, Identify your true vocation, Find the tools to relax and enjoy life, Bring out your spirituality. A
Life Coach will help you discover what's really most important to you in your life, then help you design a plan
to achieve those things. They'll work with you to eliminate any obstacles or blocks that stand in your way and
partner with you all the way to success.
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Types of Psychotherapy - Information Sheet #1: Individual Therapy
Touch Therapy:
Through both light touch and the clearing of your energy system without touch, you are assisted in the release
of stress and anxiety. You are also provided a safe and relaxing healing space. Touch Therapy is a wonderful
assistance in your personal growth and self -fulfillment. Many people worldwide have experienced the positive
effects of this type of therapy.
EEG Biofeedback:
Neuro-feedback, also known as EEG Biofeedback, is a learning procedure that enables participants to improve
mental performance, normalize behavior, and stabilize mood. Neuro-feedback is a technique in which we train
the brain to help improve its ability to regulate all bodily functions and to take care of itself. When the brain is
not functioning well, evidence of this often shows up in the EEG (Electroencephalogram).
By challenging the brain, much as you challenge your body in physical exercise, we can help your brain learn to
function better. A better functioning brain can improve sleep patterns. When you sleep more efficiently, you are
more alert during the day. It can help with anxiety and depression, and with syndromes like migraine or chronic
pain. Secondly, it can be helpful in managing attention - how well you can persist even at a boring task. Thirdly,
it can help you manage the emotions. Emotions may feel like the real you, but your brain has a lot to say about
how you feel and react. If the emotions are out of control, that's trainable. If they aren't there---as in lack of
empathy, for example---that, too, is trainable.
(See http://www.something-fishy.org/reach/treatmenttypes.)
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APTED
Types of Psychotherapy - Information Sheet #1: Individual Therapy
APPENDIX I: EXPRESSIVE ARTS THERAPIES
Art Therapy and Eating Disorder Treatment:
(Excerpted from www.Mirasol.net )
“In art, there's no way to lie”
Art therapy as a profession evolved in the 1930s, when psychiatrists began studying the artwork created by their
patients to see if there was a link between creativity and illness. They discovered that the simple act of creating
art reflects the client's experiences, including unresolved emotional issues and conflicts.
"When we speak, we are taught to be polite in a way that compromises the truth," says art therapist Donita
Dixon. "But in art, there's no way to lie. When I ask someone to make a drawing, the truth is there, and the
subconscious puts it on paper."
A typical first assignment is to draw a house, a tree and a person. Donita asks the client to complete all three
drawings and then describe each one. Called the "discovery" period, this exchange often reveals stories that are
imprinted deep in the artist's memories.
Although certain symbols appear to be universal, the therapist's challenge is to discover what the elements in
the drawing mean to the client.
"Instead of suggesting an interpretation, I ask the client to tell me what it means," says Donita. "I watch body
language, eye movements and what gets erased." Donita takes notes while the client describes her drawing, and
simply reading back the client's words can trigger powerful realizations.
In the drawing at right, there's a tree that's "about 20 years old". A path from the house intersects the tree near
the roots.
"Typically, the tree represents what has happened to that person in the past, and what the soul is holding onto,"
Donita explains. "It also represents the person's age." The path from the house to the tree could indicate
important events in early childhood. The explosion of branches halfway up the tree coincides with the
emergence of body image issues in adolescence.
The house represents the internal self. Smoke coming out of the chimney could indicate inner turmoil or family
difficulties. The number, size and placement of windows and doors convey the ease or difficulty of
communication. This client drew a house with a four-sided roof with four windows with four panes, which may
represent the four members of her family. But there are no windows where the client's room would be, and the
wall is obscured by a bush. How hard will it be for her to talk about family issues?
"The person is usually the artist herself," says Donita, "and what the artist leaves out tells us a lot about her."
Are the eyes closed? What doesn't she want to see? If the person has no feet, she may feel stuck and unable to
move or change her situation. Missing or hidden hands could signify that the client has difficulty reaching out
for help.
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APPENDIX I: EXPRESSIVE ARTS THERAPIES
Art Therapy and Eating Disorder Treatment: Continued
Through regular individual and group art therapy sessions, Donita works with clients to reveal the truths they
cannot speak. The power to withdraw into the art process will accompany them on their journey back to good
mental health.
This excerpt about Art therapy from the Mirasol website. To learn more about Mirasol, visit www.Mirasol.net.
To find out more about art therapy, go to: www.arttherapy.org.
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APPENDIX I: EXPRESSIVE ARTS THERAPIES
Dance-Movement Therapy:
(The following article excerpted from www.Mirasol.net)
"The Body Says What Words Cannot"
This quote from Martha Graham is a perfect description of Dance/Movement Therapy (DMT), one of the many
creative arts therapies used at Eating Disorder Recovery Centers.
The American Dance Therapy Association defines DMT as "the psychotherapeutic use of movement as a
process which furthers the emotional, cognitive and physical integration of the individual". Dance/movement
therapists work with both groups and individuals in a wide variety of settings, helping clients improve selfesteem, body image, and self-awareness by expanding their movement vocabulary and creating new coping
skills.
Because they are direct expressions of the self in relation to the body, they can be used to help individuals
identify strengths, feelings, memories and behaviors.
Experiences of past physical, emotional and sexual trauma stored in the body may be evoked through
movement expression, providing clients with new ways to express their emotions without the need for words.
This is particularly helpful for people with eating disorders, who often detach from their physical selves to
avoid painful emotions, sensations and memories.
Dance/Movement Therapy is also a powerful antidote to the distorted body images that are common in eating
disordered individuals.
A typical Dance/Movement Therapy session might include the use of recorded music or instruments, props such
as scarves, balls and "Body Sox"™. Music may serve as a catalyst, but not always. Some clients move without
music, as the therapist guides them to explore their internal rhythms, sensations, emotions and tensions within
the body.
There's no set formula for a Dance/Movement Therapy session. Content evolves organically within the group
through cooperative or solo movement, dance, games, free expression and play. The therapist creates safe
environment and serves as a witness to the client, observing the body, guiding and verbally processing the
movements.
For clients who are traumatized and disconnected from their bodies, just becoming aware of one's breath and
simple body sensations can be a huge step — especially clients with formal dance training — struggle to let go
of their "inner critics," but most will be surprised by how much they are able to let themselves go while learning
new ways to express themselves.
This excerpt about Dance and Movement therapy from the Mirasol website. To learn more about Mirasol, visit
www.Mirasol.net. To learn more about DMT, visit the American Dance Therapy Association website at
www.adta.org.
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Types of Psychotherapy - Information Sheet #1: Individual Therapy
APPENDIX I: EXPRESSIVE ARTS THERAPIES
Drama Therapy:
To watch a documentary on drama therapy work with eating disorders, go to:
http://www.indiegogo.com/projects/expressing-disorder?website_name=EDdoc
(The following article excerpted from: http://blog.normallearning.org/2011/07/25/the-power-of-expressivearts-part-1-drama-therapy.aspx)
This series educates about the array of expressive arts that are useful, specifically, in the healing process from
eating disorders and other addiction programs. According to the http://www.ieata.org/about.htmlInternational
Expressive Arts Therapy Association, expressive arts combine the visual arts, movement, drama, music and
writing to foster deep personal growth and community development.*
The focus of this post is drama therapy.
As a collaborator on http://www.indiegogo.com/EDdocDavid Alvarado’s documentary about expressive arts
therapies in the treatment of eating disorders, I met http://www.linkedin.com/pub/caroldietrich/17/a55/b33Carol Dietrich, a Registered Nurse and Drama Therapist who -- herself -- is recovered from
an eating disorder.
Dietrich’s treatment philosophy stems from her belief that optimal healing and recovery is achieved through the
integration of body, mind and spirit and by using exercises that are active and experiential, a space is created for
individuals with eating disorders to experience a more flexible and open way of being with themselves and the
world.
She says of her own healing process from eating disorders, “I had been in individual talk therapy for several
years, which was extremely helpful, but it wasn’t until I added the experiential component of drama therapy
to my therapy that I started to experience a different relationship with myself which led to increased
healing.”
“The power of this modality, she says, “is that the exercises are active, experiential and holistic in their
approach, integrating mind, body, emotions and spirit.” Dietrich’s expertise – in particular – lies in her
sculpture and mask work (featured in http://www.indiegogo.com/EDdocAlvarado’s documentary film).
Dietrich began to incorporate masks as a projective technique in externalizing the eating disorder. Using masks,
patients role-play the story of the eating disorder (what role has it played in the person’s life, what is the
person’s relationship with the eating disorder), role play a different story (talking back to the eating disorder,
exploring “who am I without my eating disorder?), and role play a different internalized voice (the voice of
recovery, the voice of compassion, the voice of forgiveness, the voice of wisdom). Through these enactments,
old stories are explored, new stories are developed, and meaningful relationships with ‘self’ are established. By
expanding into creating a mask of the eating disorder, one can then enter the drama space and ‘embody’ it rather
than talk about it.
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Types of Psychotherapy - Information Sheet #1: Individual Therapy
APPENDIX I: EXPRESSIVE ARTS THERAPIES
Drama Therapy: Continued
photo copyright David Alvarado. All rights reserved.
“Utilizing drama therapy and mask work helps to identify and address the intra-personal power struggle in order
to move through and embrace recovery. It creates a transformative space in which a new voice can be spoken
and different choices can be made.” She says that the masks are created in an art therapy session, then taken to a
drama therapy group and, in this way, bridge the gap between the two therapies.
In addition to asking patients to create a mask of their eating disorder, Dietrich also has them create a mask of
compassion/recovery/healing to begin facilitating a different dialogue. “It is often easy for someone to have
compassion and a recovery voice for someone else yet difficult for someone to have it for herself.”
The revelations from her patients as they journey through the healing process, speak to the efficacy of the work:
“I never said it out loud, I never heard it in this way before, I never talked to it in this way before, I didn’t
realize how much I was hurting myself.” The mask is both protective and liberating, enabling the expression of
what lies buried beneath our real-life roles.
For many clients, it is in the context of drama that they experience -- sometimes for the first time in their lives -the experience of embodying an untapped part of themselves. The behaviors, roles, and emotions portrayed in
drama become part of one’s repertoire, a repertoire that can be drawn upon in life situations and can offer new
choices for healing.
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APPENDIX I: EXPRESSIVE ARTS THERAPIES
Drama Therapy: Continued
Dietrich shares two reflections that inform her work from a book she recommends
called http://jillmellick.com/publications/current/coming-home-to-myselfComing Home to Myself by Marion
Woodman and Jill Mellick:*
"Body work is soul work.
Imagination is the bridge
between body and soul.
To have healing power,
an image needs to be taken
into our body on our breath.
Only then can the image connect
with the life force.
Only then can things change."
"If you travel far enough,
one day you will recognize yourself
coming down the road to meet you
and you will say
YES."
To watch the documentary on drama therapy work with eating disorders, go to:
http://www.indiegogo.com/projects/expressing-disorder?website_name=EDdoc
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