Eating Disorders are multi-faceted, complex, and affect both the brain and the body. Unfortunately, they are also highly lethal (the most lethal of all mental health issues) and the outcomes for full recovery become worse as time goes by without an adequate treatment team. In some cases, seeing a therapist who is versed in some parts of an Eating Disorder is adequate treatment; however, in the majority of cases it is best to see someone who knows all of the complexities of an Eating Disorder (or ED) and the outcomes for full recovery are much better.
Why is it so important to choose a person who specializes in ED’s? The following is a list of reasons and things to look for when choosing a therapist for you or a loved one struggling with an ED:
- Assessment is a different animal. It’s important with ED clients to assess for things not typical for a general intake assessment including: ED behaviors, the history of family members and eating attitudes, motivation for treatment, food related treatment goals, labs from a well-versed physician to test the physiological components of the ED, the full range of ED behaviors including use of dieuretics, exercise history, what does a binge consist of, self-esteem/worth measures, body image disturbances, and abuse/trauma history. All of this can be done over the course of several sessions, and assessment for ED behaviors/discussion with a dietitian/doctor may be part of treatment throughout the entirety of the therapeutic relationship to ensure client integrity, safety, health, and accurately measure for the client’s status.
- A good ED therapist knows when to call out the ED lies. Unfortunately, the insidious nature of ED’s are that they can be so elusive that a client could be feeling like they are telling the whole truth while lying to themselves and others. This can be especially dangerous when it comes to clients who can backslide in progress while “saying all the right things” to an unknowing therapist and can make their real recovery time much longer. Finding a good therapist means being able to find someone who can see between the “honest lies” or “ED lies” and help a client face truth in a kind and direct way.
- Understanding that the eating behaviors serve a function/role and honoring that in the therapy process. For many, they tell clients to “just eat” or see the eating behaviors as “attention seeking” or “something they will grow out of”. This is dangerous, and especially when taking a punitive, shaming stance approach toward the reasons for the ED. All EDs serve a purpose and likely help the client emotionally survive in various relationships and environments…what may seem “immature” or “rebellious” on the outside has much deeper roots and meanings.
- Knowing when to refer for inpatient hospitalization or more intensive care. One of the harder parts of working with ED clients is knowing when to refer them to more intensive care. When a person’s health is jeapardized, so is their brain health and they may unintentionally cause irreversible damage to their organs or worse, death. It is crucial that those working with a client understand the signs and monitor a client in a way that they are able to refer to inpatient hospitalization when needed and provide a client and their loved ones with the adequate resources. In my own work, I’ve made it a priority to tour all of the inpatient and IOP hospitals within 6 hours of my location to ensure that I can provide a client with in-depth knowledge about hospitalization when/if the time comes, and it’s helpful for clients in distress over going to the hospital to hear, “I’ve been there… here’s what I know and how I can support you while you’re there.”
- The “wounded” healer. Lastly, an important part for many clients is to garnish hope and to know that “full recovery is possible” by example. It is controversial in the field, but I am in the camp that working with a person who is “a wounded healer” or has gone through their own ED experience and fully recovered is especially helpful for clients, as they are able to become hopeful by seeing that full recovery IS possible and they find comfort in talking with someone who can deeply empathize with the struggles they are facing.
All in all, my hope is to encourage more clinicians and therapists to join me in specializing in this field. Although there are many complexities, the reward and honor of working with this population is far beyond what I could’ve imagined.
Jenny Helms, TLMFT, Eating Disorder & Obesity Specialist