Eating Disorder Clinicians Guide: Listen to your Patients

In the early days of eating disorder treatment, the days when psychoanalysis and intensive psychotherapy still predominated mental health treatment, clinicians realized that eating disorders stemmed from a feeling of not being heard. The essence of any successful treatment started with listening to the patient. The eating disorder represented a nonverbal expression of some deeper feelings and fears that nobody would stop and pay attention.

Despite the explosion of cases in recent decades, the widespread dissemination of idealizing thinness, the takeover of treatment by private equity and the newest onslaught of GLP-1 medications to eradicate any fat in the world, the essential truth about eating disorder treatment has not changed.

Providers cling to measuring weight as a sign of health in eating disorders, reflexively recommend HLOC (higher level of care) despite the evidence that these programs seem to harm the majority of their patients and use the trope of the “eating disorder voice” to promulgate blame as the most powerful tool to cow and silence people with eating disorders.

None of these interventions involve listening.

There doesn’t seem to be much teaching or guidance for clinicians anymore to listen to their patients. People with eating disorders are still people with viable and important thoughts and feelings, values about the world and beliefs about what is more or less likely to help them. Given the limited options for care, patients often give up and understand there aren’t many places to seek help. Even a small window of hope that someone will listen in treatment inspires a desire to get well very quickly.

Eating disorders can come with many concomitant issues: traumatic events, medical issues as discussed here in recent posts or terrifying social pressures. These similarities don’t eliminate the differing needs between individuals. Each person wants to be heard in order to find a path towards getting well.

Expansion of care has been a boon for people with eating disorders. Not long ago, the lack of access to care was the biggest issue in treatment. Much of this expansion came with financial firms investing in programs for a profit, not for quality of care. The treatment philosophy can be just as cost effective if clinicians don’t follow an exact protocol but instead follow the patient, listen and help that person find a way to pursue their own goals and the life they want to live.

Granted, any treatment still needs to involve working on food plans and enabling the patient to get to a healthy place in their life. Physical health can accompany mental health when personal goals and desires are just as important as the number on the scale. Listening to people is the only way clinicians truly make a difference.