Is Your Therapist an Eating Disorder Specialist? Five Questions to Help You Find Out.

“But you don’t look like you have eating disorder.”

“Just count calories to make sure you’re getting enough and try to get plenty of exercise - it will boost your mood.”

“Your weight is fine, it’s really not that big of a deal.”

“I wish I had that kind of willpower to skip a few meals.” {insert patting belly here}

These are just a few of the comments made by well-meaning but uninformed clinicians we’ve heard from our incredibly resilient clients over the years. There are so many more examples that make us cringe at best and break our hearts at worst.

You’ve heard us say it before and we’ll say it again: not every therapist is a good fit for every client. We all have different personalities, different styles and different specialties - and eating disorders are SUCH a specialty. Therapists with the best intentions can do more harm than good working outside their training and expertise.

So how the heck do you know who to see when reaching out for help already feels so vulnerable? ASK QUESTIONS! The right therapist will welcome your questions and have answers that put you at ease and show their competence in what you’re struggling with. This is your time and your recovery that you’re investing in - it’s worth it to take a few extra steps to make sure you’re partnering with a therapist you click with AND who has the experience to back it up.

Here’s a few great questions to ask as a place to start:

1.     What evidence-based practices are you trained in to treat eating disorders? How do you incorporate those into sessions with clients?

You want a counselor who has SPECIFIC answers with the training to back it up. Family Based Treatment/Maudsley for teens, empowering parents as part of the treatment team. RO-DBT to help clients challenge perfectionism and rigidity. ERP to overcome food rules and body image avoidance. ACT to learn to tolerate uncomfortable emotions that surface without the numbness of the eating disorder. DBT for distress tolerance. CPT or EMDR to address underlying trauma.

 CBT alone isn’t going to cut it. Intuitive eating is awesome but absolutely not appropriate for someone who needs to weight restore or is deep in a restriction mindset. Reading a book or taking one workshop isn’t enough. Look for a commitment to continued education, consultation, and lots of experience.

2.     How long have you been working with eating disorders? What percentage of your caseload is made up of clients with eating disorders?

Eating disorders are a specialty. Someone who’s caseload is 10% individuals with eating disorders probably isn’t a specialist. If you’re talking to a graduate-level intern or a newly licensed therapist, ask about their supervisor and their training. They might be newer in the field but completed hundreds of hours of training with a supervisor who has years of experience with a caseload that is 90% food and body image concerns. You’ll never know if you don’t ask. 

3.     Do you ever encourage dieting, calorie counting, or weight loss? Do you work from a Health At Every Size perspective? How do you help clients implement intuitive eating?

If you see a counselor who says they specialize in weight loss or obesity, RUN! A counselor who truly works from a HAES perspective will not encourage dieting, calorie counting, or weight loss as a goal. Instead, they will help you understand what’s at the root of your relationship with food and your body, find new ways to cope, and focus on cultivating self-compassion and body respect.

Look for a counselor who recognizes the different approaches needed depending on what your particular struggles with food are. If you need to weight restore or have been engaging in significant restriction or bingeing and purging, intuitive eating is not the right approach right off the bat. The structure of a meal plan is necessary to help your hunger/fullness cues heal (think of it like a cast on a broken arm). Have a teen with an eating disorder? Look for a counselor who works WITH you as a vital part of your child’s recovery. Struggling with overeating or are in active recovery? Intuitive and mindful eating is the best direction to go. You want a counselor who understands these nuances.

4.     Do you collaborate and take a treatment team approach (dietitians, psychiatrists, local treatment centers, etc.)?

Eating disorder treatment takes a multidisciplinary approach. Ask who this counselor’s referral resources are and what their relationship is like with local treatment providers. Look for someone who can rattle off a long list of dietitians, psychiatrists, pediatricians, school counselors, PCPs, and higher levels of care. You want to work with someone who is committed to helping you create a treatment team approach and who will coordinate to make sure each aspect of your recovery is being addressed.

5.     Do you believe in full recovery?

Fully recovery IS possible. Working with a counselor who doesn’t believe in full recovery will limit how far you can go and the freedom you can experience. And you deserve to experience full freedom.

Questions about eating disorder-specialized counseling? This is exactly what we’re here for. All of our counselors are extensively trained in eating disorder treatment. We are committed to consistent consultation and continuing education. We adore our community referrals (shout out to Crossroads Nutrition Therapy and MSU’s Eating Disorder Treatment Team!) and work with them closely. We’re here for you. Reach out today: rootedcounselingmi.com.