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Practitioners…. avoid these common pitfalls
- A person does not have to be thin or starving to be suffering from an eating disorder. In fact, many of the deaths from these disorders occur in people who are of normal weight, but whose purging has imbalanced body chemistries and electrolytes to the point where the functioning of vital organs is compromised.
- Don’t expect your client or patient to voluntarily reveal the existence of an eating disorder. He or she may not recognize the condition as a problem, or may feel committed to holding it as a closely held secret.
- A malnourished person cannot benefit from the psychotherapy process unless and until he or she has been re-fed. First things first. An evaluation by a medical doctor must be a first priority for any eating disordered patient who walks in the door.
- It is a mistake to assume that by simply treating the patient’s “other” (underlying emotional) issues, the pathological behavioral aspects of the eating disorder will eventually disappear. Eating disorders cannot be treated as you might treat other emotional or mental health problems. The treatment process is many faceted and based on a framework of combined attention to physiological, emotional, and family spheres simultaneously.
- If your approach to practicing psychotherapy has, to date, been purely non-directive, you need to rethink whether or not you are game to learn this new approach. The eating disorder therapist needs to use the self with an active, directive, though fully client-centered and self-determining therapy approach. The approach is reality-centered, cognitive-behavioral and psychodynamic, based on the dynamic here-and now process of the therapy relationship and of the moment. The eating disordered patient needs to be educated and informed; the eating disorder therapist needs to be the educator, guiding the patient purposefully and intentionally through the process of recovery. At the same time, the patient needs to be empowered to take on these skills that are first borrowed, then learned, as his or her own. The eating disorder practitioner functions as teacher, therapist, reality-tester, cheerleader, communication liaison and life coach.
- Don’t expect that the child patient who sees you for individual treatment is not a candidate for family treatment as well. Eating disorders are family diseases. Research has shown that family treatment for the young child living under the same roof with parents is the more effective approach than individual treatment. The psychotherapist’s orientation must be firmly rooted in family systems theory with a healthy respect for, and comfortability with, the need to treat the total family.
- The patient/therapist relationship must enjoy an inviolate sense of privacy, trust and protection. Maintain strict confidentiality and avoid the pitfall of privacy or confidentiality breaches by bringing family members together face to face to communicate first-hand in a family therapy milieu.
- Remember that the parents of your child or teenage patients are your patients too. Kids can’t beat this disease without the help of parents. Parents cannot be prepared to respond adequately to their child, the disease or the recovery process without the guidance of the child’s health professional. Professionals need to empower parents to fight for the child so the child can be free to battle the disease. The health professional who does not fully comprehend the effects of the family system on the disorder and the effects of the disorder on the family system can make matters worse.
- Remember that weight restoration does not indicate recovery, though it may be a sign that the process may have begun to take place in some aspects. Don’t fall into (or be dragged into) weight watching as a benchmark for recovery.
Psychotherapist Abigail H. Natenshon has specialized in the treatment of eating disorders with individuals, families, and groups for the past 34years. She is the author of When Your Child Has An Eating Disorder, A Step-by-Step Workbook For Parents And Other Caregivers, Jossey-Bass, 1999. Based on hundreds of successful outcomes, this book shepherds concerned parents step-by-step through the processes of eating disorder recognition, confronting the child, finding the most effective treatment for patient and family, and evaluating and insuring a timely recovery. A guide to eating disorder prevention, this book is useful to parents, health professionals and school personnel alike in countering the pervasive epidemic of unhealthy eating and body image concerns, and destructive media and peer influences. Her work can be reviewed further at www.empoweredparents.com and www.empoweredkidZ.com.
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