Choosing a Therapist

The relationship between therapist and patient is the foundation of any successful eating disorder treatment.  All of the anxiety, fear, anger and hope reside in that relationship. No treatment can move forward without a therapeutic bond that works. There is so much weight on the choice of the therapist but how does a patient know she has found the right one?  There are no directions, there is no checklist, no magic wand that confirms this is the one. The only guide is the almost mystical idea of a good "fit" between therapist and patient.  To make it even harder, an eating disorder makes someone doubt everything about herself, yet choosing the right therapist is based on trusting oneself. So the best advice is to ignore the eating disorder and trust your instincts.

No wonder this decision is so daunting.

Here are five important clues a patient can identify even after one session. These clues will help guide a patient in the right direction and are closely related to traits important in an eating disorder therapist.

The best place to start is to ask a few questions right after the  first session.  Did the therapist really listen and try to understand? Did the therapist think she knew everything already? Did the session feel like an awkward and forced exchange or a real conversation between two people?  In other words, the patient should feel like she just had a good conversation, not a psychological evaluation.

The next question to ask is how knowledgeable and experienced the therapist seems to be.  It is worth asking about the therapist's training and experience treating people with eating disorders. This information is important but far from enough. The best gauge is to ask for a treatment plan. Both the answer and the way the answer is given are important. The treatment needs to be specific and include members of the treatment team, goals for how to handle food, reduction in symptoms and the expected time frame to see results. The answer should come easily and naturally: the patient needs to feel the therapist can handle the treatment and has successfully treated patients before.

Eating disorder treatment demands flexibility. As a patient starts to get better, the therapy will need to change considerably by providing different types of support through different stages of treatment. There are many small but critical variables in an initial session such as where to sit, how to pay and how often to meet. Negotiating each seemingly minor issue is a clue. The easier each step felt, the more likely the therapist is flexible.  Using this flexibility will indicate if the therapy can become a true collaboration. The therapist knows how to treat people with eating disorders and the patient knows herself. This foundation of mutual respect and a flexible relationship starts right in the first session. If it is not there, it is very unlikely to develop.

This relationship will be a very important part of a patient's life. She will spend a lot of time with the therapist and invest time, energy and money so it is important to assess the therapist as a person too. Did you like the therapist?  Is this someone you want to get to know?  Could you trust this person?  A first appointment can be so stressful that a patient might ignore her own instincts. It's okay to put these thoughts together later and not know right away.

Invariably during a first session, a patient asks me if I think she can really get better. Struggling with an eating disorder day after day leads to feeling trapped and hopeless. After all, people who don't understand often say no one should feel so confounded by food! Eating disorders are much more complex, but our society floods us with simple ways of handling food and only makes someone with an eating disorder feel more hopeless. Coming out of a first session, a patient needs to feel hope again. She needs to believe her life can really change.

These five attributes--a therapist who is real, knowledgeable, flexible, likeable and hopeful--are a place to start in choosing the right person. It is better to plan to pay attention ahead of time: write these questions down and check the list right afterwards. Once the therapist is in place, often the next big question is treatment with  psychiatric medications: whether to use them, what they do and will they work.  Look for the next post.

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