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Section 1
Narrative Therapy

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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
The first concept of narrative therapy is creating a story. Narrative therapy’s aim is to help anorexic clients resolve problems by discovering new ways of storying their situation. My role is to help the client find an alternative and preferable story, one that enables him or her to escape their problem-saturated situation.

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
Jenny, age 23, had been diagnosed with anorexia nervosa at the age of 15.  Since then, she has fluctuated between a healthy 120 pounds and 80 pounds.  Because Jenny had been struggling with her anorexia for such a long period of time with little success, she had lost most of her self-esteem. 

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:

"Drill Sergeant Waste-Away doesn’t like to see a gap in behavior and demands a consistent amount of discipline from his pupils.  He shouts at me ‘You don’t need that extra piece of chicken, fatso!  You have enough on your hips!’  He has boils on his face and stands six-feet tall.  I hate him, but I’m also afraid of him."

Jenny stated, "That is exactly how it sounds in my head!  Is that what anorexia is doing to me?  Ordering me around?"  I stated, "Anorexia is like a tyrant in your life that you have to overthrow.  From now on, I want you to think of they voice in your head as Drill Sergeant Waste-Away whenever you begin to feel that it is your fault you are this way." 

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
The second concept of narrative therapy with anorexic clients is opening the thought window.  After personifying and externalizing the disorder, I have found that anorexic clients become more open to sharing their thoughts and interpreting their triggers to their behaviors. These clients find it easier to understand their own motives if they can step back from the disorder. By separating anorexia from themselves, it becomes possible to ask about anorexia’s tactics, about its rhetorical strategies, the moves it makes, and its attempts to cover its tracks in order to deny its effects. 

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
In addition to creating a story and opening the thought window, the third concept of narrative therapy with anorexic clients is anorexia as a con-man. In our modern society, it is normal for people to work deliberately to discipline themselves in order to meet the established demands of being "a person of good standing". The scrutiny of the public and the outside world has become instituted internally in many anorexic clients as a system to police themselves to conform to ideals of health, beauty, wisdom and success. Clients punish themselves for their transgressions as a taken-for-granted part of being a good person.

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.
Reviewed 2023

Peer-Reviewed Journal Article References:
Duffy, M. E., Calzo, J. P., Lopez, E., Silverstein, S., Joiner, T. E., & Gordon, A. R. (2021). Measurement and construct validity of the Eating Disorder Examination Questionnaire Short Form in a transgender and gender diverse community sample. Psychological Assessment, 33(5), 459–463.

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.

Isserlin, L., & Couturier, J. (2012). Therapeutic alliance and family-based treatment for adolescents with anorexia nervosa. Psychotherapy, 49(1), 46–51.

Manley, R. S., & Leichner, P. (2003). Anguish and despair in adolescents with eating disorders: Helping to manage suicidal ideation and impulses. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 24(1), 32–36.

Obeid, N., Carlucci, S., Brugnera, A., Compare, A., Proulx, G., Bissada, H., & Tasca, G. A. (2018). Reciprocal influence of distress and group therapeutic factors in day treatment for eating disorders: A progress and process monitoring study. Psychotherapy, 55(2), 170–178. 

Williams-Reade, J., Freitas, C., & Lawson, L. (2014). Narrative-informed medical family therapy: Using narrative therapy practices in brief medical encounters. Families, Systems, & Health, 32(4), 416–425. 

QUESTION 1
What are three components of narrative therapy as it relates to anorexia? To select and enter your answer go to Answer Booklet.

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