Eating disorder intervention, prevention, and treatment: recommendations for school counselors

Professional School Counseling,  Dec, 2004  by Angela D. Bardick,  Kerry B. Bernes,  Ariana R.M. McCulloch,  Kim D. Witko,  Jennifer W. Spriddle,  Allison R. Roest

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At this stage, school counselors may be better able to address daily concerns that arise for individuals recovering from an eating disorder by offering different points of view to counteract the black-and-white thinking (Wilson et al., 1997) that often accompanies an eating disorder. School counselors may encourage individuals to monitor their daily activities to develop a balance between work and relaxation (e.g., playing on one sports team versus three), and academically challenging courses and optional courses, as well as to meet socialization needs. Continued support is crucial at this stage to encourage the student to continue developing healthy cognitive and behavioral changes, to deal with the process of change, and to address occasion al setbacks appropriately.

Phase 3 of eating disorder treatment involves the exploration of relapse prevention strategies (Garner et al., 1997; Reindl, 2001; Wilson et al., 1997). Relapse is common in eating disorders, even 4 to 12 years after recovery (Schneider & Irons, 1997). Individuals with eating disorders may continue to show signs of weight and dieting preoccupation, obsessive thoughts and behaviors, emotional restraint, a drive for thinness (especially with anorexia), a psychopathology related to eating habits, perfectionism, and negative affect (Kaye et al., 2000; Pike, 1998). Symptoms may be less intense after recovery, but concerns are likely to remain the same.

Future difficulties and potentially stressful circumstances must be anticipated (e.g., stress related to graduating, leaving home, going to college), because an individual with an eating disorder may be vulnerable to a recurrence of eating problems, feelings of inadequacy, emotional and physical dysregulation, and dissatisfaction with body weight and shape (Garner et al., 1997; Reindl, 2001). A maintenance plan includes continual self-awareness and self-monitoring, practicing problem solving strategies, recognizing the onslaught of irrational thinking, utilizing cognitive restructuring strategies, and setting short-term, realistic goals (Wilson et al., 1997). School counselors max' contribute to maintenance plans by helping individuals prepare for inevitable challenges by exploring an individual's stress triggers and encouraging him or her to develop rational and healthy plans for action.

Guided imagery. Guided imagery may be a useful clinical tool for the treatment of eating disorders (Hutchinson, 1994). The use of guided imagery is a subtle, respectful, and nonintrusive intervention that may be used with individuals who lack a solid sense of self. Relaxation through guided imagery is healing, and the use of imagery has a strong connection to shaping reality (Hutchinson). Specific examples of guided imagery may include imagining enjoying a relaxing meal with friends, allowing one's body to become nourished and healthy, and viewing a problem from multiple perspectives. Guided imagery may be a useful intervention tool for school counselors to use with a student recovering from an eating disorder by helping the student to imagine different outcomes for stressful situations, develop relaxation techniques, and diminish anxiety.