The standard of care for an eating disorder, if someone doesn’t need residential or hospital care, is to assemble a treatment team. This involves several components: a therapist, a dietitian, a primary care doctor, a psychiatrist (frequently but not always) and a set of other possible options such as meal support or group therapy.
This team covers all the bases and provides treatment for all different aspects of recovery. It’s almost dogma for clinicians to automatically suggest assembling a team and for many people doing so leads to progress.
However, there is a reflexive element to this process; as if the team itself somehow creates an illusion that recovery and wellness is easily within the grasp of all patients. The reality of eating disorder treatment consistently shows that not everyone gets well quickly and not everyone gets well.
This advice also serves another purpose: to insulate practitioners from responsibility if treatment doesn’t go as planned. Since the team approach is the standard of care for people with eating disorders, it’s easy for treatment providers to tell themselves they did their part. They were part of the team or recommended assembling a team. If the team didn’t help, tacitly blaming the patient is an easy option to fall back on.
For people early in their treatment, working with a team makes sense. Exposure to all types of eating disorder clinicians will help someone find what works best for them.
After this introductory period, individualized treatment is crucial. Continuing to suggest the exact same thing for someone who already has tried that path with limited benefit deserves more thoughtful care.
It is the responsibility of the clinician to think outside the box for different ideas to help. Relying solely on the standard care only shows a lack of creativity and frankly a lack of caring. Since eating disorder treatment is far from perfect, patients need to know all possible elements of treatment are on the table and that the people in their corner are doing everything they can to make a difference.
That is a thoughtful thought.
ReplyDeleteI would add... While assembling a team theoretically provides the best way to cover the bases, it also, as you say, leads to the possibility that not all bases will be covered. From the perspective of the sufferer, i would like to add:
That construct itself of shared responsibility can be so powerful and so dangerous.
If the patient feels like each person on the team cares "fully" and all members are working together for their greater benefit, it can be very powerful. On the flip side, even the fear that "they are relying on each other so they individually don't want to take responsibility" can put up sosmany roadblocks to progress. It also feeds into the eating disorder mindset of "they are out to get me" versus "we are in this together".
The bottom line is that sometimes the most important thing is that very real and genuine connection with the patient, and to whatever degree, part of that intrinsically has to be reaponsibility... And yes, yhat cancbe almost as scary for the "helper" as the one being helped.