“To Tell or Not to Tell, Therapists With a Personal History of Eating Disorders Part 2: Self-Disclosure Guidelines for Recovered Eating Disorder Practitioners”
By Carolyn Costin, MFT, FAED, CEDS and Alli Spotts-De Lazzer, LMFT, LPCC, CEDS
(This is the second of a 2-part series. Part 1 can be accessed by clicking here)
“The nature of an eating disorder strips away hope, making those suffering feel like they will never be free. Paired with this sense of impossibility, clients are often told that they will never fully recover both by people in their lives and professionals…Sharing stories of recovery and success (whether it is my own or simply that I have worked with many people who have indeed recovered) instills hope and belief. It provides hope and faith that recovery is possible until someone can believe it personally.” Respondent from group 1
The above quote is from a therapist who recovered from an eating disorder and has found that sharing her experience can be helpful in her work with eating disorder clients. Not all agree with her position; some believe that this kind of self-disclosure is inappropriate. The term “therapist self-disclosure” can conjure up images of therapists talking about themselves and their problems, becoming too personal with their clients, and crossing boundaries. Freud considered self-disclosure counterproductive because he felt it would distort the transference if patients had knowledge about their therapist. Therefore, self-disclosure was considered inappropriate in psychoanalytic theory. Over the years, feminist therapists, client-centered clinicians (e.g., humanist Carl Rogers), self-psychologists (e.g., Heinz Kohut) and others, brought forth different ways of being within the therapeutic relationship, and self-disclosure gained increased acceptance. Sharing some of who you are, as a person, became a way to help facilitate connection, collaboration, and a positive therapeutic alliance, which has been associated with a successful treatment outcome.
Self–disclosure is still controversial. The eating disorder field has been grappling with this issue, especially related to recovered clinicians disclosing their past eating disorder histories to their patients with eating disorders. Over the last few years, this topic has been the subject of increased discussion and debate amongst eating disorder professionals.
My experience of disclosing my past eating disorder to my clients is that it never occurred to me not to. From my first eating disorder client to now, it seemed right, humane, important, and even wrong not to share that I recovered from an eating disorder. I have experienced no disadvantages from clients regarding my disclosure, but rather endless advantages. Sharing about my own recovery helps me establish understanding, rapport and trust, reduces shame, and instills motivation and hope. I can provide empathy as a survivor of an eating disorder and can challenge clients as someone who once did not believe I could change my behaviors or ever get well. I have, on the other hand, experienced disadvantages from colleagues in the eating disorder field.
I have been told that:
- I should not share my history of an eating disorder.
- I should choose between being a recovered anorexic or being an eating disorder therapist.
- I think I am better than other therapists because I am recovered.
- People who have had an eating disorder have no business treating eating disorders.
- No one is ever really recovered, so I could not be.
I have been scrutinized:
Specifically, for over three decades, my food and weight have been the subject of scrutiny and comments from colleagues questioning my recovery status. Even though I am a normal weight and BMI, I have heard that I am too thin and that “people are thinking I might not be recovered.” At a conference where I passed on a chocolate dessert (I don’t like chocolate), I heard later that colleagues thought I was “restricting.” I have been denied speaking engagements due to the fact that I was openly recovered. I have also been rejected for a position in an eating disorder organization for the same reason. However, partly due to my being recovered, I have also been appreciated and sought-after by clients and their families, become a successful therapist and author, and have been catapulted to the limelight for the success of the eating disorder treatment centers I founded.
Over the years, things have changed. There are an increasing number of recovered clinicians in the eating disorder field reporting a personal history of an eating disorder. Many of these clinicians are self-disclosing their eating disorder pasts, speaking out, and helping to change perceptions. As we share in this article, colleagues in the field are beginning to indicate support of therapists self-disclosing a past eating disorder, as long as it is done thoughtfully, appropriately, and in the best interest of the client. To date, we know of no existing guidelines to help self-disclosing clinicians do just that.
In Part 1 of this two-part article, Alli Spotts-De Lazzer and I discussed the current debate surrounding recovered practitioners disclosing their eating disorder history to their clients. We cited research in this area, discussed pros and cons, listed advantages and disadvantages, and described benefits and risks for clients and clinicians. The article articulates our position in support of self-disclosure by recovered practitioners. However, we continue to stress that we do not believe that those who have recovered from an eating disorder are better treatment providers than those who have not. We are instead suggesting that recovered clinicians are uniquely suited to share personal perspectives on the journey of eating disorder recovery along with what it takes to be recovered and could benefit from guidelines on how best to do so.
Here in, Part 2, information gleaned from the experience of recovered practitioners is summarized and incorporated into guidelines for self-disclosure that help ensure a focus on the client’s best interest.
“I disclose as a way to talk about life after recovery, what it looks like, how you can get there and mostly…to instill hope in the clients when they feel that recovery is not possible for them.” Respondent from Group 2
Before Carolyn Costin and I began writing “To Tell or Not to Tell: Therapists with a Personal History of an Eating Disorder” (2016), I was curious about current beliefs and practices regarding a therapist’s self-disclosing of his or her recovery from an eating disorder in clinical work. So, I reached out to eating disorder specialist practitioners.
I did not seek practitioners who identified as “recovered,” nor did I know many of their histories. Excepting one, I had limited to no information about who openly endorses the use of, or discloses, a personal past history of an eating disorder in their clinical work. Each was emailed a three-question survey and was promised anonymity. A total of 12 eating disorder specialists—from different disciplines, locations within the United States, and treatment approaches (evidence-based, psychoanalytic, eclectic, Intuitive Eating, etc.) —offered their perspectives on practitioners self-disclosing personal recovery from an eating disorder along with the potential benefits and risks.
My questionnaire was informal and the sample size small, so it cannot be considered a representative sample or provide research-worthy statistics. However, the following unanimity surprised me: All practitioners seemed to support a clinician’s eating disorder recovery disclosure, though, some with caution. For example, practitioners stressed that disclosure should be “for the right reasons” and offered stipulations such as, “After the clinician has enough information and knows enough about the client to feel very confident that it would be in the client’s best interest,” and “Disclosure needs to be handled on a case-by-case reasoning and only done when it will benefit the client’s treatment and developing recovery storyline.” Others highlighted the importance of a careful, thoughtful approach. Despite the stipulations, it was clear; there seemed to be an acceptance and clinical valuing of a recovered practitioner’s experience.
Furthermore, the survey respondents identified potential benefits of self-disclosure by recovered clinicians, and a dominant theme emerged: increased hope (e.g., that “someone else made it out” and “that recovery is, in fact, possible”). As one clinician stated, “After all, how can someone be committed to treatment and recovery if they don’t think it is possible to obtain?”
Support for recovery self-disclosure reported by practitioners (even from those whose orientations may not traditionally embrace this kind of self-disclosure) felt exciting to me. With this interesting new data, I reached out to Carolyn to share the survey responses. We both wanted to pursue gathering similar but additional information, this time from self-identified “recovered” clinicians. We hoped to learn more about, help clarify the experience of, and compose guidelines for recovered eating disorder providers who use self-disclosure of their eating disorder past in their work.
Brief Synopsis of the Recovered Providers Survey
The following is a brief description of our survey and the overall themes of the respondents. A detailed summary of the results is found at the end of this article.
Adding 11 questions to the original survey’s three questions, we distributed the survey on a Facebook page, “Recovered Eating Disorder Professionals,” and through emails. We received feedback from 45 practitioners of various disciplines (coaches, dietitians, medical doctors, mentors, and therapists). Therapists made up the majority of the group (at 35 out of the total of 45). The respondents were from various locations in and outside of the United States. All identified themselves as being “recovered” from an eating disorder for at least two years.
44 out of 45 “recovered” practitioners responded that they do generally use self-disclosure of their recovery in their work; with one not responding to the question. Consistent with the dozen respondents in the first group of practitioners, a majority regarded self-disclosure of recovery as valuable for instilling hope that “recovery is possible,” that “an eating disorder is not forever,” and more. In fact, most (30 of 45) used the word “hope” in their answers. Additional named benefits included rapport building, clients feeling understood, and clients not feeling judged/feeling less shame.
Even for recovered practitioners trained to use their past history in clinically relevant and helpful ways, self-disclosure of one’s eating disorder recovery brings complications that need to be navigated. Our “recovered” respondents brought up similar concerns to those expressed by colleagues in the field who question such self-disclosure. Aspects that require consideration and attention:
- “Boundary issues in general” can increase.
- Comparisons by the client can happen, “either real or imagined – body size and shape and imagining what my history has been and how it differs or is worse/better.”
- Clients “may feel competitive” (e.g., speed of recovery, severity of illness experienced, etc.).
- Over-identification by the therapist can create “blind spots” and opportunities to “make mistakes in assuming” instead of learning the client’s experience.
- Self-disclosure can come off as a “tactic” or “a desperate attempt to ‘bond’ with the clients” rather “than an authentic connection that slowly develops.”
- Focus distractions can challenge treatment (e.g., “the client may attempt to shift the focus off of them” and onto the practitioner).
- Many practitioners feel that self-disclosure can bring about increased scrutiny of them (e.g., body, food intake, and other behaviors) by both clients and professionals. A clinician that openly identifies as “recovered” can face scrutiny from colleagues who don’t necessarily believe that one can be fully recovered.
- Finally, there is “always the potential for patients to become worried about ‘triggering you.’”
Of interest, when asked if a personal history of an eating disorder has ever put the practitioner at risk for a relapse or setback, 3 of the 45 reported a setback or a relapse. However, most made statements suggesting the opposite; that it made their recovery stronger.
“I feel like it’s kept me aware of my own experiences and supported my efforts to be mindful and balanced in my own skin.” Respondent from Group 2
Overall, most respondents favored self-disclosure and expressed that it needs to be approached thoughtfully, as it comes with inherent benefits and risks. However, without guidelines or available supervision on disclosure of one’s eating disorder history, which most agreed did not readily exist, how does a recovered practitioner thoughtfully approach self-disclosure? What can be helpful to know or consider?
Of the eating disorder programs currently in existence, we know of only three examples where recovered eating disorder treatment providers are trained and supervised on how to best use their past history of an eating disorder in their work. The three programs are: The Emily Program in the United States, Human Concern in the Netherlands, and all programs founded by Carolyn Costin.
Carolyn is a pioneer in the use of self-disclosure as a hope-instilling, therapeutic intervention. She has developed and run multiple treatment centers, written 6 books, and spoken at conferences about her approach and success with eating disorders. Carolyn has trained hundreds—probably thousands—of practitioners (including me) throughout her 37+ years in the eating disorder field, including how to use one’s own eating disorder history when treating eating disorder clients.
In the following sections, Carolyn reviews background on self-disclosure and offers written guidelines for recovered eating disorder providers who use personal recovery self-disclosure in their work. We believe these guidelines may be the first of their kind.
Background on Self-Disclosure of Recovered Providers
As previously referenced in our first article, literature on therapists self-disclosing their own eating disorder history indicates that it can be an effective intervention (therapeutic tool) with positive effects. However, the eating disorder field has conflicting views on recovered clinicians working in the field, and if they do, disclosing their eating disorder history. In Part 1 of this article we described various concerns that have been expressed:
- “Can someone even be fully recovered?”
- “How can you tell when someone is really recovered?”
- “When is a provider recovered enough to treat others?”
- How can the provider avoid over-identification, boundary crossing?
- What if the provider relapses?
Here in Part 2, I analyze and summarize the perspectives we received from recovered providers who use self-disclosure in their work with eating disorder clients. The information from these providers, along with my years of experience training recovered providers, was combined to establish written guidelines. We greatly appreciate our colleagues who participated in these surveys, and I am continuing to collect and analyze additional contributions.
A standard rule of thumb generally given for self-disclosure of any kind in a therapeutic relationship is that it must be in the “best interest of the client.” We definitely saw this theme in our surveys where, “Self-disclosure only in the client’s best interest,” was clearly the most prominent theme discussed by clinicians and other providers regarding when, and if, to disclose a personal eating disorder history.
It makes sense that the client’s best interest is the touchstone for ethical self-disclosure, and it has been discussed in various papers, articles, and books on therapeutic boundaries. However, it begs the question of how one decides exactly what is in the best interest of the client and what is not. Information gathered from our survey respondents reinforces both that there are positive benefits of self-disclosure and that providers are thoughtful about when and how to do so. However, the information that respondents provided falls short of helping others who are trying to learn best practices for self-disclosure. For example, if clinicians share something to instill hope or motivation, what is considered hopeful and what is not? What motivates one client but not another? And, of course, here is where the art, and not the science, of therapy comes into play; every client, every circumstance, and every therapeutic relationship is different. Nevertheless, I know from my experience training recovered providers that specifics can be taught and guidelines established that help lead to fewer complications and greater success.
My fundamental bias is that it is always in the best interest of the client to know that I am recovered from an eating disorder. I’ve self-disclosed since 1979 and am known for my stance on this, so most clients know I am recovered before coming into my office. However, even years ago, before I had spoken about this publicly and before my books were published, I always disclosed my own eating disorder history in my first session. I have yet to find a reason to keep this from clients or why it would not be in the client’s best interest to know. To this day, I still get clients who say they have never heard they could be fully “recovered” and/or have never met anyone who was “recovered.” My sharing that I am recovered is often the first time clients hear that it is even possible, which I find profoundly disturbing. Imagine being treated for something and having no example of someone who has completely recovered from it. Therefore, for 37 years, I have disclosed to every client that I had an eating disorder, that I recovered, and that they can do so, too. However, what details I disclose, to whom, when, why, and how I disclose are much more complex and nuanced and deserve thoughtful attention.
Over the years, through trial and error, I developed my own guiding principles for hiring and training recovered clinicians. Here, with information gathered from 45 recovered practitioners who also use self-disclosure, I have established written guidelines. All of the guidelines presented have been put into practice successfully and can be easily applied and discussed with colleagues or in ongoing supervision. However, guidelines can never take the place of a practitioner making the best call in the moment for a particular client and circumstance.
Self–Disclosure Guidelines for Recovered Eating Disorder Practitioners
By Carolyn Costin, MFT, FAED, CEDS
Note: These guidelines use the term “recovered” rather than “recovering” or “in recovery.” A definition of what is meant by “recovered” is provided.
Recovered providers who self-disclose say they share their history to provide hope and motivation, and always in the best interest of the client, but those are not clear guidelines. What motivates? What inspires? What is in the client’s best interest? The answers to these questions cannot be taken for granted. It is all too easy to get trapped into disclosing something meant to be helpful that turns out to be triggering. Of course, clients will get triggered by things, and this cannot be completely prevented. However, much of it can be avoided with proper planning and preparation. The following guidelines, written for practitioners, offer specific parameters and suggestions to help break down self-disclosure into appropriate, usable, hands-on practices.
- Providers Should Meet the Definition of “Recovered” For at Least Two Years
The eating disorder field does not have a standard, accepted definition of what it means to be recovered. For years, I have used my own definition that can be found in 8 Keys to Recovery From An Eating Disorder (Carolyn Costin and Gwen Grabb). I share my definition with clients and refer to it when hiring and training recovered professionals.
“Being recovered is when the person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on the scale. When you are recovered, you do not use eating disorder behaviors to deal with, distract from, or cope with other problems.” (Costin/Grabb)
Make sure you have been recovered for at least two years before you work with eating disorder clients so you are solid in your recovery. This time period will give you time to work through the inevitable triggers that come from living in a weight and diet obsessed culture or from any psychological stressors that arise. If you have gone two years living your life and dealing with issues without resorting to eating disorder behaviors, chances are you have found other coping mechanisms, leaving the eating disorder behind, a thing of the past. Being solid in your recovery is important because working with clients can bring up potentially triggering issues and you need to be prepared for it.
You might feel that after six months or a year of solid recovery that you are ready to start working with clients with eating disorders. However, it is crucial for your future clients and for your health and well-being that you allow at least two years to elapse between the time you become recovered and the time you start seeing clients with eating disorders. The two-year time frame allows you to discover how you deal with a multitude of challenges and stressful situations in the absence of your eating disorder. It will also allow you to develop strong empirical evidence for helpful coping strategies you can share with your clients.
Some eager practitioners have started in the field too soon, disclosing their own eating disorder, unprepared for the difficulties they would encounter and the multitude of issues that arise. A few have relapsed and needed to go back to treatment.
Clinicians who begin working with eating disorders too early and relapse as a result can create a negative experience for the client. It can be extremely discouraging for a client to see someone who claimed to be recovered, but then relapsed. It is important to note that practitioners should not hide or feel ashamed to seek help if they feel they are slipping into old thoughts and behaviors. Ongoing support, supervision, and mentoring are crucial and may prevent a relapse.
- Tell Clients What You Mean by “Recovered” and How It Might Differ From Other Terms
Tell clients what you mean when you use the term “recovered.” You can share the definition of recovered that is spelled out in these guidelines and explain it as the goal.
Some clients might want/need to understand the difference between “recovered” and other terms they hear or use, such as “recovering” or “in recovery.” Clients who are using a 12-step model will need help navigating the situation if you are using a different term than those used in their 12-step meetings or by their sponsor. Be prepared to discuss the different points of view regarding these terms and how you can work with a client who does not feel comfortable with the term “recovered.”
Ideally, we would like all clients to embrace the idea of being recovered as a goal. If a client isn’t comfortable with the term “recovered,” it’s important to address it, including how it affects their feelings about you as a recovered practitioner. It’s possible that the client has never met anyone who is recovered and doesn’t believe in it for that reason. In a case like this, you can teach the client about it and be a positive example of what “recovered” can be. However, there might be instances where the client has a fundamental opposition to using this term. If this is something that seems to be problematic, then collaborate with the client to find a way you can work together. You do not have to push your terms onto the client, and there are many ways to sort out this situation. There could also be cases where it might be better to refer out to a trusted colleague who you believe might be a better fit.
- Focus Self-Disclosure on Empathy, Understanding, and How You Got Better
The following is a basic list on what to disclose versus what not to disclose. Details are given in the other guidelines.
- Share specifics on how you got through things rather than specifics on why you got an eating disorder or details of your eating disorder behaviors. Share few specifics on how sick you were. You may have to share some information so clients know that your eating disorder was real, but certainly NO numbers, no amount of calories you ate, your (past or present) weight, miles you ran, laxatives you took, times a day you binged, etc. These should not be shared—ever.
- Share to express empathy, understanding, and bonding (e.g. that getting better is hard and feels bad, but is worth it).
- Share things to reduce the client’s shame (e.g., if a client is feeling badly regarding lying about how much food he ate, if you did the same, you could share that when you had an eating disorder you lied about the amount of food you ate, too). There are numerous opportunities to share things that can help reduce shame because you will find that clients often feel shame about things you did too. Your sharing can help them feel better about where they are and where they can get to.
- Share sometimes for levity in the session. Sharing things that help clients laugh at themselves is useful. Of course, you have to be careful about this and know your client’s sense of humor.
- Share to inspire hope when a client feels like something can’t be done. As a recovered person, there were undoubtedly many times along the way when you thought you would not be able to stop doing something or begin doing something, but eventually were able.
- Share things from your experience about how recovery can be progressing, even when it might not feel that way.
- Share examples of how being recovered is easy once you get there and that it does not have to be a difficult, ongoing battle. People who are recovered can uniquely share this important perspective. Clients often think recovery will be an ongoing lifelong struggle to stay well and may not accept hearing otherwise from people who have not been there.
- Share strategies that worked by disclosing things you did that helped you. Clients might be more willing to hang in there or try something if they have a real-life example of how it can work.
- Don’t just share for sharing sake. Instead, disclose in response to something the client says or is struggling with. For example, clients who express doubt about stopping laxative abuse for fear of not being able to return to regular bowel movements may benefit from hearing that from someone who has gone through this and is fine. More on this in guideline 4.
- Avoid sharing things that allow clients to make easy comparisons to you. More on this in guideline 6.
- Assess how clients are responding to your disclosures (verbally and by their body language) to help determine how much or how little to share.
- Disclose Information Based on the Patient and the Issues That Arise in Therapy
After your initial disclosure of being recovered, be specific and thoughtful about whom you are disclosing to and when. A good guideline is to share things when you think it matches something the client is dealing with or has mentioned. Be careful not to over-identify too quickly with them. Let their dialogue unfold and avoid responding too soon. Other than general disclosure of being recovered from your own eating disorder, most self-disclosure should come in response to issues the client is dealing with at the time.
You might disclose, for example, how you stopped counting calories if a client is having a hard time with that, or how you managed to deal with cutting back on exercise (if your client is addicted to exercise), or how you learned to reach out to others (if the client is having a hard time doing so). You might also disclose ways you dealt with body image issues when a client is struggling with that particular issue. All of this keeps the focus on how you got through things rather than how sick you were.
5. Disclose Based on Who You Are Disclosing To
Take into account the client’s age, cultural background, religious beliefs, gender identity, relationship status, and, of course, their basic sensitivities, personality, and personality traits when choosing what and when to disclose. You may innocently share an experience that could be off-putting to your client, because you did not take into account one or more of these factors. For example, you may feel that prayer or reading the Bible helped you recover, but your client might not feel comfortable with prayer, might not be religious, or might believe in a different religion that does not use the Bible.
- Never Discuss Horror Stories of How Ill You Were or Give Detailed Specifics of Your Eating Disorder Behaviors
Initially sharing you had an eating disorder and which eating disorder is often enough for clients. They do not need details of how ill you were or awful things you did. Some clients will want, or benefit from more information than others. The key is letting clients know you had a real, legitimate eating disorder without giving them unnecessary details that are useless or potentially damaging. For example, a client might benefit from knowing you too were emaciated and still saw yourself as fat, but hearing that you only ate an apple all day or could count all of your ribs is not appropriate. A client hearing this kind of information now has something to compare themselves or their behaviors to. In other words, this kind of information might cause the client to think, “I eat way more than an apple a day, I need to cut back,” or “I can’t count all of my ribs, I need to lose more weight.” Be as general as possible, for example, saying you over-exercised and suffered injuries and yet were able to get exercise back in proper balance can provide empathy and hope to an exercise addict. Saying you ran 10 miles or did Ironman competitions is unnecessary and can easily lead to comparison and potential triggers.
- Don’t Discuss Numbers (Weight Lost or Gained, Number of Calories Eaten in a Day, Number of Miles Run, Amount of Laxatives Taken, etc.)
Discussions involving numbers nearly always fuel competition and do not serve a purpose that can’t be served in another, healthier way. Depending on the client and the situation, you can say you lost far too much weight, or you over-exercised and lied about it, or you ate very little, or you binged often, or took enough laxatives such that stopping was difficult but doable. These statements can help clients see that you were actually in a situation similar to theirs and got yourself out of it, which can provide guidance and hope. None of these examples gives the clients a direct number that their eating disorder self will try to compete with, consciously or not.
- Do Not Discuss Any Limiting Behavior You Have Regarding Eating
What you eat will likely be more important to your clients than you think it should be, but as someone who says they are recovered, what you eat is usually of great interest. It is best if you can discuss and, if applicable, model eating all foods in balance. The goal for clients is to be as free with food as possible. Any eating limitations you have out of preference or for medical reasons is best kept to yourself. For example, if you are a vegetarian or eat gluten-free, don’t discuss this with clients. If you work in a treatment program or other setting where you and your clients will interact with food, it might be hard to conceal that you are a vegetarian or don’t eat gluten, or have other food limitations, but do your best. Legitimate medical issues must take precedence, but it is best to put preferences aside when eating with clients. It is not that being a vegetarian or eating gluten-free are not viable ways of having a healthy diet for some people; instead, it is the fact that people with eating disorders often find reasons to eliminate foods for the wrong reasons. Clients often jump to conclusions such as, “If my therapist (or other provider) is not eating dairy why should I?” If you are in a situation where you have to reveal food limitations you have for a legitimate medical reason, such as gluten intolerance, explain it quickly and matter-of-factly, rather than trying to skirt around it. Be brief and do not continue to answer ongoing questions. Direct the conversation back to all the things you can eat and how you hope the client will focus on that.
- Be Comfortable In Your Body
Even if a practitioner has never had an eating disorder and is working with eating disorder clients, the increased focus on the body and weight can be expected when working with clients in this population. Whether a provider struggled with an eating disorder in the past or not, those who treat eating disorders need to be comfortable in their own skin and prepared to deal with scrutiny about all aspects of their body, its shape, and function.
When you self-disclose about being recovered, you must be prepared for even closer scrutiny of your body and your relationship to it. Clients will want to know if you accept or like your body. They will usually compare their body to yours, try to determine your weight and how it compares to theirs, and decide if your recovered body would be “acceptable” to them. You need to be comfortable with your body and know what to say and not say about it in order to deal with clients observing, asking questions, and making comments.
It can be helpful for clients to hear from you that being recovered does not mean being perfect, never having a bad body image thought, or never wishing you looked different. Some form of body image dissatisfaction is normative and we need to be careful not to set, or have clients set, expectations too high in this area. They need to understand that body image issues are evident in people who never even had an eating disorder and that they might continue to have some, too. That said, I have witnessed many recovered individuals who actually have less body image dissatisfaction than the norm.
Clients might make direct comments about your body: “I could never let my thighs get as big as yours,” “I don’t want to look like you,” “That’s easy for you to say because you are skinny,” or “How do you stay so thin?” Being comfortable with your body and unflappable when it comes to hearing these kinds of comments is important. It is also important to be prepared for how to respond.
When a client says something specific about your body, you might lighten things by laughing a bit, or discuss their tendency to make comparisons and the consequences of that. You could ask for further clarification, or ask how the client thinks you feel about their comment, or how others might feel if the client said the same thing to them.
If a client makes a comment about a specific body part, you can take the focus off of the aesthetic and bring it to how that part of your body serves you, e.g., “I love having strong legs” and further expound on an activity you enjoy where having strong legs serves you.
There is not one way to respond but a key here is not becoming defensive or argumentative.
If you have a session where your body was the subject of discussion, pay attention to be sure that you are not holding onto thoughts or feelings about it. Nobody likes to hear something challenging or critical about themselves or their body, so be honest with yourself about how you are handling what was said and how you responded. It is wise to discuss any lingering discomfort in supervision or with a trusted colleague.
- Accept that You Are a Role Model, and Be the Best One You Can Be
Whether you say it or not, anything you share with clients, or do in front of them, can be viewed by them as “what being recovered looks like,” thus, this makes you a “role model.” It is important to be a good role model at all times, even when you don’t feel like it. Frame what you share with clients in a way that sends a positive message. As mentioned earlier, you are allowed to have bad body image days, most females and many males on the planet do, but feeling badly about your body is not useful information to share with clients. If in a situation where you are asked about your body or your feelings toward your body, even if you are having a “bad” day, find a way to share something positive or at the very least neutral.
Regarding eating, strive to be the best role model you can. As mentioned in guideline 8, it is best not to reveal any eating limitations. This does not mean you don’t have preferences or foods that you don’t eat. It simply means that you do not disclose this to clients unless put in a situation where for some reason you have to. If in a situation like this, you will likely need to identify a good reason why you don’t eat a certain food (e.g., doctor’s orders) and eat in a way that alleviates any of the client’s fears that you are “restricting.” If you are a vegetarian, for example, when eating with clients, it is easy to avoid revealing this by eating their fear foods such as pasta, pizza, lasagna, avocados, nuts, butter, bread, cakes, ice cream, candy bars, etc. All of these are vegetarian but that will most likely not be what the client notices. Clients are not usually waiting to see if you can eat grilled chicken or fish; they want to know you can and will eat the things they are really afraid of. So, when eating with clients, or talking about eating, let them know how easily you can eat foods they consider fattening or scary.
Remember that everything you do, especially when it comes to food, is going to be investigated by the client. There are behaviors that healthy people do when eating that can also be eating disorder behaviors. It is important not to do these in front of the clients. For example, if you are having a salad with a client and you like to order the dressing on the side and put it on the salad yourself, don’t do it. Just order it and let it be served. Many people without eating disorders put their own dressing on salad and no one cares, but this kind of behavior can have a significant effect on clients who see you do it. They may think you fear oil, like they do, and might feel justified not wanting to eat it. For the same reason, it is best not to do things like drink diet sodas with clients, even if you think, “I am not the one with the eating disorder and should not have to abstain.” (This sentiment has been expressed several times by clinicians in training.) Think of the situation as similar to treating people with alcohol or substance abuse. If you were working in a chemical dependency treatment program and having lunch with a patient who was trying to become abstinent from alcohol, you would not have a beer with your meal. In support of the patient, you abstain too, rather than making it harder for them. At some point, clients will have to deal with all kinds of triggers such as people drinking diet sodas, going on diets or doing other things the client needs to avoid, but as a treatment provider, your job is to be a positive role model not a triggering one. It may be appropriate, at some point, for clients who are doing well to have challenging meal sessions where you purposely eat in a way so as to expose them to potential triggers and help them learn how to handle it. These kinds of exposure sessions have to be done at the right time in therapy and in collaboration with the client.
There are many other ways that your clients will be looking to you as a role model. If you do disclose something about your life – a recent vacation you went on, a trip to an amusement park – it might be useful to point out that you weren’t able to enjoy these things when you were ill. It is usually OK to use specifics here, because you are giving the client specific details about being recovered. You can tell them that you used to dread, or even avoid vacations because you were so fearful about eating different foods, having to eat with others, missing workouts, etc. and now, as a recovered person, you don’t have any of those thoughts while traveling or preparing for a trip.
Some might feel that a guideline that asks treatment providers to be a role model for clients is too much pressure. However, once you self-disclose your recovery, you are a role model of someone who is recovered, whether you want to be or not. If this feels like too much pressure, then it is probably best not to disclose your eating disorder history. However, be aware that whether you disclose your past or not, clients may still look to you as a role model for other reasons.
- Be Prepared to Deal With Increased Scrutiny About What You Eat, How Much You Exercise and Your Behaviors (Including Your Appearance, Clothing, etc.)
Scrutiny regarding weight and body size happens from clients towards all practitioners, not just practitioners who have had an eating disorder. Yet, recovered clinicians are examined on deeper and more varied levels, partly because more has been exposed. The increased level of being watched and studied from clients regarding what you eat, or wear, or how much you weigh, or if you are really recovered can become bothersome and clinicians often cite this as a disadvantage of self-disclosure. Instead of thinking of this as a disadvantage, the comparisons and scrutiny from clients should be expected and accepted as part of the therapeutic process to work through. When a clinician is Recovered, he or she might feel annoyed by the watchful eyes of and comments from clients but should not get triggered by it. Clinicians trained to use their eating disorder recovery can openly discuss scrutiny and comparisons in the therapeutic work with the client. Sometimes you can answer the client’s questions and move on, and sometimes you can ask for further information such as:
- “I am interested why you want to know that?” “What might that mean to you to know?”
- “How would it change you or what you do if that were true or not true about me?”
- “It seems you are comparing yourself to me and I think it would be important for us to talk about that.”
Food, calories, and weight are going to come up a lot. When recovered, you will be in a place where you consume food without thinking about the caloric or fat content, but clients will be constantly reminding you of the nutritional value of everyday items, talking about how “bad” or “fattening” they are. Be sure you process these conversations and make sure they don’t affect your own eating. If you find yourself having hesitation about eating certain things or changing your eating behaviors, seek out supervision.
If a client criticizes your body, don’t get into an argument and don’t get defensive. Hear the person; do your best to understand where the comment is coming from and what the client might be trying to express. Express your understanding, and depending on how things are presented, you might even thank the person for their honesty. Try to end things on a positive note; for example, acknowledge that the client was able to share this information with you. Stay neutral, even if you feel like you are being judged or attacked. Remember that you are having a conversation with the client’s eating disorder self, and you need to come from a place of compassion and understanding.
- Be Clear that Recovery Can Mean Many Different Things and Take Many Different Paths and Phases
Be careful about over-identifying with a client’s story. Be curious about your client’s unique experience and open to the fact that there are many variables and many paths to recovery. Clients may relate to some things about your experience and not others. For example, if you share that in your recovery you discovered that you loved cooking and this is one of the things that helped you recover, make sure the client understands that falling in love with cooking helped you but may not help him or her. If you place too much emphasis on something you did that helped you recover, and your clients don’t want to do it or it does not feel right to them, they might think they are doing something wrong. Clients might also fake an interest in something for fear of disappointing you, which can prevent them from discovering what is truly best for them. All clients need to understand that while something may have helped you, you accept and embrace the fact that it doesn’t mean it will be helpful for them.
Comparisons often happen regarding how you got well, how long it took, what kind of providers you saw, etc. Most of this kind of talk is best avoided. It is ok to share different strategies you used if you have reason to believe this will help your client. However, remember that clients might need to do things differently than you. If so, come up with other ideas.
- Know Your Boundaries and How to Explain Them to Clients
Know your boundaries around self-disclosure and the relationship between you and your clients and how to talk about these things. While it’s impossible to predict every question, you can prepare yourself by having clear answers for clients about why you don’t disclose certain things, e.g., past or present food intake, weight, etc. The guidelines here will be useful in helping you cover things that need to be talked about.
Clients may not know the value of rules about maintaining a therapeutic relationship. Even if you are not a therapist but rather a dietitian or eating disorder coach, there are boundaries to the relationship that are important and need to be clear.
You might be the first treatment provider to self-disclose to a client. Some clients might mistakenly perceive that lines have been blurred if you self-disclose without explaining the reasoning and discussing your boundaries. Clients are more likely to misinterpret your self-disclosure as a friendly overture if they have no understanding of why you are sharing personal information. Discussing boundaries can help prevent this. Some preliminary discussion around boundaries can be held in the very beginning, but other things just have to be discussed as they arise. To say you will share information but not about this, or this, or this, can be off-putting. When clients ask questions that cross your line of comfort it is ok to share that when it happens, as long as they have a general understanding of how you work.
The point here is that the client must understand that you are acting in a professional capacity and your self-disclosure is not a slip-up or confession, otherwise they might begin to view you more as a peer than a clinician.
- Do Not Share Things that Make You Uncomfortable
Always check in with yourself before answering questions regarding your eating disorder history and recovery. Sometimes you will not know cognitively why not to disclose, but it will be a feeling. This can take a split second, but you need to notice if there is a feeling in your body telling you not to answer, or that answering does not feel right. Pay attention to this, and take some time before responding. You might need a minute or a few days. During this time, you can benefit from supervision focused on handling the situation. To create the space you may need, you can even say, “I want to think a bit (or awhile) before answering that.” If you decide not to answer (which is usually the best bet if you even have a trace of discomfort), then you can say something like:
- “I want to think about whether it would be useful for you if I answered.”
- “I don’t see how it would be helpful to tell you.”
- “Those kinds of questions are a distraction from what you need to do.”
You have to know how to say “No” when asked to disclose information that you don’t want to share. So, go over in your mind what kinds of things would work best for you to ensure that you won’t be caught off-guard when you find yourself in this situation.
Your comfort with the information you share is of paramount importance. Clients will usually readily pick up on your discomfort, sensing when you are uncomfortable answering a question they asked. You can share that discomfort. You can potentially say, “Answering your question would make me uncomfortable because I don’t think it’s useful information for you,” or “I don’t feel comfortable sharing personal information just to share, and in this case, I don’t think it would be beneficial.”
The key is being honest, with kindness and without giving too much away. If you feel uncomfortable and answer the question anyway, clients might assume your discomfort is because you are not telling the truth or are not really recovered. Remember, they typically scrutinize everything you say and do. So, do not disclose anything that makes you uncomfortable. Over time, you will get better and better at listening to your body’s subtle feedback about when and what to share and you will get increasingly more adept at handling difficult questions, whether you answer them directly or not.
- Check for Feedback
Ask clients about their experience of you as a recovered person/therapist. Does the client have doubts about whether or not you are fully recovered? Does the client believe that someone CAN be fully recovered? Is the client worried that something he or she might say will possibly trigger you? It is important to have an open and honest conversation about these topics with your client. If your client does not believe in full recovery, or doesn’t believe that you are fully recovered, accept it and discuss it. Not doing so could cause the client to disregard or distrust some of the things you say or to have less faith in you in general. Talk openly about these things with clients, try to ease any discomfort, and do your best not to challenge their position. Instead, validate their thoughts or concerns, and help them figure out if there is anything you can do. It is usually helpful to share that you know you can’t prove you are recovered, that the client will have to decide for themselves, and that you understand and respect this.
Some clients might conjure up mental images of you as emaciated, overweight, weak, or binging and purging. You can explore this with clients in session and talk through their images and the thoughts and feelings associated. It might be worthwhile to ask them to juxtapose their images of you from the past with the version of you they know now. Visualizing you as sick or hopeless and contrasting that with the person who is sitting in front of them today, recovered and in a position to help others, can be powerful. This is a useful reframe and one way to transform what might have been a negative situation.
- Repair Any Disclosure That Has Gone Wrong
There is not one simple disclosure formula that will work for every client, every time. This is one of the reasons why so many self-disclosing clinicians refer to using their clinical instinct and best judgment as to when to disclose, what to disclose, and to whom to disclose.
There is inherent trial and error during this process. You might have thought through a disclosure and felt it was right; yet it backfired. You might say something then notice a certain look from the client or recognize that the client seems to have wandered off mentally since you made the comment. The client might actually say something either in the moment or later. You could ask for feedback even if you don’t see any signs. In any case, if something seems to go wrong, e.g., the client is upset, it doesn’t necessarily mean that you did anything wrong or that the client did anything wrong, and it’s important that both parties understand that. The important thing is to rectify the situation with the client. If done correctly, it can be a learning experience for both of you since you will discover certain nuances about what is or isn’t effective for each client. Additionally, the client will learn that he or she can be open and honest with you if something doesn’t feel right for him or her. If the situation is handled properly, it encourages open communication and can strengthen the bond between you and your client.
Sometimes clinicians can get stuck in problem-solving mode and forget that it’s OK to just admit that something went wrong and simply say, “I’m sorry” to the client. You don’t have to analyze every situation from a “therapeutic” point of view. There is something very powerful and humanizing when you just turn to your client and say “I’m sorry,” if, in fact, you are sorry about what transpired. If something went wrong and you do not feel sorry about it, approach the discussion in a different way, but do not be dishonest with the client, or yourself, and say “I’m sorry” if you are not sorry about whatever happened. Clients can, and usually will, pick up on insincerity. An empty apology has the potential to do more harm than no apology at all.
Whether or not you feel it is appropriate to apologize for something (there will be instances where things go wrong and there is no apology necessary on either side), it’s important to still talk about the situation with the client. Ask the client to articulate what didn’t feel right about the disclosure, acknowledge his or her feelings, making sure he or she knows they are heard, and then discuss ways you can approach this situation differently in the future. It is important to validate the client’s feelings, discuss the situation, and ensure that the client is comfortable before moving forward.
- Get Well-Rounded Training, Don’t Go Directly From Having an Eating Disorder to Treating Eating Disorders
As has already been mentioned, it is important to wait two years after being recovered before working with clients who have eating disorders. It is also important to get well-rounded training before treating eating disorders. Many eager recovered clinicians want to give back and start treating eating disorders right away. But when you treat people with eating disorders, you will also need to know how to deal with anxiety disorders, obsessive-compulsive disorders, depression, substance abuse, and many other comorbidities that often occur with eating disorders. Being trained to handle these other illnesses will improve any provider’s ability to successfully treat eating disorder clients.
- Have Ongoing Supervision Meetings Where Any Issues Can Be Discussed
When using your experiences of recovery in your work with clients, getting good supervision or consultation with colleagues is important for success, helps prevent potential problems, and helps resolve issues in a more expedient manner.
Being honest about what comes up when working with clients is critical to processing feelings and letting them go. In supervision, transference and countertransference issues can be worked through, boundary issues can be discussed, over-identification with clients can be curtailed, and old thoughts and feelings surrounding the eating disorder history can be dealt with.
Especially at the start of this type of work, some sessions may bring up strong feelings. You need to know how to best handle things in the moment and where to go for supervision and support. After a session where a client similar to you discusses things in graphic detail, you might find yourself triggered in some way, shape, or form. Supervision and consultation with colleagues can help prevent a potential vulnerability from turning into a slip or relapse. Each experience will better prepare you to handle these types of situations in the future.
Ideally, clinicians who want to disclose their eating disorder history and use their recovery experience in their work could get their required, or any desired, supervision from another seasoned recovered clinician. Someone who has recovered from an eating disorder, worked with eating disorder clients, and has supervision skills, will likely be prepared to help guide others in the nuances of, and how best to use one’s personal recovery. If you don’t have access to a recovered supervisor, seek supervision from a professional with the willingness and expertise to guide you in using your own recovery history. Getting the right supervision can significantly contribute to success.
Summary of Responses to Recovered Providers Survey
By Carolyn Costin, MFT, FAED, CEDS
Special thanks to this section’s co-author, Jeanette Batur BA, Eating Disorder Coach
Note: All authors were survey respondents and are included in the analysis.
At the time of this analysis, there were 47 respondents to the Recovered Providers Survey posted on the Facebook page, “Recovered Eating Disorder Professionals.” Since 2 respondents were not currently working with eating disorder clients, (respondents, #15 and #46), we removed them from the response sets and analysis, leaving us with a total of 45.
- Are you in favor of clinicians disclosing personal recovery from an eating disorder to their current clients with an eating disorder? (*If yes, please proceed to the next questions).
Two out of the 45 respondents did not answer this question. Of the 43 who answered, 42, (97.67%) said “yes,” indicating that they are in favor of clinicians disclosing personal recovery to their current clients with an eating disorder.
One respondent who answered, but didn’t provide “yes” or “no” response, said that “it depends on the level of recovery of the person” and indicated in Question 2 that she uses self-disclosure of her history “often” in her work with clients.
One respondent who did not answer this question acknowledged the potential benefits of a clinician self-disclosing in her response to question 14, “…if and when it happens, it seems to help pave the way for a potential bond or connection with a client who is struggling with an eating disorder,” which, she notes, “has the potential to relieve the client of some fear and/or shame and may give them a glimpse of hope.”
While the majority of respondents answered with a simple “yes” to this question, several stated that self-disclosure be done only if it would be beneficial to the client.
- Do you personally use self-disclosure of your own eating disorder history in your work with clients? (If yes, how often—always/automatically, some of the time, never)?
No Answer = 1 (This response has been taken out as it cannot be assumed a yes or a no)
Yes = 44/44 (100%)
*Automatically or Always = 16/44 (36.36%)
*Selectively (Those who answered “yes,” but not Automatically/Always, e.g., “sometimes” or “most of the time”) = 28/44 (63.64%)
No= 0/44 (0%)
100% (44/44) said that they do use self-disclosure of their own eating disorder history (either always or sometimes) in their work with clients. The one who did not answer was the same individual from the question 1, so while she has self-disclosed, she did not specify whether or not this is something she “uses” in her work.
Of the 44 respondents, about 36.36% (16/44) said that they disclosed automatically, either on their website or just as part of who they are and how they relate to clients/potential clients. The other 28 said they disclosed selectively, i.e., they either disclose sometimes or most of the time – depending on the situation/client, but do not do so automatically.
One respondent noted that she previously worked in an inpatient ED unit that had a no self-disclosure policy, but now in a situation where she is able to openly self-disclose, she does so “often.”
3.What are the three to five best advantages you have seen/experienced from disclosing your history with patients/clients?
The most frequent response to this question was about hope. Almost everyone referred to hope in some way, shape, or form, with 30 respondents (68.18%) specifically using the word. Others alluded to hope, saying things like “clients learn recovery is possible firsthand,” “clients believe in recovery,” and “It helps them to know that I struggled once and came out happier and more whole as a result of my recovery.”
Other benefits cited by respondents were: rapport, clients feeling understood, clients not feeling judged, and feeling less shame.
“They know that I have at least a window into their experience that is more than just theoretical”.
- What are the three to five disadvantages of disclosing your personal history of an eating disorder?
Many felt that self-disclosure brought about increased scrutiny of their body, food intake, and other behaviors. Two respondents (a therapist and a coach) noted that disclosure of an eating disorder history might make the client perceive the practitioner as flawed. A third cited a client’s family using her self-disclosure as a way to discredit the work she was doing with their daughter, as if she wouldn’t know how to help because she had been anorexic, too, which implies the same ‘flawed’ assumption the other two noted.
Some noted that self-disclosure might create boundary issues. At least one respondent thought that self-disclosure could appear “unprofessional” and clients might feel that they are speaking with a peer rather than a clinician. Some concern was expressed that self-disclosure could make the session more about the clinician than the client.
Over-identification was another frequent answer. Over-identification can occur on either the client’s or clinician’s end. Some clinicians noted that they remain cognizant of the fact that clients can idealize them and if they disclose too much about their recovery, the client might become too fixated on doing things exactly the way they did it.
It is worth noting that two respondents (both therapists) pointed out that a clinician that openly identifies as “recovered” might face scrutiny from colleagues who don’t necessarily believe that one can be fully recovered.
- What are your top three to five personal rules/guidelines you follow for appropriate, effective use of self-disclosure of personal recovery from an eating disorder when treating a person with an eating disorder?
There were some variations in answers here because some automatically self-disclose and others do not. However, a theme among both groups shared by most (30/44, or 68.18%; one did not respond) was not sharing specifics about the details of the provider’s illness. These respondents all agreed that providers should not discuss details, i.e., things such as weight, how sick they got, where they received treatment, specifics of their behaviors, or food intake (past or present).
Of those who do not automatically self-disclose, the most common rule was to do so if/when it was beneficial for the client, which is a recurring theme. Other guidelines that respondents followed were: are they filling time in the session, helping the client feel less ashamed about something, sharing useful information, using it as something to relate to the client about, and are they disclosing because it makes them feel good or is the disclosure for the client’s benefit?
Again, the main theme was making sure that disclosure was always done in a way that is beneficial to the client.
- Do you feel that you have experienced bias or discrimination from colleagues about your personal history of an eating disorder? If so, what kinds/how?
No answer = 1 (Because one person did not respond, response percentages are based on 44 respondents)
Yes = 17/44 (38.64%)
No = 23/44 (52.27%)
Maybe = 4/44 (9.09%)
In their responses to this question many felt judged by their colleagues and overly scrutinized, whether it was being told that they lacked boundaries or being scrutinized regarding their eating or their bodies. Four respondents noted the issue of colleagues not believing that someone can be fully recovered from an eating disorder.
Three other respondents noted that they had received or perceived positive responses from colleagues.
- Do you think you would have benefitted from supervision from a therapist who was also recovered? If so, how?
No Answer/Not Applicable = 5 (These were removed and percentages are based on 40 respondents instead of 45)
Had a Recovered Supervisor/Mentor = 11/40 (27.5%)
**10/11 indicated it was an asset
Yes = 22/40 (55%)
Maybe = 4/40 (10%)
No = 3/40 (7.5%)
Since 10 of the 11 respondents who said they had a recovered supervisor or mentor said it benefitted them, we can combine those 10 with the 22 responders who said YES they would have benefitted. In other words, 82.5% of responders indicated that having a recovered supervisor/mentor would be of benefit.
(One respondent didn’t say whether he or she believed it was an asset or not, just that she had supervision from someone who was recovered.)
Three respondents indicated “maybe/not sure”, while 2 stated, and a 3rd implied, that they did not have recovered supervisors and/or they believe that what is important is the quality of the supervisor rather than whether or not the supervisor is recovered.
- What advice would you give to a clinician who recovered from an eating disorder and is about to start working with clients with eating disorders?
Respondents gave advice on two levels, personal and dealing with clients.
For personal advice, the most common suggestions given were: take care of yourself, get your own therapy or supervision, or colleagues you can talk to, make sure you’re strong in your recovery, be honest and know your sensitivities.
For dealing with clients, the most common advice was not to share specifics or too much and only disclose in a way that is thoughtful and beneficial for the client.
- How do you choose when to or not to disclose?
Responses were pretty much covered in previous questions. Of those who don’t automatically self-disclose, the remaining clinicians do it when it feels right and when/if it will be beneficial for the client. There was no set “time frame” or protocol reported, it really just depended on whether or not it would benefit the client.
- What’s the worst consequence you have witnessed from your or someone else’s self-disclosure of personal recovery from an eating disorder in a professional setting?
Seventeen respondents noted that they had not witnessed any consequences. Of those that had seen negative effects, there were mentions of: being judged by colleagues, boundary issues, increased scrutiny, clients comparing their recovery to the clinician’s, and someone working in the field and disclosing that he/she was “recovered” when it was evident that the person was still struggling or relapsing.
- How do you gauge what’s safe to share “in the client’s best interest”?
The common theme presented was, “Do not share specific details of your illness.”
34 responses indicated that sharing information was done using their gut/intuition and/or best judgment and on a case-by-case basis. Criteria for disclosing ranged from clinician to clinician based on things such as: their working relationship with the client, how far along the client is in recovery, how the session is going (reading client’s reactions and body language), and the client’s maturity level.
Two people responded that they gauged how much to share in part by how the client reacts to initial information. One respondent bases it on the client’s history and their working relationship, another discloses based on how the client uses information he/she got in the past from other people, while another checks in directly with the client.
- Have you ever found any guidelines about self-disclosure of recovery as an intervention? If so, please provide the reference.
*Note, 7 people either did not answer this question or answered “n/a” so percentages that follow here are based on 38 respondents.
No Answer: 7 (These non-answers were removed )
No= 26/38 (68.42%)
Yes, (Guidelines From Carolyn)= 9/38 (23.68%)
Yes, Other Than Carolyn= 3/38 (7.89%)
Of the 38 responses, 35 (92.11%) had not seen any guidelines on self-disclosure of recovery, other than the few (9) who had heard Carolyn Costin talking about or using guidelines in supervision or lectures.
3 individuals (7.89%) had seen some other kind of guidelines, but the majority 26 (68.42%) indicated that they had not seen any guidelines anywhere.
Respondents who said they had seen guidelines (other than Carolyn’s), cited 5 articles, all of which were about general self-disclosure in psychotherapy. None were related to self-disclosure for recovered eating disorder providers.
- As an eating disorder therapist, has your personal history of an eating disorder ever put you at risk for relapse or a setback while working with this population? If so, please say more about this (please include defining “relapse” or “set-back” for you).
Only 3 respondents out of 45 (6.67%) reported a setback or relapse, one reporting she only experienced thoughts and not behaviors.
Six indicated they had some sort of body image issues that came up and were dealt with.
Most respondents answered “no” and many indicated that, if anything, working with eating disorder clients and/or disclosing their history has strengthened their recovery and increased their motivation (to stay recovered).
“I feel like it’s kept me grounded, aware of my own experiences and supported my efforts to be mindful and balanced in my own skin. Once I understood more of the neurobiology about eating disorders, my experience made so much more sense to me. I can share that with clients in a way to help them understand themselves, and it doesn’t have to be triggering for me.”
- If there is something missing from these questions you’d like to comment on or you feel is important, please include!
This was our last question and we got several suggestions including people suggesting outcome studies, guidance for approaching a clinician who might be in relapse, and of course, the need for self-disclosure guidelines.
If you are interested in the topic of Recovered Eating Disorder Professionals and becoming more involved in a community of professionals and others who are recovered and work with, or want to work with eating disorders, visit Carolyncostin.com and look at the Recovered Professionals page and sign up to subscribe to the mailing list. Also please join the new Facebook group Recovered Eating Disorder Professionals. You will get updated information and articles on the topic and be a part of a community forum.
In addition, members of the Academy for Eating Disorders can join the special interest group (SIG) Professionals & Recovery, which is devoted to defining eating disorder recovery and issues related to recovered professionals.
About the authors:
Carolyn Costin MA, MEd., MFT, CEDS FAED, is a world renowned, highly sought-after eating disorder clinician, author, and international speaker renowned for her expertise, passion and accomplishments.
In her twenties, Carolyn recovered from anorexia and became a teacher and a psychotherapist. After successfully treating her ﬁrst eating disorder client in 1979, Carolyn recognized her calling was to treat people with eating disorders. After her success in private practice as well as developing and running several hospital eating disorder programs, Carolyn opened the first residential program in a home setting, Monte Nido.
Carolyn’s humanistic, relational approach, her knowledge base, her numerous books, and the outstanding success of Monte Nido all spurred Carolyn to international acclaim.
Having left Monte Nido in 2016, Carolyn maintains her private practice and remains very active in the eating disorder field lecturing, training, teaching, writing and supervising.
In 2017, Carolyn founded The Carolyn Costin Institute, which offers Eating Disorder Mentor and Coach Training, on line and in person Continuing Education for clinicians, and other specialized trainings.
Carolyn’s newest book, 8 Keys To Recovery From an Eating Disorder Workbook is now available.
or email: Carolyn@carolyncostin.com
Alli Spotts-De Lazzer is a Licensed Marriage and Family Therapist (#49842), Licensed Professional Clinical Counselor (#844), and Certified Eating Disorders Specialist (#3106) with a private practice in the San Fernando Valley, Los Angeles. She has had the privilege of presenting workshops to medical and mental health professionals at training facilities, graduate schools, hospitals, and recently an international conference. She also writes about current issues in the field of psychotherapy. Her articles have been published in The Therapist, Family Therapy Magazine, Psychotherapy Networker, and Practice Innovations. Alli is the creator of #ShakeIt for Self-Acceptance!®—sparking important conversations through inspiration and flash mob fun! For info: www.TherapyHelps.Us
This is really helpful.
I particularly appreciate the 8 concerns raised by recovered respondents, toward the beginning.
As well as the Guidelines.
Seems to me that truth will, of course, set you free. But it is a great reminder to give thought as to WHY we are disclosing at a particular time and to be aware of these well articulated pitfalls.
In my experience, both as a client in recovery from disordered eating and as a counselor years later working with individuals who have food issues, I have found self-disclosure from therapists to clients beneficial. I recall about 25 years or so ago when I first went into therapy, my therapist then was very transparent in sharing how he had struggled with weight and food issues during his childhood. That was helpful to me in letting me know that I wasn’t alone in my struggles, and that my struggles with food, body image, etc. could be overcome. Now when talking with a client, or even a friend, who reveals having a problem with food, body image, etc., I follow the example of former therapists I had who felt comfortable enough to be transparent with me about how they overcame similar issues. I believe when therapists self-disclose about struggles they have overcome, this sets a positive example encouraging clients to self-disclose about their own issues and also lets them know they are not alone in their struggles. Of course, self-disclosure should be used minimally by therapists where the sessions do not become about the therapist rather than the client. Finally, I also believe self-disclosure is biblical based on 2 Corinthians 1:3-4–“3. Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, 4. who comforts us in all our tribulation, that we may be able to comfort those who are in any trouble, with the comfort with which we ourselves are comforted by God.” (NKJV)
I appreciate this article as well as the comments. As a recovered professional who lets that fact be known, i agree with all the recommendations and guidelines. I have never regretted telling a client that I am recovered, as it has always generated positive results in that client’s journey. Thank you!
Thanks, Carolyn, as always, for your wonderful combination of humanitarianism and professionalism about this topic; I am glad there is a growing clan of us who have been on both sides of the process — having the blessing of our own recoveries, and the blessing of watching & supporting others’ recoveries as well! I have been additionally blessed by the opportunity to supervise other professionals in the field, with and without their own personal recovery experience, in a way that (I have hoped anyway) has helped them “climb into the experience” of those they were/are working with…
Deborah Brenner-Liss, Ph.D., CEDS, iaedp approved supervisor
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