Interpersonal Psychotherapy for Bulimia Frequently Asked Questions 1. What are the indications for interpersonal psychotherapy for bulimia? A: For patients with eating disorders with predominantly bulimic symptoms; recommended body mass index of 17.5 or higher; willingness to accept treatment; and ability to establish a relationship between interpersonal events and bulimic and emotional problems. This range of applicability is set because there is currently ample evidence of the effectiveness of this treatment in patients with predominantly bulimic symptoms, while the effectiveness of its application in patients with predominantly anorexic eating is yet to be supported by research findings, but such a recommendation does not mean that this treatment cannot be used in the treatment of patients with anorexia nervosa. The requirement for body mass index takes into account the effect of nutritional status on the individual’s cognitive ability and emotional regulation, and patients who have not yet been able to regain weight above the basic safety line often have more energy tied up in the struggle to gain weight, which may interfere with the interpersonal psychotherapy-focused work process and compromise efficacy. Willingness to accept treatment is a basic requirement for most specific psychotherapies, and it represents the patient’s willingness to try to trust the therapist, to be open to exploring what is troubling them in their lives, and to make attempts at change in a particular area. 2. Does interpersonal psychotherapy for bulimia nervosa have to be once a week and why? A: Interpersonal psychotherapy is a focused therapy where the treatment focuses on the process of change. The once-a-week schedule is designed to give patients time and opportunity to try to apply the changes and solutions explored in therapy in real-life situations and to practice new skills. Shorter than once a week can leave patients too late to practice and summarize their experiences, while longer than once a week can leave patients without timely summary and feedback, and the effectiveness of their collaboration with the therapist can be diminished. In addition, regular therapy once a week often helps bulimics carve out some of the orderly space in their chaotic and disorganized lives, which in itself has a therapeutic effect. 3. What are the treatment goals of interpersonal psychotherapy for bulimia nervosa? A: Bulimia is mostly combined with depression, so the immediate goal of interpersonal psychotherapy for bulimia is to improve mood and improve bulimic symptoms. In some cases, the mood of the treated patient has basically returned to normal, but the bulimic symptoms are still severe, so the main goal of treatment can be to relieve the bulimic symptoms. If the patient develops emotional problems again during treatment, improvement of mood can be included in the treatment goals and assessment at any time. 4. What does it mean to say that interpersonal psychotherapy is focal therapy and change therapy? A: Focused therapy refers to the process of assessment through the initial treatment phase, where the therapist works with the patient to identify the key objects to work on in the next phase of treatment, also known as ‘focus areas’. In the initial assessment phase of interpersonal psychotherapy, the therapist collects information, discusses with the patient in depth to establish the relationship between interpersonal issues and symptoms, and then works with the patient to identify a ‘focus area’ as the focus of the next phase of work. For example, if a patient has an onset after entering high school, and it is discovered that the patient is having ‘role transition’ problems with adjusting to being away from home, being independent and in a new environment, then the ‘focus area’ could be to deal with the ‘role transition’. The next 10 sessions will focus on this area. Transformational therapy means that the emphasis of the therapy changes. The therapist will talk to the patient about the area of work, discuss methods, strategies, and plans for change, help the patient practice the skills needed in the change process, support and motivate the patient to practice in their life, and give feedback and further guidance. Since change is a long-term process and change therapy is a short-term course of treatment, change therapy does not require patients to completely change problem behaviors that have plagued them for years in a short period of time, but rather to help patients begin a process of change and learn skills and strategies to cope with the difficulties of change, so called “teaching people to fish” so that they can This is called “teaching someone to fish” so that they can use what they have developed in therapy to continue the change journey after treatment ends. 5. Is interpersonal psychotherapy effective for bulimics who do not want to change? A: Motivation to change is a prerequisite for all psychotherapy to be effective. If a patient has little or no motivation to change, the effectiveness of any treatment will be diminished. However, eating disorder itself is a disorder full of contradictions, and most patients experience the reverse force while hoping to get better. Therefore, motivating and facilitating patients to change is also an ongoing task and goal in interpersonal psychotherapy. The therapist will identify and reinforce the motivation through discussions with the patient, and set different treatment goals depending on the level of motivation, e.g., in the case of bulimic symptoms, there is a difference between reducing the frequency of binge eating and eliminating it completely. Treatment is supposed to be a process of change, a part of the recovery process of an eating disorder, so this short course of treatment is not supposed to ‘completely’ eliminate the disorder. However, if during the treatment assessment phase or later, the therapist identifies that the patient is not currently sufficiently motivated to begin treatment and make the effort required for treatment, then the therapist will recommend trying other treatments and moving into interpersonal treatment when motivation is sufficient. Other treatments include inpatient treatment, outpatient medication, supportive therapy, cognitive behavioral therapy, etc. 6. How do I find a suitable interpersonal psychotherapist for bulimia? A: Qualified psychological counseling and treatment professionals need not only systematic theoretical training, but also, and more importantly, sufficient practical experience. An interpersonal psychotherapist for bulimia requires expertise not only in interpersonal psychotherapy, but also in eating disorders. However, interpersonal psychotherapy itself did not develop from a distinct psychotherapeutic theory; it is a synthesis of various psychotherapeutic theories based on focusing treatment on the ‘interpersonal problem domain’. That is, any therapist or miscellaneous practitioner of any theoretical school can provide such treatment to patients after learning the interpersonal psychotherapy model. Therefore, a therapist with systematic training in psychotherapy theory and practical experience can be relatively competent in this treatment. At the same time, good psychotherapy requires continuous review and improvement. Therefore, any good psychotherapy practice requires a continuous supervision mechanism, i.e., regular guidance from colleagues or senior professionals.