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Expert Advice for Clinicians
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Remember that with effective treatment, ED are curable in 80% of cases.
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This sub-specialty demands unique requirements for care, standing apart
from generalist practice or other specialties. ED treatment requires
professionals to use themselves and their diagnostic and treatment
skills differentially. Recognize
and respect this.
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As bio/psycho/social diseases, as disorders of the body and mind, the
psyche and mood, of sociability and cognition, ED are highly integrative
disorders of sensing and perception and brain function, of attachment,
trust, and of relationship… with food, self and others…the latter
pointing to the importance of how we, as practitioners, use ourselves
personally and interpersonally, to treat them.
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Marked by compulsions, excess and lack of control around food and
eating, these same characteristics invariably seep over into other life
spheres as well, interfering with all modes of self-care and
self-regulation.
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Highly skilled clinicians need to be open to an integrative treatment
perspective (modes, methods and milieus) in response to an integrative
disorder; and to using oneself with mindful versatility, intention and
courage, particularly in the face of counter transference issues.
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In ED recovery, the means to the end or the journey itself, is as
important as the destination.
What the recovering anorexic “recovers,” aside from lost weight, happens
through the
process of learning to
re-feed and care for oneself , to assume self-determination,
self-regulation, self-trust, and self-esteem. It is through the
treatment relationship and cognitive behavioral learning that emotional
flexibility, sound coping and problem-solving accrue, leading to a
reintegration of the core self exiled through illness.
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Keep expectations for recovery changes realistic; the process of
achieving recovery feels worse before it feels better, and sometimes the
best learning is camouflaged in behaviors that may at first appear to
represent failures.
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The only real and sustainable recovery is a complete recovery.
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When a clinician and client sit down together face to face, he or she
needs to become aware of the presence of three separate entities; you,
the client, and the eating disorder. All must be respected, addressed
and managed.
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When the individual ED client walks through your door, it is safe to
anticipate that effective treatment will address a virtual "crowd,"
including families and loved ones, members of the professional team
inpatient as well as outpatient, the school, etc.
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Doing What
Works: An Integrative System for the Treatment of Eating Disorders from
Diagnosis to Recovery by Abigail
Natenshon is a robust and comprehensive resource for all members of the
treatment team. Natenshon teaches courses online; See
www.empoweredparents.com for details.
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There is hardly a more fulfilling specialty. Nothing is more gratifying
than creating hope where none exists, where recovered clients declare
that they have "their life back" or that they are now "the very best
self they can be."
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