Eating disorders like anorexia nervosa, bulimia nervosa and binge eating disorder are complex conditions. Restoring physical and mental health, ie, recovering from them, is therefore a process that takes time and requires the support of a suitably qualified and experienced therapist.
Whilst many counsellors can help with some of the underlying issues, it is suggested that only 3.4% of UK therapists have undertaken extensive eating disorder-specific training [1].
So how do you, as someone needing help, identify the right support?
Evidence-based practices and other therapies to look for
Evidence-based practices describe those therapies that have been clinically tested in research trials to the point where they are generally considered to be a safe and effective treatment.
In the UK, the National Institute for Health and Care Excellence, NICE [2], makes recommendations as to how mental health conditions should be treated. One of the treatments it recommends for eating disorders is eating-disorder-focused cognitive behavioural therapy, commonly known as CBT-E (enhanced CBT). This is a specifically developed type of CBT that includes a focus on eating and body image concerns.
Meeting your specific needs
Given that CBT-E is a recommended treatment, it can be helpful to seek out a therapist who is trained in this approach.
Other types of therapies that have been adapted for working with eating disorders and have been found to be helpful include:
- Acceptance and Commitment Therapy (ACT)
- Cognitive Remediation Therapy (CRT)
- Compassion Focused Therapy (CFT), which is particularly helpful for those who struggle with shame, guilt, or self-criticism.
- Dialectical Behaviour Therapy (DBT), which can be very helpful if the eating disorder is being used as a way of managing difficult emotions.
- Family-Based Therapy (FBT), which can be helpful for younger people.
- Interpersonal Psychotherapy (IPT)
- Psychodynamic Psychotherapy (FPT)
Research suggests that there are significant links between neurodivergence, ADHD or autism and eating disorders, so your therapist needs to be able to explore these with you and adapt their approach accordingly if needed.
Nutritional rehabilitation
Whichever psychological therapies your therapist specialises in, to be able to support you fully with an eating disorder, they will need to address nutritional rehabilitation. This means that they will be able to provide information and advice about the impact of irregular eating patterns on your body and brain, and support you to establish balanced patterns of eating over time.
To do this, you will likely be asked to keep a record of food and mood. In some cases, the therapist may recommend the support of a specialist dietician. If you aren’t ready or are unsure about making changes to your eating, your therapist needs to be able to explore this with you and work on motivation. The NICE-recommended therapy, MANTRA (Maudsley Anorexia Nervosa Treatment for Adults), was developed for this reason, so you may want to find a therapist trained in this.
Professional bodies
It's essential that any mental health professional you work with has the right credentials and is affiliated with a professional body that has a code of conduct or ethical framework for its members and will protect you in the unlikely scenario that you need to make a complaint.
Therapists working in eating disorders may belong to the BABCP, BACP, HCPC or UKCP. Psychologists will be members of the BPS. Each of these professional bodies has a therapist directory so that you can cross-check the registration of any therapist you identify. Registered membership of one of these organisations demonstrates that they have reached a recognised standard in their practice and are committed to maintaining high standards in clinical practice, supervision, and professional development.
Accreditation indicates that they have additional skills, qualifications and hours of practice. These are more important than the specific title that the therapist uses.
Up-to-date knowledge
What we understand about our bodies and brains is developing all the time, and this can provide new insights into how we support people with eating disorders. Make sure that any therapist you choose can tell you how they stay up to date on the latest research and therapy recommendations for working with eating disorders and associated issues. They should also be able to recommend current resources and books to support you.
Next steps
If you are reading this article, then you have already started to get informed.
Here are some other tips:
Explore different therapy approaches
Explore different types of therapy. Have a look at the NICE guidelines for the recommended approaches depending on age and presentation, and look at reputable websites to explore other types of therapy that have been found to be helpful.
Use filters to narrow your search
Always use the filter options when searching general directories for therapists. For example, if you select eating disorders as a concern, you may get a large number of results. Narrowing your search further using keywords such as "CBT-E" can help reduce this and make it easier to find more relevant support.
Make the most of initial consultations
Make use of the free initial chat that most therapists offer. Qualifications and experience are important, but you need to feel that there is potential to build a trusting relationship with them.
Prepare questions in advance
Be prepared by making a list of questions in advance. Ask about the type of therapy they would recommend and how many sessions you might expect to have. Ask what to expect and what will be expected of you, and share any concerns that you might have.
Understand how progress is monitored
Ask which tools they will use to support your therapy and monitor progress. Given the nature of eating disorders, experienced therapists will use outcome measures to assess and monitor your physical and mental health.
This means that before or during the first session, they will ask you to complete questionnaires. They will want to know your height and weight and will usually also ask you to complete a food and mood log. If you have any concerns about knowing your weight, this will be discussed.
Know how your physical health is supported
Your therapist will also ask you to consent to sharing your GP details so that they can liaise appropriately if you are not within a healthy weight range or there are additional risk factors. This may include asking the GP to monitor your physical health, for example, through blood tests.
Ask about neurodiversity-informed support
If you are neurodivergent, or suspect that you are, ask about their experience and how they might adapt their approach to better support you.
References
[1] O’Neill, K. Uncovering weight bias in therapists’ responses to risk for clients with Eating Disorders. International Weight Stigma Conference. June 2018.
[2] https://www.nice.org.uk/guidance/ng69