Building a life instead of rehashing the past?

I recently read an interesting blog post on the treatment of borderline personality disorder at mentalhelp.net. Many people with BPD have had childhood trauma, and this is where therapy usually begins. The patient and clinician delve into whatever traumas they may have faced, what happened, how they felt, etc. Sound similar to eating disorders, eh?

In a new book titled Treatment of Borderline Personality Disorder –A Guide to Evidence-Based Practice by Joel Paris, a researcher and professor at McGill University, he offers a different viewpoint. In studying various forms of theories and controlled trials of psychotherapy of BPD, Paris concludes that the most effective BPD treatments all have one commonality. He says:

They focus on the present, and on the current issues a person is dealing with. According to Joel Paris, people with BPD don’t get better by uncovering memories and rehashing the past, but by using the past as a context for understanding the present. This includes validating and acknowledging a person’s life history, and then putting it behind them. What sets successful therapies for BPD apart is that, in one way or another, they teach people how to tolerate painful feelings and to how experience difficult emotions without acting upon them in self-destructive ways.

He goes on to say that how a person with BPD needs to give a commitment to making a life for themselves. The goal is to work on building a life worth living, while putting the past into perspective and learning skills to tolerate intense emotions. Building a life for oneself is by no means an easy task. It includes developing goals for the future, finding work, and building relationships...The trick is to diversify one’s interests, and to try to retrieve satisfaction and pleasure from a range of different activities, relationships, and emotional investments.

Much of what Paris proposes has similar connotations with DBT therapy, but I still think it needs to be heard more. So often in eating disorder treatment, it seems the clinicians want to focus too much on the past and not enough on the present. While I certainly think delving into the past is one integral part of therapy, it doesn't need to be rehashed but more than once or twice unless it is causing a complete detriment to the present. All the past does is offer context and understanding for the who we are and how we came to be. Once we learn that, it really is time to let go, move on, and live in the present. After all, the past cannot be changed, but you do hold the power to change your own future.

Note--*I'm currently working on one past issue which has plagued me for awhile, but I'm hoping after that to not revisit the past. More can be learned at post Revealing secrets

CBT-E and eating disorders

The hot article of the day is about about a "new" form of Cognitive Behavioral Therapy (CBT) called Cognitive Behavioral Therapy-Enhanced (CBT-E). It's interesting to see how the media decides to title the article. Words range from "potential" to "curing" eating disorders.

CBT-E, developed by Christopher Fairburn, professor and researcher at Oxford University, is an extension of the standard CBT treatment used for bulimia. Fairburn developed two forms of CBT-E--one focuses only on the eating disorder, while the other also delves into low self-esteem and extreme perfectionism issues.

In a study of 154 patients with bulimia and "atypical" eating disorders, results found the majority showed improvement and had sustained effects over a period of a year with both forms of CBT-E. Two-thirds of those finishing the study had complete and lasting responses.

Fairburn says, "Now for the first time, we have a single treatment which can be effective at treating the majority of cases without the need for patients to be admitted into hospital." He is now currently studying a large-scale trial using CBT-E with anorexic individuals.

I guess I'm not quite seeing what the big hoopla is and how this CBT-E is "different" from standard CBT. I'm certainly not a fan of some media outlets saying how this therapy could "cure" eating disorders. Perhaps, that's just the skeptic in me.

I guess my other qualm with all this is, well, shouldn't issues of perfectionism, low self-esteem, depression, etc. already be addressed in whatever therapy is considered?

Obviously, more information on this new psychotherapy needs to be given. Maybe those of you in the UK might know more about this since it is apparently increasingly being used there.

Here's an interesting article The Independent which asks similar questions and looks at both sides of the coin in how CBT is effective and also its problems.