Telehealth in therapy is here to stay. The abrupt transition to remote treatment in eating disorder work during the pandemic was noteworthy. There won’t be a return to mostly in person appointments. That ship has sailed. We all—clinicians and patients—have agreed to this new method of treatment.
It’s clear what has been gained from telehealth: increased access, convenience and new programs for in home treatment.
The practical considerations of treatment work well remotely. Monitoring food, cognitive tools to combat eating disorder thoughts and even group sessions for people with similar recovery experiences are all effective in this new modality.
However, another equally important question, one that few people are asking, is what have we lost?
Eating disorders require secrecy, isolation and obfuscation to remain powerful in a person’s life. These behaviors aren’t nefarious. In order to stay sick, people with eating disorders need to hide what they are regularly doing. Remote treatment can’t address the secrecy easily.
The screen provides an easy means for people with eating disorders to hide. They can hide their bodies. They can hide their thoughts and feelings. They can hide their behaviors. They can hide their true selves and create enough of a persona to slide by unnoticed.
And that’s what people with eating disorders find themselves doing. They remain unseen in the world and feel safe and protected. The thoughts and behaviors that structure their lives stay omnipresent, and the remote work means no one can ever really spend time with them, can fully see them.
I am an advocate for at least some in person sessions, especially with a therapist. Telehealth will work to a point. Symptoms will improve, but the fundamental emotional and psychological work will lag unless the therapy relationship has an in person component.
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