I recently received an email from the mother of an 11-year-old child which spoke poignantly to the needs of parents seeking expert professional care for their child. Recognizing the pressing nature of her venture, this mother was painfully aware that she had no idea about what to look for, or how to identify the qualities of a truly expert practitioner. She wrote:

“My problem is that we live in Tokyo in Japan and I am unsure of how to find a professional who can help us. If we choose just any psychiatrist or psychologist, I am afraid that they may make the problem worse if they are not experienced in eating disorders. Do you have any advice which you could give me as to how to find help?”

Though parents can feel wholly confident putting their child in the hands of highly trained mental health generalists for other conditions, the treatment of eating disorders requires uniquely skilled and knowledgeable professionals. Eating disorders are complex, diverse, and multi-faceted diseases, affecting every aspect of personality and life function, including emotions and behaviors, cognition and mood, nutrition and physiology, relationships and self-image. Treatment leaves little margin for error; if not dealt with in a timely and effective manner, these diseases are debilitating and can be fatal. When treated properly, full recovery can be anticipated in 80 percent of cases.

The Therapist’s Treatment Style

Expert care-givers need to be eclectic and versatile in what they know and how they use themselves in approaching treatment for an eating disorder. Within the course of treatment, effective eating disorder practitioners will show themselves to be:

·    “Big picture” thinkers, with the capacity to hold fast to the vision of a far reaching recovery even as they systematically attend to the small details of ongoing treatment.

·        Integrationists with a firm grasp on the wider implications of disease, and functioning as part of a multi-disciplinary team of professionals, practitioners need broad-based diagnostic acumen, diverse practice skills, and the capacity and willingness to access varied treatment support resources.

·        Activists, urging parents and families to participate in treatment, educating clients, and shepherding the healing process forward.

·     Bottom-liners, outcome-driven, expecting and demanding that the recovery progress keeps up with the pace of a disease that is perpetually on the move. (If the patient is not getting better, you can be assured she is getting worse.)

·       Loving caretakers, unafraid to use themselves creatively and openly as strong connectors, building self-esteem and inspiring the motivation to heal.

The Initial Telephone Inquiry

Once a parent has recognized a problem and confronted the child, the next challenge is to find a practitioner who can effectively connect with child and family, and direct the recovery process. The best referrals will come from people you know…friends, your child’s pediatrician, school counselors, or from national eating disorder organizations such as NEDA or ANAD. In assessing the qualifications of potential therapists, the knowledgeable parent needs to be prepared to conduct an informal telephone interview. Your child’s practitioner should be willing to engage with you on the phone to answer your questions, thereby beginning the education process. This first meaningful interchange should reveal elements of the therapist’s personality, treatment approach, and willingness to be forthcoming, inclusive, and educative.

The phone conversation might begin with the question, “Is this a good time for me to ask you a few questions?” If not, make arrangements to call back at a more convenient time. Don’t hesitate to ask about his or her professional background and experience in treating eating disorders; in many cases, their experience and reputation will precede them.  Notice whether the clinician is listening closely to you. The best therapists have a way of listening with a “third” ear, of providing answers not only to the questions you ask, but also to those that you may not yet have the words or knowledge to formulate. The therapist should give you the sense that by becoming your ally, he or she is becoming your child’s recovery advocate.  Expert caregivers will be knowledgeable and educative, caring and forthcoming, imparting knowledge, offering a sense of where you and your child are in the disease and recovery processes, and of what needs to happen next, laying out alternatives for care provision.

The following are questions that might guide your inquiry:

·         Ask about the benefits of outpatient therapy versus treatment in a hospital or day program.

·         Inquire about the therapist’s treatment style or philosophy and then listen for such words as eclectic, cognitive-behavioral, psychodynamic, relationship-oriented, and family-systems based. Does this person have a philosophy of eating disorder treatment that focuses on both the dysfunctional behaviors and the emotions driving them?

·         Does this person offer pointers about what to say to your child, and how to say it, to express your concerns and convince your child to accept professional care?

·         Does this person recognize medical issues that may be serious and require immediate attention or hospitalization?  Does this person suggest that your child be seen by a medical doctor for an evaluation as a first priority of care?

·         Does this person collaborate with skilled professionals as part of a treatment team? If not, the task of creating such a team may fall to you as the parent. Do you get the impression that you can count on this person for cooperation and guidance?

·         Does this person request that you procure the services of a nutritionist for your child, and possibly a psychopharmacologist where needed, as part of a multi-disciplinary approach to care?

·         Will you and your spouse be invited to join your child in family therapy, becoming mentors and advocates of the recovery process?

·         Does this person work with insurance companies?  Does he/she offer pointers about how to secure optimized insurance coverage and is he/she willing to intervene in your favor with insurance companies?  Does the person offer a sliding pay scale if needed?

·         Does this person reassure you that eating disorders are highly curable diseases if treated in a timely and effective fashion?

Your Child Needs You Now More Than Ever

Depending on your child’s age and the severity of his/her eating disorder, he or she is likely to be too ill and/or too young to make responsible decisions about self-care on her own.  Despite age or life stage, your child needs your assistance now more than ever. Don’t fall victim to the commonly held misconception that a parent’s appropriate intervention is synonymous with interference, or that your participation in family treatment violates your child’s independence, compromising confidentiality or privacy rights. If a therapist implies that generic therapy techniques are sufficient to heal an eating disorder, that parents are to blame for their child’s disease, or that parents should “butt out” of their child’s disease and recovery, hang up the phone and seek help elsewhere. Speaking in your child’s voice, threatening, intimidating, and resisting your efforts to become involved, the eating disorder…along with professionals who are inexperienced and not sufficiently knowledgeable…can easily throw you off track. Your educated and responsible responsiveness and sound judgment could save your child’s life.

In search of the multi-disciplinary team

As integrative diseases, eating disorders are most effectively addressed by an integrative, collaborative, multidisciplinary team of professionals. Depending on your child's needs, the outpatient eating disorder treatment team should include you and your child, as well as an individual and family therapist (who, in most cases, should be the same person), a nutritionist, a medical doctor and a medicating psychiatrist. School personnel and hospital staff may also be helpful additions to the team. The nature of participation of these various disciplines will vary from case to case and from stage to stage of treatment and recovery. Though certain disciplines may not be active at a particular point in treatment, this does not minimize their potential for influence and involvement later, should the need arise.

Parents and patients typically express concern that involving several professionals will be costly. In reality the team approach is so comprehensive and effective, it invariably proves to be the least time-consuming and most cost-effective form of treatment. A treatment team is more likely to get results, and to get them faster, more efficiently, and more sustainably.

In Seeking Effective Health Professionals…

Do not be taken in or misled by health professionals who:

• May not be familiar with the unique protocols of eating disorder treatment.
• Believe that parents are at fault.
• Believe that for ethical reasons, they cannot offer interested parents any kind of information about eating disorders, the child’s recovery efforts, or the parent’s role in facilitating recovery at home.
• Believe that a parent’s wish to become involved in family treatment indicates “enmeshment” within the family system.
• Believe that encouraging emotional distance is the preferred way to promote independent function and the capacity of the child to separate from family. Quite the contrary, bonding and connectedness are what allows the child to learn the essentials of autonomous survival first, before going off on his or her own.
• Do not understand the potentially positive impact the family system can have on the child’s recovery.
• Do not appreciate how eating disorder issues are generally shared by the family, how they effect family function, and are affected by changing family dynamics. Family therapy allows for the sharing of information without breaches in confidentiality; it fosters trust, open and direct communication, interpersonal well-being and problem-resolution. Change within the family system enables change in the afflicted child.
• May not be comfortable conceptualizing the individual child’s therapy in a “family systems framework” or be sufficiently skilled to involve the family in constructive ways. Families may be brought together for regular or occasional family therapy or information getting and sharing sessions. They may be educated through phone and face-to-face contacts as well.
• Do not envision treatment as a partnership among patient, professionals and parents.
• See parental inclusion as a threat to their professional relationship with the child.
• Who may pit the child against the parent, creating chasms and deepening rifts.

North American Serial Rights

Abigail Natenshon