By Abigail Natenshon MA, LCSW, GCFP  (North American Serial Rights)

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 problem has been recognized, the next challenge is to find a practitioner who can effectively connect with patient 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 addition, a reliable and internationally-based referral source is the Internet, through web sites such as www.EDReferral.com or www.Find-a-Therapist.com.  In assessing the qualifications of potential therapists, the knowledgeable patient needs to be prepared to conduct an informal telephone interview. Your 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 recognize medical issues that may be serious and require immediate attention or hospitalization?  Does this person suggest that you 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 yourself and possibly a psychopharmacologist where needed, as part of a multi-disciplinary approach to care?

·         Will parents and family be invited to partifcipate in treatment where appropriate and agreed upon as mentors for the recovery process?

·         Does the professional 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?

If a therapist implies that generic therapy techniques are sufficient to heal an eating disorder, or that these are not fully curable, hang up the phone and seek help elsewhere. Your educated and responsible responsiveness and sound judgment could save your  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.  The outpatient eating disorder treatment team should include patient and family where appropriate, 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 for young adults 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.

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.
• Do not appreciate how eating disorder issues are generally shared by the family, and understand the potentially positive impact an enlightened family system can have on the child’s recovery.
• Do not envision treatment as a partnership among patient, professionals and parents.
• Do not understand the importance of the integration of techniques and methodologies and milieus in the treatment of these disorders.
• Do not understand the importance of the trusting, sound and loving therapeutic relationship, enabling “tough-love” expectations, demands and limit-setting throughout the treatment process.