Dear J,
I subscribe to the non-diet approach pioneered by therapists like Jane Hirschmann and Carol Munter (see their book, Overcoming Overeating). I also like to be really clear that sugar has never been shown to be an addictive substance, but that there may be a psychological dependence on sugar or carbohydrates because of the calming effects they have on the body. All addictions, obsessions and compulsions are about managing anxiety, after all.
Often clients will avoid certain foods or food groups in an effort to maintain control. And as we know, control is a hallmark of addictive thoughts and behaviors, whether trying to control food intake, alcohol intake or even the co-dependent trying to control others. Control (or the illusion) makes us less anxious.
Where abstinence works well for substances we don't need like alcohol or drugs, it's a flawed model when it comes to food. Fortunately, the body has its own self-regulating mechanism, hunger and fullness. I find it useful to encourage clients to define abstinence as eating according to these natural, built-in mechanisms. If they are eating when hungry and stopping when full, they are being abstinent. No food plan can determine when they get hungry or how much they need to feel sated.
Then, when they are not abstinent, I work with any tendencies toward shame or self-flagellation. It becomes evident at some point that if they are eating to soothe painful feelings, then creating more pain through self-blame is counter-productive. As an inner voice of compassion develops, binges, or behaviors of deprivation (both are non-abstinence) become opportunities to look at the anxiety that needed to be soothed through eating or deprivation. As such the disordered eating becomes a friend, a guide to when something's not right.
