ENHANCING MOTIVATION FOR CHANGE IN TREATMENT-RESISTANT EATING DISORDERS

Denial and resistance to change are prominent features in most patient s with anorexia nervosa. The egosyntonic quality of symptoms can contr ibute to inaccuracy in self-report, avoidance of treatment, difficulti es in establishing a therapeutic relationship and high rates of attrit ion and relapse. Individuals with bulimia nervosa are typically more m otivated to recover, but often ambivalent about forfeiting the ideal o f slenderness and the protective functions of binge-purge behavior. Fe w attempts have been made to assess denial and resistance in the eatin g disorders, or to examine alternative strategies for enhancing motiva tion to change. Review of the clinical literature indicates a striking convergence of recommendations across conceptually distinct treatment approaches. Clinicians a re encouraged to acquire a frame of referenc e that can help them understand the private experience of individuals with eating disorders, empathize with their distress at the prospect o f weight gain, and acknowledge the difficulty of change. The Socratic method seems particularly well-suited to work with this population bec ause of its emphasis on collaboration, openness, curiosity, patience, focused and systematic inquiry, and individual discovery. Four themes are crucial in engaging reluctant eating disordered clients in therapy : the provision of psychoeducational material, an examination of the a dvantages and disadvantages of symptoms, the explicit use of experimen tal strategies, and an exploration of personal values. (C) 1998 Elsevi er Science Ltd.