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Choosing
a Therapist
Reprinted
from The
Beginner's Guide to Eating Disorder Recovery
By Nancy Kolodny, MSW, LCSW
To find out more about this helpful book click
here.
"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.
Additional Resources:
Serotonin: Implications for the Etiology & Treatment of Eating Disorders
Shapesville
Small Book Fills Big Need for Children
Soul Lessons: Finding the Meaning of Life
Surviving Holiday Meals
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