THERAPEUTIC INTERVENTIONS IN THE TREATMENT OF EATING DISORDERS: A NATURALISTIC STUDY

This study used naturalistic data from psychodynamic (PD) and cognitive-behavioral (CB) clinicians in the community to offer a portrait of treatments for ED patients as provided in everyday clinical practice. The research aims were: (1) to examine the differences in therapeutic interventions reported by PD and CB clinicians working with ED patients; and (2) to assess the impact of various variables––such as patient personality styles, ED symptomatology, therapists’ theoretical orientation and experience––on the techniques employed by clinicians. A national sample of PD and CB clinicians (N = 105) completed the Shedler-Westen Assessment Procedure-200 (SWAP- 200; Westen & Shedler, 1999a, 1999b) to assess personality disorders of a female patient with EDs in their care, as well as the Comparative Psychotherapy Process Scale–Bulimia Nervosa (CPPS-BN; Thompson-Brenner & Westen, 2005) to describe the interventions used in their treatments. Results showed that PD clinicians tended to use primarily psychodynamic interventions, while CB clinicians employed cognitive-behavioral techniques supplementing them with a wider range of psychodynamic strategies. Although, clinicians from both theoretical orientations used adjunctive treatment techniques for EDs at a similar level. In addition, use of psychodynamic interventions were strongly associated with the personality styles of ED patients regardless of therapists’ orientation, primarily being used more often when patients exhibited dysregulated and impulsive styles. Conversely, use of cognitive-behavioral interventions were primarily related to a clinicians’ CB orientation, patients with more explicit symptoms of anorexia nervosa, and negatively related to clinicians’ years of experience. The clinical implications of these findings were discussed.