Choosing a Therapist￼
“I’m scared to change. I’m afraid I’ll fail. I’m afraid I’ll succeed.” – Terry L., age 18
Changing something that’s familiar to you, even if that “something” is harmful, can be difficult to do. When that “something” is an eating disorder, the motivation to change can be further complicated by your history, especially if you’ve previously tried and failed to overcome your problem or have spent a lot of time denying that the problem even existed. You may have little hope that you’ll succeed this time and assume that you’ll always be “stuck” in your current patterns. You might be skeptical about therapy and therapists. It’s only logical, then, that you’d hesitate to ask for, much less accept, assistance. Instead, if you’ve been through this before, try to “reframe” your present situation in positive, proactive terms. Whether you’re having a temporary lapse in recovery or a more severe, prolonged relapse, think of the flare-up as a wake-up call that you need additional help to renew your commitment to life without an eating disorder.
If you’re starting this process of recovery for the first time, your initial challenge may be to admit that your problem won’t go away by denying it exists. In fact, the opposite usually happens: the added strains of secrecy and lying make the situation worse. What will make it go away is your willingness to face up to reality and to work hard on your recovery. In either case, it takes a lot of courage to decide to face up to an adversary as tough as an eating disorder and then let a group of virtual strangers help you redirect your efforts and energies toward recovery. But you can do it.
How to Find the Help You Need and Want
Once you decide you’re willing to try therapy, the next step is to find the right kind of help. If you’re a teenager or young adult, your parents or guardians will help you do this. They’ve probably made most decisions about your health care, to date, and it’s possible you’ve never before had a voice in this process. But this is one time where your input is both desirable and important. How do you begin? What are your options?
1. Find a qualified therapist who has special training in working with anorexics and bulimics.
The Academy for Eating Disorders (AED) (703/556-9222; www.aedweb.org) and the International Association for Eating Disorder Professionals (IAEDP) (877/540-5691; www.iaedp.com) maintain memberships lists of qualified therapists. Both of these organizations have stringent requirements for professional training before they will allow health care professionals to become members. (This doesn’t mean the therapists who aren’t members of either group are untrained or unprofessional. It may just mean that they have not applied for membership or haven’t yet fulfilled all the continuing education and training requirements for membership.) The AED also publishes an annual directory of health care professionals with information about each member’s practice (the geographic location of the office, if they work with children and adolescents or adults, if they do individual, family, or group therapy, how to make contact by phone, fax, or email). A number of other directories also exist online at websites such as the Eating Disorders Referral Center (www.edreferral.com), Something Fishy (www.something-fishy.org) and Pale Reflections (www.pale-reflections.com). In addition, most hospitals with inpatient eating disorder units as well as other independent eating disorder treatment facilities list their staff members as part of their website information.
2. Shop around.
Since finding the right therapist is such an important part of recovery, call and/or interview as many people or places as you need or want to before making your decision. This is a common practice which is expected by most therapists. A family member might help you do the ground-work, but the more you’re involved in this process, the greater will be your commitment to therapy. In a way, this is similar to beginning a class in school that you’re initially hesitant about. Maybe you’re afraid you’ll be bored or worried it will be too hard. If you sit in the back of the room, never answer questions, rarely participate in discussions, then those negative expectations will probably come true. But if you sit up front, raise your hand a lot, and get involved in activities, you might like the class so much that you want to come back to the next session.
3. Make a “shopping list” of the qualities of the professional “helper” or “helpers” with whom you see yourself succeeding.
Answer the following questions:
*Does the gender of the doctor or therapist matter to you? Why? If you are a girl, would you prefer a female practitioner? If you are a boy, would you prefer a male doctor or therapist? What are the reasons for your preference? Have you had a particularly good or bad experience with a same-sex or opposite-sex health care provider in the past that has caused you to feel this way?
*Would the age of the doctor or therapist alter your willingness to work with this person? Why? For instance, could you discuss your problems more openly with a young therapist because you’d feel more in sync? Do you think you’d have more confidence in someone older who had more professional experience? Is your reasoning based on actual past experiences with older versus younger teachers or doctors? Is your reasoning based on gut feeling?
*Does the therapist’s style of working with patients matter to you? Do you feel so overwhelmed at this moment that you think you’d prefer a directive, authoritative therapist with a clear-cut approach? Or would you like someone with a more flexible approach? Are you looking for someone who is willing to give you all the time you need to tell your story and explore your problems? Or do you want to work with someone who will dive right in and try to get things resolved quickly?
*Would you be willing to be seen by a health care provider who had worked with and was recommended by one of your friends or relatives, or would you prefer going to someone unknown by anyone else in your network of relationships? Why? Some people find that knowing about a therapist’s personality and reputation from the firsthand experience of a friend or relative eases the tension of initial visits and makes the thought of therapy a bit less unnerving. What qualities match the items on your own “therapist shopping list”? On the other hand, you might be concerned about privacy and confidentiality, and feel threatened by the thought that someone else who knows you also knows your therapist. Perhaps you’re concerned that you won’t be able to speak openly and honestly with a therapist who has a connection to your family or peers.
*Is there a chance that the location of the office might affect your willingness to work with the doctor or therapist? As odd as this question might seem, many people are put off by the location of some offices. This is often the case when appointments take place in hospital-based offices, because some people find hospitals to be intimidating. Perhaps the location is hard to get to: maybe it isn’t within walking distance from home, school, a bus or subway stop, or is so far from home that driving there and back takes a long time. Lots of people get sloppy about keeping appointments if getting to them is such an effort that the payoffs don’t seem to outweigh the inconvenience involved. Think about this ahead of time so that the office’s location won’t turn into your excuse to avoid or stop therapy after you’ve begun.
4. Make a list of anything you would want to ask a therapist.
Here are some questions I’m frequently asked by prospective clients.
* What is your educational background?
* How long have you been a therapist?
* How and why did you become an eating disorder therapist?
* Do you or did you have an eating disorder?
* Are you a licensed professional?
* What is your preferred treatment approach?
* How much does a session cost?
* Do you accept insurance?
* Do you have a sliding fee scale if I don’t have insurance that will cover your services?
* Do you prescribe medications? How do you decide what medications to prescribe?
* Will you work with me alone and have my family work with another therapist, or will we all work with the same therapist or therapy team?
* Do you offer group therapy?
* How often would we meet? How do you decide how many times we will meet?
* Can I contact you between our scheduled sessions if I need to? Will those interactions be confidential?
* Can I communicate with you by email? Will those emails be confidential?
* What will you do if I disagree with your suggestions during therapy?
* How long will it take me to know you’re the right therapist for me?
* What if you and I don’t click? Can you refer me to someone else? Will you be angry with me?
* Can I be forced into treatment against my will?Any concern you have is valid; it’s better to ask too many questions than too few.
When Negotiation Isn’t an Option
The last question in the above list, “Can I be forced into treatment against my will?” is a very common fear of people who struggle with eating disorders. The answer to it is “Yes,” if your eating disorder is so far advanced that your life is currently in danger.
In such a case, your preferences may have to be overridden by the choices that others must make, on your behalf and in your best interest, to save your life. You won’t have a chance, then, to negotiate and choose a particular style of therapist or treatment situation. You may find yourself in an emergency room at a hospital, or on one of the inpatient facilities discussed in Chapter 8. Until your health has stabilized to a point at which life or death is not the overwhelming and overriding concern, don’t expect to negotiate about anything, much less your ideal therapy situation.
How to Improve the Odds for Success
Once you’ve thought about the therapy environment in which you see yourself succeeding, and the style of therapist you’d like to spend such intense moments with, you may be more ready to talk about this with your parents, guardian, or any other appropriate person. Comparing your preferences with those of your family members should result in a win-win situation for everybody, even if it involves some compromise between what you want and what your family thinks you need. Whatever therapy situation you eventually end up in, give yourself credit for being actively involved in the selection process, approaching things logically, stating your needs and wants, and accepting the challenges of recovery.
Whomever you choose to work with, you must be honest and accurately represent your problem.
It’s especially crucial that you tell them about any and all physical problems along with the emotional issues that are bothering you. For example, if your parotid glands are swollen because you’ve been vomiting, admit it and don’t pretend you’ve just had a bout of the flu. If your menstrual periods have stopped, don’t say that they’re irregular. If your gums and teeth are affected by bulimic vomiting, don’t blame the problems on too much candy as a child, or poor heredity.
No therapist is a mind reader. If you don’t speak candidly, he/she might not ask you about the issues or situations that you feel are problematic and important to discuss. Worse, the therapist may diagnose and want to treat you first for something other than an eating disorder because you’ve been dishonest about your signs, symptoms, concerns, etc.
A New Base of Competence
By doing all this thinking and preplanning, you’ve effectively changed the focus of your life from problems to solutions, from negatives to positives. You’ve made a commitment to therapy and taken the first steps. You’re now at a potential transition point in your relationship with family and friends; you’ve confronted yourself and your eating disorder; you’ve admitted the need for help and taken the steps to find it; you’ve shown your strength and guts, and your willingness to grow. You’ve proven that you can be assertive and self-aware; your words and actions show that you can be capable, rational, and assume appropriate control of some aspects of your life. You are building a foundation of competence-success breeds success, and confidence comes with competence. Competence is a powerful word that implies readiness, skill, ability, fitness, and proficiency. From this stage of recovery on, others will continue to believe in and respect your competence as long as you remain well-informed and honest about the changes that are happening in your life. Familiarizing yourself with the clinical definitions of anorexia and bulimia that you will find in the Appendix of this book might make it easier for you to discuss your symptoms with your therapist. Take your responses to the EAT-26 (in Chapter 4 on anorexia) or your answers to the statements about bulimic behaviors (in Chapter 5 on bulimia) with you to your initial therapy sessions. Also, bring your written responses to any of the exercises throughout this book. The more concrete, current data you share about yourself, the more raw material your therapist will have to work with.
Ten Things to Remember About Finding a Therapist
1. Your input in finding a therapist is a desirable and important element in the selection process.
2. If possible, find a therapist who has special training in eating disorders.
3. List what you think would make your therapy experience successful, including characteristics of the type of place and kind of person you imagine helping you.
4. Take the time to compare and contrast your preferences with those of your parents or guardian, and see what kinds of compromises can be reached so you all feel confident.
5. Write out a list of questions you want a therapist to answer to help you and your parents decide.
6. It’s okay to talk with several therapists before making the final decision about whom you will hire to work with you.
7. If your health is in grave danger, your choices and preferences may have to be overridden by immediate choices others must make to save your life.
8. No therapist is a mind reader. Once you make the commitment to therapy, it’s crucial that you’re honest and describe your physical and emotional issues with as much accuracy as possible.
9. Choosing a therapist is an unmistakable signal to family and friends that you have the courage, strength, and willingness to challenge and change your eating-disordered ways.
10. Your willingness to learn and share about your self and your disorder with your therapist will greatly increase your feelings of competence and confidence.
Reprinted with permission from The Beginner’s Guide to Eating Disorder Recovery
By Nancy Kolodny, MSW, LCSW
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