At university, I was trained in Cognitive Behavioural Therapy (CBT) and elements of this therapy underpinned most of the eating disorder evidence-based interventions I then went on to train in and use with clients as I became a psychologist. I liked CBT because it was structured, achieved some good results relatively quickly and it made sense to both me and my clients.
However, I just as quickly realized that these changes achieved symptom reduction but not the long-lasting change that I and my clients were hoping for. My client knew in their heads that they were worthy and safe but on a gut level they did not believe it. Therefore, they defaulted to old and familiar eating disorder coping strategies to deal with the pain of feeling inadequate and then felt hopeless and defeated about their capacity for change.
This article looks at how we can incorporate parts work to achieve some of the goals of CBT and other top-down interventions and make them stick on a gut and emotional level.
Why can a parts model help improve our existing interventions?
Parts work assumes that we all have different parts of self that form from different experiences in life. Parts work involves getting to know the different parts of yourself, their functions and exploring how they can work together more harmoniously. Different parts have different needs, roles, feelings, thoughts and behaviours and may have formed at different times in our lives depending on what was happening.
Using an eating disorder as an example, a person may develop an eating disorder part of self to help shield another part of self that feels rejected and inadequate. The eating disorder part serves the role of protection from rejection by moulding the person’s body into something that is more socially acceptable. The rejected part is then forgotten about and hidden in some way because of the shame this part experienced. Alternatively, a binge eating part might stuff down or repress the feelings of rejection.
A CBT approach or other top-down approaches, often work with only one part of the person, the rational and wise part. The assumption is that the eating disorder is the problem and needs to go away, replaced by healthier thoughts and positive coping strategies. The problem is that removing the eating disorder part leaves the person wide open to the emotional parts of self that the eating disorder part was designed to protect them from.
Another reason that having a parts model can be helpful is when addressing traumas and negative life experiences that contributed to the development of an eating disorder to cope. The parts of self that experienced the traumas are usually younger, more reflexive and have different emotional learnings from the experience than the wise part of the person.
For example, a person’s wise part might KNOW that the reason they were not invited to a party as a child was not because of their appearance but the younger more emotional part of the person does not know this. The younger part encoded this experience of not being invited to the party as shameful and made sense of it by concluding that “I am not good enough or likeable”. The eating disorder part was then created to help the emotional part feel good enough. Ultimately, we need to work with the emotional parts and help them have a new felt experience of being worthy or acceptable.
How to begin working with parts
Certain interventions adopt parts work as a central aspect of the intervention. For example, Internal Family Systems (IFS), Ego State Therapy, Gestalt Therapy, EMDR Therapy and Schema Therapy. I was first introduced to the concept of parts and parts work through Schema Therapy, and it literally changed the way I worked with my clients.
Here are some brief points on what to consider when first working with parts during eating disorder work:
- Introduce the concept of parts of self to clients and begin identifying their parts.
I use all sorts of ways to map out parts of self, such as using Lego people or babushka dolls. You can draw the parts or find book/movie characters that represent the parts.
- Highlight parts in a session
People often understand the concept of parts intellectually but noticing the presence of a part in the moment and really feeling that part is more tricky. If a client says something in a session like, “I am too fat and no likes me”, ask them, “Which part of you believes that?”, “Is there another part of you that feels differently about that?”.
- Get to know the parts – Interview each part to understand it’s function
- Why did the part came into the person’s life,
- How old the part is
- What is the parts fears about stepping back or changing its role
- Does the part know that the person has a wise part.
- Help orientate parts to the here and now
Some parts were developed when the person was much younger to cope with adversity and sometimes, they just need a little help recognizing that the past is over and that they have their wise part to help keep them safe now.
- Build gratitude and compassion for parts
Once a person is better able to recognize and have deeper understanding of the survival role of some of their parts, they can begin to express thanks and more compassion. This creates more inner harmony and less shame and blame.
- Work towards collaboration, harmony and integration of parts
Try not to adopt, an antagonist position towards the eating disorder part. Understanding the eating disorder part more and in collaboration with other parts, “rewriting it’s job description” to meet needs in a more helpful way can help the parts to work better to achieve therapy goals.
Hopefully some of these ideas about incorporating parts work into your existing treatments have been helpful and sparked your curiosity and interest. If you would like to unpack these ideas further feel free to reach out to discuss or to make a time for supervision.
