The Triumph and Failure of Teletherapy for People with Eating Disorders

Virtual sessions, a growing trend in mental health treatment, has become the norm and frequently the only option for the past eighteen months. Video sessions had been a new direction gradually being tested and used in various settings, but the pandemic made them compulsory.

I had used virtual sessions for many years but only with long-standing patients and as part of an ongoing therapeutic relationship previously established in person. Seeing people exclusively on video was an entirely new endeavor.

Virtual treatment for eating disorders poses very specific issues not found when treating other psychiatric problems. First, for patients just starting treatment, it is much easier to hide symptoms and particularly shameful issues around their eating disorder. Second, working in person feels much more exposing for someone learning how to face the deeper shame connected with an eating disorder. And third, being in the same room with someone allows for a much more personal conversation about food, the most intimate topic anyone with an eating disorder can discuss.

However, video does have a couple of benefits, namely convenience, which makes it easier for some people to have an initial appointment, and safety since they will already be home after talking about an emotional issue and not have to navigate their way in public.

But the pandemic did not allow a gradual process to evaluate and improve teletherapy. Instead, clinicians and treatment programs dove in and found themselves often not ready or able to adapt.

The end result is decreased effectiveness of care. With the increased incidence of eating disorders and relapses during the pandemic, many people have remained ill with limited opportunity for treatment.

Since virtual therapy is so convenient, many therapists gave up their office space and some have no plans to return to in person treatment any time soon. If convenience begins to trump efficacy, eating disorder treatment may suffer further.

Two things need to happen. First there needs to be more data showing the effectiveness, or lack thereof, of virtual therapy. Second, clinicians and programs need to learn how to adapt virtual treatment in ways that improve overall care. Although the treatment continues to adapt on the fly, that slow improvement may not be enough to stem the tide of illness.

In the absence of in person treatment and due to the long waitlists for treatment programs, for many patients, especially those newly diagnosed, social media became an even more important part of the eating disorder treatment world during the pandemic. That will be the topic of the next post.