Healthcare Training Institute - Quality Education since 1979
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As you are aware anorexia nervosa is defined as a severe loss of weight, a body weight reduction of 15% or more. It is characterized by a refusal to gain weight and a distorted body image. Clients view themselves as fat, even though they may be dangerously underweight.
In this section, we will discuss three components of narrative therapy as it relates to anorexia. These three components of narrative therapy include: creating a story; opening the thought window; and anorexia as a con-man.
3 Components of Narrative Therapy
♦ Components #1 - Creating a Story
To begin the process of creating a story, I first ask my anorexic clients to personify their anorexia so that they can dissociate themselves from the problem itself. Thereby, they begin to view the disorder as a type of authoritarian figure rather than a diseased part of themselves.
♦ Technique: Identify the Tyrant
She stated, "Why can’t I just keep eating right? I’m so weak! I have no will power of my own! Why can’t I do the right thing?" To help Jenny dissociate herself from her disorder, I asked that she "Identify the Tyrant" or in other words personify her anorexia. I asked that Jenny write a description of her disorder that portrays a negative and totalitarian figure.
I even suggested Jenny give it a name to further externalize the disorder. The next week, Jenny had created a persona to characterize her anorexia. She included the following in her description:
By externalizing the problem, Jenny could see that her anorexia is controlling her and needs to be overthrown. Think of your Jenny. Would he or she benefit from "Identifying the Tyrant"?
♦ Component #2 - Opening the Thought Window
Julian, age 19, had named her anorexia "Teeny Weeny." She stated, "He’s like a teeny-weeny parasite that lives with me, but he has a really loud voice." I asked Julian to describe how anorexia is parasitic. She stated, "He’s sucking the life out of me by forcing me not to eat! But then he won’t admit he’s doing it. He tells me I look beautiful and that others don’t understand what I’m trying to achieve!"
Through Julian and her personification of anorexia as a "teeny weeny parasite," she could more clearly see the manipulation that the disorder is using on her. Think of your Julian. What does his or her personification of the eating disorder reveal?
♦ Component #3 - Anorexia as a Con-Man
It is thought patterns such as these that anorexia preys on, and given the slightest opportunity, will co-opt to its own purposes. Anorexia seduces a client by promising itself as the very means to realize the anorexic client's internalized ideals. In this way, anorexia works like a con-man would, beguiling its victims into a plot of deadly proportions. In narrative therapy, this type of discourse further detaches the client from the disorder itself.
Laura, age 24, had personified her anorexia as a con-man. She stated, "He’s sleazy and instead of wanting my money, he wants my life! He’s really attractive, though. He makes promises to me, like saying how great I’m going to look because he looks so good. And at times, he does."
I stated to Laura, "The next time you hear your con-man speaking to you, take a closer look at him. Visualize him as ugly and falling apart. His hair is coming out and his skin hangs off the bones. Kind of like a ghost." The point of this exercise is to reduce anorexia’s seductive powers. By visualizing a man so decrepit and old, the disorder starts to lose its attractiveness and thus gives Laura a better means to resist it.
Think of your Laura. Would she benefit from visualizing anorexia as a con-man? How about an old, dying figure?
In this section, we discussed three components of narrative therapy as it relates to anorexia. These three components of narrative therapy included: creating a story; opening the thought window; and anorexia as a con-man.
In the next section, we will examine three social implications related to anorexia nervosa. These three social implications include: economic demographics; the diet fad; and conflicting media images.
Groth, T., & Hilsenroth, M. (2019). Psychotherapy techniques related to therapist alliance among adolescents with eating disorders: The utility of integration. Journal of Psychotherapy Integration. Advance online publication.