This is so important I've put it top of our information list. I don't think this is perfect, but if you follow these tips you have a better chance of getting the right kind of help.
TIP 1: Ask about their training
Eating disorder work is a specialisation demanding that therapists know much more than psychology or counselling. They need to have training in nutrition and physiology with some understanding of neuroscience. They need to understand the physiology of weight gain and loss, the neuroscience of appetite and all about exercise physiology and mythology. They must not get their information from newspapers where there are a lot of myths and half-truths which confuse us all. You, the seeker need to know that counselling courses do not give people knowledge about eating disorders. There are many one or two-day eating disorder training courses out there. Many therapists have done the odd weekend but that will not make them an expert. To be an expert you need; Proper training, ongoing supervision with an eating disorder specialist, and at least two regular specialist eating disorder journals to keep up with the latest research. Doctors who become medical specialists rise through the ranks through training, exams and experience. But no such pathway exists for eating disorder therapists. Even membership of a charity like B-Eat doesn’t make someone an expert. You would not ask a GP to stand in for a cardiologist if you had a heart problem. You wouldn’t ask a handyman to fit your new bathroom. Would you? It’s the same with eating disorders. Get a fully qualified therapist or, they will do half a job or do you harm. True experts will be willing to answer your questions and should be able to give you a training CV. Without proper training, experience on its own is worthless. Have the courage to ask.
TIP 2: Ask about their way of working with eating disorders
Therapists have their own secret language for how they go about healing people. They might say things like “I will do CBT” or, “I think that this is about feelings not food so we don’t have to talk about food”. Such therapists will spend a lot of time talking about your past hurts and stresses to get you to deal with it all, then the disorder will go away all by itself. They are wrong. There is no one-size-fits-all explanation for why someone gets an eating disorder. Treating an eating disorder means helping you to change behaviour plus all the many other things which are keeping them stuck in the revolving door. One simple thing that keeps people stuck is just…. habit! So there are many tools an eating disorder specialist must have at their fingertips. These tools will ALWAYS include “cognitive” skills, because we know that people with eating disorder have a mindset that is full of thoughts and ideas about food and weight. The therapist should also know how to do motivational therapy , mindfulness training and basic nutritional medicine. It takes years to build up the skills that help our clients to grow and thrive. This helps them to give up the disorder by finding something else in life which makes them feel much happier. Very recently qualified therapists may not yet be skilled enough to work with complex cases. Your expert therapist will be able to explain clearly how he or she works.It will go something like this “There is no cause of an eating disorder. Once you begin dieting, other things come into play which keep you stuck. For example, starving helps you to block feelings. Or, bingeing becomes a habit and a way of helping you to deal with stress. And, constant thinking and worrying about food also helps to keep you stuck. …. and so on…. I will work to stabilise you physically and I will also change the emotional issues which are keeping you stuck including simple things like habit, and more complex things like how you manage stress and feelings. There are many ways of doing this including lots of enjoyable things to do at home”.
TIP 3: Ask about the therapist's history of an eating disorder
About half of all eating disorder specialists have a history of disordered eating which is not necessarily severe; this is why we are passionate about this work. You have the right to ask whether they have a good relationship with food now. A good therapist will be able to answer you, simply and honestly. A therapist who is not recovered can still help you a little – but would you want to get alcohol treatment from a drunk? “Recovered” means that your therapist can eat a wide diet without missing out any nutrient like carbs. They should not be exercise obsessed and they are not following quirky diets. They can eat in front of others and they relate well to food, as a friend and as a way of taking care of themselves. They don’t spend much time thinking and worrying about what they have eaten and what they will eat. Their weight is stable; they probably don’t weigh themselves at all. They always practice what they preach, such as eating regularly and going easy on alcohol and other stimulants. (that’s how you stay recovered). Beware if they are too thin as well as morbidly overweight. (I shouldn’t say that should I). So ask them what they ate yesterday. Why not, they will certainly be asking you. You must have a therapist whom you respect and who inspires you with hope, not bizarre treatment ideas. Don’t be afraid to ask how they control chocolate of how they feel about their body image. No one’s eating is perfect but it can be perfectly imperfect and normal. You need a guardian angel if you are going to put your eating disorder behind you.
TIP 4: Don't go to a hypnotist or someone who treats you as an addict
This is very controversial to therapists who have invested a lot of time and money in hypnotherapy or addiction therapy. However, I mean, don’t see a hypnotherapist/addiction therapist who lacks eating disorder training and proper supervision. Your behaviour with chocolate and biscuits may feel like a sugar addiction. Sugar, exercise and starving does affect the brain, like drugs and nicotine. But an eating disorder is more than a simple addiction to substances. Hypnotherapy has a poor success record for eating disorders. So please don’t pin your hopes on this unless the therapist also has the training I have written about in tip number 1.
TIP 5: Ask about their supervision
All therapists are required by law to use clinical supervision, where they discuss their cases in confidence and take advice about how to go forward. An eating disorder therapist needs two kinds of supervision, supervision for general mental issues and ALSO, supervision for eating disorder work. There are very few eating disorder supervisors in the UK with good enough training, experience and wisdom to guide a therapist through complex cases. My readers would be horrified to learn how few therapists use specialist supervision. Many therapists are working blindfold, without a properly designed treatment plan. It’s wrong and it is dangerous. You or your loved one deserve better. Ask your therapist what kind of eating disorder supervision they have in place.
TIP 6: Look on their book shelf
An eating disorder specialist will have a lot of textbooks – at least 30 specifically about all the eating disorders plus professional journals about eating disorders on their bookshelf – in full view of clients. If you can’t see the books, there might be a problem. I am busy putting together a list of books which are required reading for eating disorder therapists. If they are not real specialists they simply won’t bother to read these; they will always be trying to learn to do something else. Ask your therapist if there are any textbooks about eating disorders which you could read. Say you want to become an expert in your own problem. I believe that your knowledge will become your power, so you need to read the wise words of world experts, not books written by people wanting to make a quick dollar. The therapist should be able to show you their text-books and recommend one or two that you can buy on Amazon or direct from the publisher. Then you will know that they are as good as they claim to be.
TIP 7: An Assessment is not a one-way street
No matter how much you or your loved one is suffering, you must assess the therapist as much as they are assessing you. Liking the therapist is not as important as having a sense that they know what they are doing.
- Do they know what is in your thoughts without you having to tell them first?
- Do they communicate this or just ask you lots of questions?
- Do you feel fully understood?
- Do they just sit and listen to you with a nice cup of tea? Being nice is not enough.
- Do they ask you what you want to know about them and their practice? Good.
- Do they just take a lot of notes and ask you to come back for an indefinite number of weeks? Not good, they should give you something back, like a careful written assessment of what is amiss and what they plan to do about it. Experts are trained to make a care plan fast.
- Do they mention blood sugar instability and the effects of dietary chaos on mood and appetite? If they don’t, they don’t know about it BEWARE.
- Do they use the word “cause” with respect of your eating problem? Beware; there is no single cause of an eating disorder.
- Have they asked you to keep a short food diary before you come? You might not tell the truth – that’s OK, but if they do not, they are not assessing you properly.
- Do they say they can help you lose weight and treat binge eating at the same time? This is wrong and not good practice.
TIP 8: Does the therapist discuss your mixed feelings about change?
Eating disorder therapists will know that you have mixed feelings about change and that some of you will be hostile about the idea of change. A good therapist will know that change is scary no matter how much the eating disorder is hurting you. We know this and we understand. A good therapist will not just leap into “therapy”. They will tease out your fears about change the first time you see them, not the second or the third time you come through their door. Will treatment make me fat? How else will I manage my feelings? How else will I cope with life? What will I be without this problem which is such a big part of my life? Your therapist should be fully trained in motivational therapy which will help you explore these fears and keep you very safe and in control.
TIP 9: Does the therapist have specialist training in trauma therapy?
Bad experiences in life don’t cause eating disorders. Yes really. But many people who have eating disorders do have some really bad experiences and sometimes they don’t even recognise how terrible those experiences were. Their effects, however, can interfere with healing. So every eating disorder therapist needs specialist skills for working with trauma, so that you can recover faster. The trouble is that counsellors are often taught that to deal with a trauma you have to talk about it all the gory details. This can actually make it worse. There are some special therapies that deal with trauma fast and safely. These include EMDR (Eye Movement Desensitising and Reprocessing), EFT (Emotional Freedom Technique) and NLP (Neuro-Linguistic Programming). Please ask the therapist if they use any of these therapies. And if they say they don’t have specialist trauma training, consider finding someone else.
TIP 10: Ask about their links to other eating disorder services
An eating disorder expert will have links to other experts for emergency help and support. Ask if they are able to call upon people like qualified dieticians if needed for medical cases, activity specialists for people with mobility problems, inpatient services for emergency cases or psychiatrists for people who are mentally very unwell. At times your specialist may have to work with a team.
And More About Me (Deanne)
I am a psychologist who has worked with eating disorders for over 30 years. I have done many years of background and eating disorder focused study. I have worked with hundreds if not thousands of people, I am still learning from you and I am learning from experts I respect, for their wisdom and knowledge. I would like to pass some of this wisdom on to you. If you want just one session with me it could change your life.