For quite some time, I've been following blogs and forums about weight loss, and occasionally the topic of therapy and the role of psychology come up. Most of the time, people who have lost or are losing weight say that counseling does not assist them in weight loss. Their general attitude is that their issues are biological in nature (e.g., sugar addiction, insulin resistance) or simply the result of poor self-control or discipline. The former can be treated with drugs and lifestyle changes. The latter has to be pushed through by "sheer force of will" until you have magically found the discipline (a notion I reject as I think "willpower" is a useless term which does nothing to assist people in making behavioral changes).
Setting aside the fact that bad habits are psychological issues, I've often wondered why people reject the idea that therapy will aid them in their efforts. I've reached various conclusions, but the primary one is that most weight loss therapy is likely too abstract in its reasoning. There need to be multiple stages to the process, and I think some counselors might be level jumping on the type of feedback they provide. For most people, the fact that their alcoholic father drowned his pain in booze and therefore role-modeled addictive behavior that the person undergoing treatment may be emulating but substituting food instead of alcohol is of limited value in dealing with the problem at hand.
If the information can't be directly applied to a change in lifestyle or at the moment when the impetus to behave destructively is motivated by that underlying psychology, it comes across as merely academic. If you stuff yourself with food to a point of physical discomfort because you create a new discomfort to blunt, mask, or distract yourself from painful emotional feelings, it means nothing as you sit in the therapist's office the day after a binge. The information has to be timely as well as accurate and relevant to be of value in the weight loss process.
In the sterile environment of the therapist's office, when the circumstances that may cause you to eat are far removed from that time and place, it is hard for the counselor to know what is driving you, and it's nearly as hard for you to know. What tends to happen is that it all boils down to "I eat because life is hard and food comforts me." This generic conclusion is of very limited value, particularly when no solution to the pain of your life is forthcoming via therapy.
In essence, knowing the cause doesn't really help with the solution for many people, particularly if the deeper knowledge doesn't come hand in hand with behavior modification therapy that teaches them new and concrete techniques for addressing stress in a fashion which does not involve food, but is adequate for alleviating your difficulties. Of course, for many food addicts, nothing soothes like food and they find all other options falling short in offering a palliative for their pain.
That being said, as someone who feels profoundly that analyzing the psychology of my problems and applying behavior modification techniques to myself have brought me to where I am today, I think that therapy can make the difference between being someone who loses weight and keeps it off and someone who starts to regain with the first forced lifestyle change or bad patch, or, perhaps worse, someone who is obsessed with food in a way which is conducive to physical health.
The process of weight loss is one thing, but living in a manner in which your relationship with food is psychologically as well as physiologically healthy is another. I believe that insights and understanding are something which should be made concurrent with changes in habits or routines, but they should not be expected to have an immediate effect or direct application. It is rather the case that they create a mass of self-knowledge that will reach a critical mass when your understanding of self comes together at later periods of time. This is something I figured out when I talked about my mental conditioning work. I didn't know how I one day stopped obsessing about food or using it destructively. It just seemed to happen, but it actually was the culmination of a great deal of therapeutic effort coming together after months and months of hard psychological work.
Many people believe that thin = cured. They think that as long as they lose weight, they have solved the problem and are effectively dealing with it. To me, this is a very narrow definition of "health" and focuses exclusively on appearances over a balanced existence in which your relationship with food is one in which your thoughts are not consumed by this issue. If you remain preoccupied with food, exercise, and weight throughout your day in a manner which consumes an inordinate amount of time or disrupts your ability to have relationships with others that do not revolve around body image, diet, or exercise, then you probably need some counseling to help you adjust your relationship with food regardless of what your weight is.
A lot of people have no idea what a mentally healthy relationship with food is, and they will fight and argue with you about what is and is not "healthy" based on the composition of their diet, their weight, and health status. Physical health as a result of lifestyle choices does not indicate mental health in regards to food. There are people who are at a healthy weight, eat nothing but healthy food, and still spend their days ruminating about eating. I'm not even talking about pining for a piece of cake or a slice of pizza, but rather people who think about their apple and yogurt snack for hours before they can eat it. They are honed in on food to the point of distraction in a manner which a person with a normal relationship with food does not think or feel.
The aforementioned types of people have all of the behavioral changes necessary in place for weight maintenance and physical health. However, they need counseling to adjust their thinking such that they spend less of their energy on diet and body image and can focus more productively, creatively, and, frankly, in a more fulfilling manner, on other aspects of their lives.
One of the many things I have learned through losing weight is that I was much more dysfunctional overall at the start of my changes in habits and choices than I was before them, and than I am now. The dysfunction was food obsession and there were times when I thought that I could simply not live the rest of my life like that. The preoccupation I had was oppressive, and I'm sure would have continued had I not labored to deal with the underlying psychological issues (particularly in regards to identity, but also all of the stuff I grew up with that caused me to become a food addict). Frankly, I'd rather remain fat than continue to live the sort of torment I experienced during the first 10 months of my weight loss process.
There are people out there who have successfully lost weight who do live in a constant state of preoccupation with food and their bodies, and they are okay with it because they are so deeply immersed in their neurotic obsession with food that they cannot see how dysfunctional they are. To the people around them, they seem to be almost manic and are clearly obsessed, but they cannot gauge themselves by anything other than their bodies. As long as they are thin, they think all is well, and they are some of the people who most frequently say that they feel counseling is not necessary if you want to lose weight. In a way, they are right. If you want to merely be thin, you don't need to have any sort of therapeutic process (be it self-reflection or with a professional), but if you want to live a life in which you are not mentally enslaved to food and preoccupied with your body, you probably need a little psychological work as well.