Confusing therapy and therapeutic

This is something that has been making me think a little bit. Many treatment facilities use a wide range of "therapies" to combat a person's eating disorder. Now, really, the more ammunition, the better. I have no fear of the use-a-sledgehammer-to-kill-a-fly approach, because Ed is one hell of a big fly. So let's bring in the big guns, shall we?

However, I'm wondering whether these modalities are really therapy or merely therapeutic. To me, therapy is learning specific skills to deal with life in a more effective manner. Although the skills may or may not be measurable, they should be (reasonably) specific. Not just "Tell me about your mother." Talking about your past and identifying patters will probably be a part of therapy. It's important to know where you're coming from, and I think personal insight can be invaluable.

Take equine therapy. Horsies can be fun. I'm not the type of girl who likes a large animal taking a crap on her foot, but I've been trail riding, it was fun, etc. That being said, this trail-riding wasn't therapy. It was therapeutic, yes, but not therapy. I learned skills- namely how not to get bucked off the horse- and enjoyed the scenery, but these things didn't really help me recover from anorexia. It's the same thing for art and music. I love photography and making collages. I love to bead and crochet. Learning that I could use crochet to calm my anxiety was something that happened in therapy; but yarn therapy isn't out there yet. It's not therapy.

What is therapy? I like behavioral therapy. My old therapist always told me "Feelings chase behaviors." The only way I might want to eat in the future was to start eating NOW. Therfore, meals are therapy. You can't really change your thoughts unless you change your behaviors. My first therapist (with whom I have learned much, but also had a multitide of issues) thought that if I could identify why I was restricting or purging or overexercising, then I would stop.

Problem was, there usually wasn't a reason why. And knowing your motivations doesn't necessarily bring about change. I needed to learn how to deal with anxiety and anger and fear in order to move forward.

So is psychotherapy actually therapy? Technically, yes. But I'm not entirely sure that it is, or rather that hving someone to talk to every week is therapeutic. There's a difference, I guess. Wikipedia defines psychotherapy as: The treatment of people diagnosed with mental and emotional disorders using dialogue and a variety of communication techniques.

Ah, the definition says it all: treatment not therapy. I know the actual word "psychotherapy" does contain the word "therapy" but that doesn't mean it is. Freud was without a doubt revolutionary and did bring a lot to the field of psychology. But still...a cigar is just a cigar.

Doing all of my creative stuff helps me in my recovery. Beyond a reasonable doubt. It helps relieve stress, and provides motivation to keep on going in recovery. Learning how to use my creativity in a positive way was therapy- it was a skill, it could be defined. Eating regularly? Therapy. Making a scarf? Therapeutic. Bitching to my therapist? Therapeutic. Learning what I could do about the situation instead of just bitching about it? Therapy.

Treatment centers get some pretty big bucks for providing all of this therapy. Most of it doesn't hurt. I don't think these places are deliberately sucking money from your wallet. However naive I might be, I do tend to believe the best about people until I know better. Yet I'm also not dumb enough to believe that they're perfectly happy to charge more because they think that you think that riding a horsey is going to cure you of your eating disorder. They probably think it will. And treatment shouldn't be like prison, either. Therapeutic venues are important. But they're not therapy.

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mary said...

I can put in MY definition on wikipedia as can you. My webster uses the word therapy where wikipedia used treatment...almost word for word otherwise.
My dad always likes to debate me so I might be inclined to play with you on this one. >:O
Are you sure that therapy and therapeutic practices aren't somehow connected? I know an older gentleman who calls his rug making his therapy because he is an alcoholic and this has become one of his tools. So, if he believes it, why can't it be his therapy? Does all therapy have to enter an office? Does it have to talk or listen? Can it be FREE?
I suppose that if he had pay someone to oversee him while he made his rugs it would appear that he was being screwed. In fact it would down right dishonest! TG for AA for those who need it.
I do understand that being expected to pay outrageous amounts of money for treatment, ought to require that those collecting it have a PLAN to see their patients move forward. Not making it prison like as they do with the elderly and most places where they deal with mental illness is another problem. [so many world problems but only a few of us thinking of change!] I really hate how unfair the whole system operates so I'm with you on that. If someone with an ED needs over seeing then why haven't we found ways to give ourselves a place to recover that doesn't cost enough to BUY THE FARM and have our own tools to keep? It's a bit insane. If a place that offers treatment operates more like a spa then had better OWN this and call it a retreat or treat their patients honestly. Horseback riding and all the other fun stuff may be helpful but you are right if you feel it's used as a lure. I'd pick the dolphin camp myself with paintbrushes and music. It really is a therapeutic tool to distract oneself and learn new ways to direct ones attention but do we really need it packaged and sold like a vacation when what we really need is someone who's willing to get there hands dirty and help those with an ED learn how to fight and win the ED war within? I told my daughter that she probably had an inner voice that was very demeaning to her and that she HAD to IGNORE it, as it was the ED. She didn't have to debate it, nor fight with it, as it was a fool to belittle her. I told her it was unworthy of her time or attention. Instead she had to replace it with kindness towards herself. 'Fake it till I make it' was one that got her started. Affirmations help when used to build ones own sense of self back up.
What do you need to know to recover? That you have to trust someone outside your own head until your own head is able to be well enough to take care of yourself. We definitely need more guides! It's a difficult lesson as this is a disease that some have claimed was caused by others being too controlling...and here I am saying to let someone else who will help lead you for a bit, even if you are an adult. Some people may have to ask for help as their parents have been told to back off. It will feel wrong but you'll know on some level that your mind is not being very friendly towards you so having someone support you will be in your own best interest. No one should have to wait till the next crisis.
Sorry I rambled Carrie but I really do get frustrated with some of what's being sold in the name of 'treatment'.

And 'What About Bob'? Ok...gone silly on you.

marcella said...

((yarn therapy isn't out there yet)) Why don't you suggest it to the NHS? they'll be delighted as it would be so cheap. We don't tend to have the luxury spa type facilities over here although the facility my daughter was in did offer her art therapy which passed the time. The main and most important therapy they offered her was food.


Actually, Marcella, in a way, therapeutic activities can be just as important as therapy itself. It's a fine line to draw, and it's not always clear.

I guess what I would say is this: the process of making the rug (as you say Mary) is therapy. The actual craft (rug-making) is therapeutic. For me, rug-making would involve less the making of a rug and more of making ME bald as I pull out my hair in frustration. Not therapeutic. But using the process to be mindful and focus is very much therapy.

It's a bizarre distinction. But it's pretty real, at least to me.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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