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Why Use Relational-Cultural Theory in hating Disorder Treatment?

RCT provides a respectful and dynamic framework for approaching clients with EDs. Additionally, RCT highlights the cultural contexts that are essential to understand in the treatment of EDs. Furthermore, RCT has been identified as an approach that works well in conjunction with other treatments for working with clients with ED (Sanftner, Tantillo, & Seidlitz, 2004; Tantillo, MacDowell, Anson, Taillie, & Cole, 2009; Tantillo & Sanftner, 2003), including those mentioned in Chapters 13 to 17 in this text. Specifically, Tantillo and Sanftner (2003) found short-term relational group therapy based on the RCT model to be equally as effective in treating bulimia and depressive symptoms as short-term cognitive-behavioral group therapy. To better understand why RCT is appropriate and effective in working with clients with EDs, disconnections and mutuality are two areas that must be explored.

Relational-Cultural Theory as a Strategy for Disconnection

Disconnections can be explained as routine challenges in relationships. These disconnections or challenges can include disagreements or arguments as well as ongoing relational patterns. Strategies of disconnection often begin as attempts to self-protect (Miller & Stiver, 1997). For example, when a person has a relationship in which the other party is unable to respond to her needs, she becomes a chameleon of sorts and develops strategies to protect herself in the relationship. Often, this means becoming – or representing herself – in a way that is acceptable to the other person, despite how she really feels. Eventually, she grows increasingly unable to access her own thoughts and feelings. Subsequently, she becomes unwilling and unable to represent her authentic self with others for fear of being ignored and devalued (Miller & Stiver, 1997). In time, if these relational ruptures are not repaired, these disconnections between self and others become increasingly isolating.

EDs have been linked to a need for a sense of control (American Psychiatric Association, 2000) and have been presented as a coping strategy (Brewerton, 2007). As such, it makes sense to conceptualize EDs as a strategy for disconnection; through disconnection with others, one simplifies one's world and achieves a perceived sense of control (Trepal, Boie, & Kress, 2012). EDs can also be rooted in a sense of disconnection with one's body secondary to not feeling as though one lives up to idealized media images of beauty. For example, images in the media often portray models who are tall and thin. If people compare their body with those images and feel or believe that their body is different from or not equal to those idealized images, they may feel disconnected or separate – from their body as a result. From an RCT perspective, EDs are aptly framed as “diseasefs] of disconnection” (Tantillo, 2006, p. 86).

Moreover, when EDs serve as a means to disconnect, ED behaviors present an opportunity to disconnect from pain and to temporarily find emotional and physical safety. Behaviors associated with EDs can distort reality and further distance people from themselves and others. People are not able to be fully aware of their bodily sensations (e.g., hunger, thirst) and feelings (e.g., anger, grief, anxiety) when they are disconnected from themselves. In addition, it is possible to distract – or disconnect – oneself from relational pain (e.g., fighting, confronting someone) when one is consumed with managing an ED.

Many different strategies used by those who have EDs result in a sense of disconnection from others, and these strategies include blaming others, criticizing, withdrawing, and isolating (Hartling, Rosen, Walker, & Jordan, 2000). Isolation in particular may be an important relational consideration because EDs often involve private rituals and behaviors (American Psychiatric Association, 2000). Similar to other forms of self-harm, the isolation created by the ED is cyclical (Trepal, 2010). For example, a person may retreat to manage overwhelming emotions (e.g., feeling out of control, stress, anger) and practice behaviors associated with his or her ED (e.g., binging, purging, ingesting nonfood objects or substances, excessive exercise). After using various disconnection strategies, individuals may feel a sense of guilt and shame at having used these coping strategies. When they disclose these behaviors to others, or when others discover them, they can be pushed back into isolation and out of actual connection.


Specifically, the RCT concept of mutuality (e.g., awareness of, connection to, and impact on another) is an essential concept in understanding the role of EDs within the context of relationships. In relationships in which mutuality is present, there is room for both parties' growth. According to Miller and Stiver (1997), people whose early relationships lacked mutuality are more likely to struggle with psychological issues, including EDs. If early emotional templates suggest that one's ideas, thoughts, feelings, and experiences are not important (i.e., they are devalued or ignored) or if these relationships are marked by chronic and irreparable disconnections, people may assume that it is better to disguise aspects of themselves to maintain their safety in relationships.

Some research support exists for the idea that low levels of mutuality in relationships can affect ED symptoms. For example, in one study women with EDs self-reported lower mutuality in relationships with friends and romantic partners than did a non-ED control group (Sanffner et al., 2004). Tantillo and Sanffner (2003) also found that clients who self-reported low mutuality in relationships with their parents had more severe ED symptoms.

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