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Prison of Food gives us a detailed account of the strategic-constructivist perspective in the treatment of eating disorders. The authors use several clinical case examples that help us understand and have a better picture of their treatment model.
According to the authors, the strategic-constructivist perspective is a ‘non-normative model that sees human problems as the result of a complex process of retroactions between the subject and reality, where a person's efforts to change actually contribute to maintaining the problematic situation’ (p. 3). The idea is for the therapist to intervene in a way that will break the vicious circle established between the attempted solutions and the modes of persistence of the symptom. Their belief is that treatment will have the ‘power to subvert the pathogenic equilibrium of the system’ (p. 4).
The model is not interested in understanding why a problem exists and even less interested in what it exists for. The idea is that if the therapist can figure out how the problem exists, he can then work toward a fast solution. The authors talk about this model as one that fosters and therefore privileges rapid and effective interventions. They believe that one can only ‘know by changing’ (p. 6; italics in original). External observation, in their view, does not allow for understanding how a problem functions. We get to know how a system functions by observing its responses to the introduction of changes. My understanding is that what they are observing is strictly the eating behaviour.
The strategic-constructivist perspective applies the same methodology of research used in other sciences. The method is structured in three phases (p. 20):
Study the specific characteristics of a problem or a group of problems.
Determine what solutions have already been attempted.
Replace the dysfunctional solutions that maintain the problem instead of solving it with other solutions that have experimentally proved capable of producing the desired effects.
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