ED Informed Therapist Guide

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As a therapist who is trained in treating people with disordered eating, I have noticed a distinction in the field between therapists who specialize in eating disorders and therapists who don’t, and in that distinction there are differences in knowledge shared. For example, almost all ED therapists make sure to say they are Intuitive Eating and Health at Every Size practitioners, but “non ED” therapists might not even know what those words mean.

I believe that just as we help our clients more effectively if we are trauma informed, we can also be more effective if we are all eating disorder informed. Everyone has a relationship with food and their body. Very often people develop patterns that harm them, but aren’t always sure how or when to talk about it. It’s our job to open that door if needed. Even further, the way we screen for addiction, we should also be screening for eating disorders. Just as substances could change your treatment trajectory, so could eating patterns. Here are some basic guidelines for disordered eating informed clinicians:

Be mindful of the way the way you:

Talk about food. People who are prone to focusing on food and body are often also prone to comparing food and body to others. Limit this comparison by limiting your discussion of food. Catch yourself when you are making any sort of judgement on food or food choices, and consider exploring your own food beliefs and where they come from.

Recommend exercise. Just about every list of coping skills includes some form of exercise, which is helpful for some people and very unhelpful for others. Talk through this with your client and ask questions about their exercise patterns. The goal here is “joyful movement”--movement that is enjoyable and not punishing or full of control. Also, exercise is not the only thing we might need when feeling low or depressed. Explore other options if a client’s only coping skill is exercise. We need variety in coping skills!

Refer out. Know your limits when treating a client. If you find yourself constantly avoiding a client’s disordered eating patterns, it might be a signal that it’s time to refer out. Also, know when it’s time to refer to a higher level of care to effectively treat a client’s eating disorder. American Psychological Association has a very helpful guide for finding the right level of care.

For the love of all things good:

Don’t talk about your diet. We have enough people promoting diet culture in our society, and diet culture doesn’t belong in a therapy room! No judgement if you’re dieting, just please don’t talk about it with your clients.

Don’t compliment weight loss. If you compliment a client’s weight loss (or anyone’s for that matter), you might be reinforcing damaging behavior. You could also be sending the message that you value their smaller size more than their previous body, when really your care and positive regard for them didn’t change at all. Compliment something more interesting, like their bravery, vulnerability, or openness to the process of therapy.

Don’t prescribe diet changes. We are mental health professionals, not medically trained dietitians. Stay in your scope and refer to people who are licensed to advise people regarding food intake. Also, if you recommend weight loss, the covert message here is “You’d be happier if you looked different.” Ouch...don’t do it.

Don’t refer to people who promote, promise, or prescribe weight loss. Diet culture delivers the message that “if you just do what they say, you will lose weight.” Weight loss diets are generally not sustainable, yet they blame the individual when it fails. In other words, they set the individual up to fail, then shame them when it inevitably doesn’t work (just like every other diet they’ve tried). Avoid more shame by not referring to people that promise or promote weight loss. There are LOTS of amazing non-diet dietitians ready to walk with their clients on their journey to a healthier relationship with food.

Recommendations:

Ask lots of questions. Don’t make assumptions about your client. Ask questions and ask more questions when you’re first getting to know each other. This is part of good assessment--if you find yourself making assumptions, check it out with the client. If a client informs you about disordered eating, take the time to understand what it looks like for them. No two people with eating disorders are the same.

Explore your own relationship with food and body. We are all human and we all have bodies! Explore your own body image and food patterns, and seek therapy if you need some extra support in this journey. When you can own your own biases, you are even more prepared to help your clients.

Do your research. This doesn’t have to mean you specialize in disordered eating, but it does help you support all of your caseload. If you find a new interest in disordered eating, that’s just a bonus! Check out the books Intuitive Eating and Health at Every Size. Take some time to browse NEDA’s website (https://www.nationaleatingdisorders.org/) to learn all the things about eating disorders. If you’re doing research on-the-go, there are podcasts focused on intuitive eating, as well.