NEDIC staff with assistance from Wendi Rockert, M.Ed.
How do you choose a therapist? What should you expect from therapy?
One of the most important steps towards recovering from anorexia nervosa or bulimia nervosa is recognizing that you need and want help. Often, individuals who suffer from eating disorders are ambivalent about seeking treatment. Many are terrified about the possibility of weight gain; others may feel confused about giving up patterns of behaviour, which have for so long been a major part of how they see themselves. Some have struggled in secret for years and are uncomfortable talking about personal issues or are embarrassed about their symptoms. And, unfortunately for many, the belief that their difficulties will somehow magically improve prevents individuals in real distress from having the opportunity to feel better about themselves.
Once you decide that you want treatment, how do you go about finding help? Aside from the National Eating Disorder Information Centre, there are other organizations that provide referrals to appropriate therapists: women’s referral centres, Canadian Mental Health Associations, your family doctor, and community service organizations.
Ideally, a therapist will have experience treating eating disorders; however, in many parts of the country this may not be possible. It is important to ask a prospective therapist about their background in treating eating disorders. The therapist should be willing to tell you about the kind of approach they use and to provide a rationale for treating eating disorders with this approach. Regardless of whether or not the therapist is a specialist in this area, they should be willing to explore your feelings and attitudes about your weight and shape. These are important issues for individuals with eating disorders and need to be addressed in treatment. Some therapists may not suggest strategies for changing your eating patterns and it may be extremely difficult to learn to eat normally on your own after years of chaotic eating. In this case, it may be a good idea to consult a nutritionist who could recommend a non-dieting meal plan and help correct any misconceptions about food.
While medication can help an individual get over a tough period, antidepressants should generally not be the first treatment prescribed, nor should they be a replacement for dealing with underlying issues.
In choosing a therapist, it is important to consider how well you will be able to work with this person. It is often advisable to set up consultations with a few different therapists to help you to select the one who you feel most comfortable with. Do you trust the therapist; do you feel that you are working together toward common goals; can you talk about the issues that are most important to you? One of the ingredients of successful therapy is establishing a good rapport with your therapist. Even if the therapist has an established background in treating eating disorders, you may not derive as much benefit if you are not at ease talking with the therapist.
Therapists vary in terms of their professional training and this may determine whether fees are charged for treatment. Psychiatrists are medical doctors and are the only therapists covered by Ontario’s public health insurance. This may not be the case in other provinces. Psychologists are partially covered by some private medical insurance plans such as Blue Cross. The issue of fees should be discussed during your first contact with a therapist. You may need to think about how you are feeling about yourself and to measure this against whatever financial arrangements would be necessary to receive treatment.
It is vital to recognize that recovery takes time and there may be periods where it is difficult to notice any progress. Some individuals expect recovery to involve consistent weekly progress. It is usually a “bumpy road” which involves progress punctuated by setbacks and frustrations. For progress to occur, both eating and psychological symptoms should improve over time.
Some things to look for include: have the episodes of binge eating decreased; have you been able to incorporate any new foods into your daily meal plan; are you less rigid about some of the rules you may have about eating; are you feeling any better about yourself; has your weight changed; if it has, how have you been dealing with this? It may have taken years for the eating disorder to develop. Although some of the symptoms may improve quite early, increased feelings of self-worth and greater trust in one’s judgments occur only over time.
Giving up restrictive eating, or learning to eat normally is necessary for recovery. This is often the most difficult obstacle to face because of the tremendous fear of weight gain. Many individuals with an eating disorder have no idea what “normal eating” is and it is common for them to have lost their ability to determine hunger and fullness. Research has shown it is important to deal with food and weight issues at the beginning of treatment and for the client to begin to normalize eating. Unless this is done, the individual with anorexia or bulimia will still be suffering from certain effects of starvation (depression, anxiety, irritability, obsession with food), which hamper the therapeutic process.
Recovery can be frightening, particularly when it means identifying and addressing underlying issues. You are in therapy so the therapist can help you deal with these issues.
The reality is, there are too few therapists specializing in eating disorders who are covered by the various provincial health insurance plans. If you have difficulty finding someone who is covered under the provincial health plan, paying fees for the help that you want may be worth considering.
Giving up your “identity” as an anorexic or bulimic can be an obstacle. Remember, you won’t have the opportunity to develop a more positive identity as long as you are struggling with your eating disorder.
© NEDIC 1987; reviewed 2015 www.nedic.ca