Red Sistémica · Eating disorders
The meaning of the symptom in eating disorders
This article presents the characteristics and conclusions of the clinical work carried out with 40 patients within the SITTA programme of CETEPO (Centre for Post-Rationalist Cognitive Therapy), an institute of the FAPS Foundation. The patients were admitted to treatment over the last four years with a diagnosis of eating disorder in its various types (anorexia nervosa, DSM-IV: 307.1 – bulimia, DSM-IV: 307.51 – eating disorder not otherwise specified, DSM-IV: 307.50).
“Unlike treatments that centre their strategy on controlling the dysfunctional behaviour, this approach favours the exploration of the symptoms.”
Juan Balbi and Gabriela Jaicovsky
Editor’s note
The text below is the excerpt published by Red Sistémica; the full text appeared in Perspectivas Sistémicas no. 83.
Characteristics of the treatment
It is an outpatient treatment, whose most remarkable characteristic lies in the psychotherapeutic approach applied. Unlike treatments that centre their strategy on controlling the dysfunctional behaviour, this approach favours the exploration of the symptoms, leading the patient to examine the way in which they arise, in order to facilitate the understanding of their meaning.
This objective is achieved by means of a process of self-observation that goes through different stages:
1
Differentiation
Differentiation between the physical experience of hunger and the emotional need to eat.
2
Understanding
Understanding, by the patient, of the relationship between food compulsion/restriction and discordant emotional experience.
3
Identification
Identification of the situations and emotional states to which the patient responds with alterations in food intake.
4
Recognition
Recognition of the emotional adjustment strategy as a general characteristic of the patient’s personal style.
5
Awareness
Increased awareness and self-reference regarding the underlying emotional and affective problems, in the stage of the life cycle the patient is going through.
Stages 1 and 2 result from the implementation of specific cognitive and self-observation techniques, aimed at achieving a re-cognition of the basic coenesthetic and proprioceptive sensations linked to eating. This work is carried out in groups called R.E.A.L. (food resensitization). Stages 3, 4 and 5 are conducted in individual psychotherapy. The latter, which begins as soon as the patient is admitted to treatment, is conducted by a therapist trained in the PCT method (post-rationalist cognitive therapy).
The patients’ relatives receive ongoing support and, when the programme management deems it necessary, relational therapy sessions are organized.
Patients are clinically assessed by specialist physicians, both on admission and throughout the duration of the treatment.
Key takeaway
The SITTA programme does not seek first to control eating behaviour but to explore its meaning: relearning to distinguish hunger from the emotional need to eat (R.E.A.L. groups), then linking compulsion or restriction to the situations and emotions that trigger them, until this mode of response is recognized as a trait of the personal style (post-rationalist individual psychotherapy). Relatives are supported and medical follow-up is continuous.
Who are the authors
Juan Balbi is a psychologist (University of Buenos Aires). He is president of the FAPS Foundation and director of CETEPO.
Gabriela Jaicovsky is a psychologist (J. F. Kennedy University), specializing in eating disorders. She is a member of the teaching staff of CETEPO and general coordinator of the SITTA programme.
References
Arciero, Giampiero (2004): Estudios y Diálogos sobre la Identidad Personal. Reflexiones sobre la experiencia humana. Colegio Oficial de Psicólogos de Las Palmas; Las Palmas de Gran Canaria; España.
Balbi, Juan (1994): Terapia Cognitiva Posracionalista. Conversaciones con Vittorio Guidano. Biblos; Buenos Aires.
Balbi, Juan (en prensa): La Mente Narrativa. Hacia una concepción posracionalista de la identidad personal. Paidós; Buenos Aires.
Crittenden, Patricia (2002): Nuevas implicaciones clínicas de la teoría del apego. Promolibro; Valencia.
Guidano, Vittorio (1994): El sí mismo en proceso. Hacia una terapia cognitiva post-racionalista. Paidós; Barcelona.
More information: www.cetepo.com.ar; contact: cetepo@cetepo.com.ar.
This article is an English translation of “El significado del síntoma en los trastornos de la conducta alimentaria”, published by Red Sistémica (first published in Perspectivas Sistémicas, n° 83). Translated and republished with the journal’s permission.
Read the original articleHow to cite this article
Balbi, J., & Jaicovsky, G. (2022). The meaning of the symptom in eating disorders (Complexe Systémique, Trans.). Complexe Systémique. https://app.complexe-systemique.com/en_GB/articles/the-meaning-of-the-symptom-in-eating-disorders (Original work published in 2022 in Perspectivas Sistémicas, n° 83; republished in 2022 by Red Sistémica, https://redsistemica.ar/2022/07/19/el-significado-del-sintoma-en-los-trastornos-de-la-conducta-alimentaria/)
To go further
- What if our symptoms had a function?The systemic premise underlying Balbi and Jaicovsky’s approach: the symptom says something.
- The Rome school of family therapy: understanding the symptom differentlyAnother tradition that reads the symptom as a language rather than as a behaviour to be corrected.
- Family therapy in context. Interview with Charles FishmanThe structural approach to eating disorders, in the line of Minuchin, as a counterpoint to the post-rationalist model.
Related training courses
Symposium
The Abnormal Normals and the Normal Abnormals
Conference replay: six clinicians explore normality — diagnoses, norms, adolescents, therapists. Immediate, lifetime access. Talks in French.
Related articles
Article The AFFIRM Model for Navigating Challenges in Continuously-Interfaith and Divergent-Interfaith Marriages
Thirty happy interfaith couples describe how they navigate their religious differences: five processes, from respecting each other’s choices to religious intimacy, gathered in the AFFIRM model.
Article Toxic, narcissistic, borderline: what therapy speak does to your relationships
Narcissistic, borderline, toxic: therapy speak has left the consulting room. Julien Besse shows how these labels close the debate and relieve us of our own part.
Article First- and second-order cybernetics: from puppeteer to dancer
Moving from first- to second-order cybernetics: the practitioner stops observing the system from outside and recognises being part of it. From diagnosis to co-construction.
Article The more things change, the more they stay the same? Not always
Morphogenesis describes how new forms emerge. Applied to families and organisations, it invites us to create the conditions for reorganisation rather than correct a symptom.
Comments 0
Log in to join the discussion. Log in