Focal Psychodynamic Therapy for Eating Disorders: What is it and How it Works...

By Lucas Mirani (Clinical Psychologist) & Tanya Franic (Principal Psychologist & Director)

A relational approach

Focal psychodynamic treatment for eating disorders has been recently developed in Germany in 2014, and been disseminated in English internationally since 2019. It specifically assists people to develop a greater understanding and insight into their emotions, behaviours and thoughts in relation to their disordered eating patterns. It recognises that the manifestation of eating disorders occurs through a broad variety of biological, emotional and/or psychological issues that people face in life and that this may largely stem from past relationship patterns (e.g., within the family system).

Given it originates within a psychodynamic framework, its treatment is focused in the following way:

• to freely explore emotional experiences and eating habits without restriction to identify key aspects in a person’s subjective worldview,

• to explore how people cope/defend themselves when exposed to a stressor/demand that feels overwhelming in life, and

• to examine family-based relationships and how this can perpetuate disordered eating patterns.

That is, it focuses on how controlling, punitive, critical and/or distant relationships can exacerbate disordered eating patterns and how people have adapted to such relationships as they move through life. Yet it is not limited to this and provides a multi-modal form of treatment. Specifically, it also focusses on: stabilising weight, nutritional rehabilitation, and exploring one’s body image.

Experts have deemed that it may also be helpful if you have experienced particular relational challenges such as finding it hard to trust others, being a people pleaser, and/or being perfectionistic.

Unlike some approaches that focus primarily on behavioural change, FPT emphasises psychological insight and the meaning of symptoms. It supports individuals to explore patterns of emotion, thoughts and behaviour in relation to food, body image and self‑regulation, often within the context of past and present relational experiences. This reflects the broader psychodynamic assumption that unresolved emotional conflicts and interpersonal patterns can contribute to the development and persistence of eating disorder symptoms.

Therapeutically, clinicians work with people to:

• Develop greater insight into emotional experiences and internal conflicts linked to eating and body image;

• Explore how habitual coping and defence mechanisms function when life feels overwhelming;

• Understand how past and current relational patterns (e.g. experiences of criticism, control, or distance in key relationships) may connect with eating behaviours;

• Support stabilisation and nutritional rehabilitation as part of a coordinated care plan;

• Explore issues such as body image and self‑perception in a reflective therapeutic space.

At our practice, some clinicians are trained in focal psychodynamic methods and may offer this modality as part of a broader, individually tailored treatment plan. This approach can be particularly useful for individuals who want to understand deeper emotional and relational factors associated with their eating experiences, particularly where relational patterns (such as difficulties with trust, perfectionism, or people‑pleasing) are prominent.

If you have questions, feel free to contact TYW on (02) 9555 4810 or email info@treatyourselfwell.com.au — Karen, Julia, and Jenny will be very happy to help. 💛