Recently Laura, a 21-year-old neighbor I’ve known for several years called me and confessed she’d been struggling with an eating disorder. She asked if I thought therapy could make a difference. I assured her that after many decades of working with people with this kind of problem, I know that people can and do recover. She asked for a referral and I gave her the names of three professionals. Before she left, a few more questions came up: How should she decide between the three recommendations? What qualities should she seek? How would she know who was a good match?
Of course all the therapists I suggested were licensed and credentialed professionals, well trained in the treatment of eating disorders—a basic consideration in selecting a practitioner. But sometimes even seasoned, experienced professionals, who are highly competent and ethically solid, are not necessarily a good match. This is crucial. While the goal of therapy is to improve how you feel about yourself and your life, the process can often be difficult and lengthy. I shared with Laura some of my own criteria for working with a professional:
1. Connections. Eating disorders reflect profound disconnections—from oneself, disconnections. Therapy can take many paths, but no matter which one you take, the relationship you form with your therapist is a steppingstone to healing your disconnections from yourself (your thoughts and feelings), from other people, and from your ability to take risks and grow.
2. Competence. Don’t be afraid to ask about the therapist’s experience. Many professionals have a broad range of skills, especially if they have been practicing for many years. But holding a degree (PhD, MFT, LCSW, MD) and being an experienced practitioner does not mean one is qualified to deal with every problem. It is appropriate to ask questions such as: Have you worked with people who have eating disorders before? How many people have you seen? How many years have you been practicing?
3. Collaboration. Therapy is a collaborative relationship, but therapists are not mind readers. It is your responsibility to convey what you are feeling and thinking and to let the professional into your private world. Recently, a young woman I’d been working with for over a year admitted that in addition to bulimia nervosa, she’d been shoplifting. When I asked why she hadn’t talked about this earlier, she said she’d been too embarrassed. Despite the difficultly of disclosing personal information, try not to censor yourself. Openness is key.
4. Care. Therapy is above all a personal relationship. It is important to feel that the person you are working with cares about your life, your well-being, and your progress. The process is work, and painful feelings will arise. A good therapist will check in with you and discuss the pace of the work you are doing together.
5. Challenging. While it is key to find a professional who is caring and a good listener, it is also smart to find someone who will challenge you to some degree—and in a caring way. Through experiencing some discomfort, we are often able to make the most meaningful changes.
6. Comfort. In choosing a professional, be an informed consumer. Become acquainted with the many orientations and styles of psychotherapy and feel free to shop around and set up more than one consultation. Therapists differ: Some talk a lot while others remain fairly quiet. Some are directive while others are less structured. Some provide homework and others do not. Begin by checking out the many websites and books recommended at Gürze Books (www.gurze.com). In addition, speak to friends and other professionals. Above all, trust your own judgment. No one style works for everyone. Find your own comfort zone.
7. Confidentiality. Trust is at the foundation of any healing relationship. It is the therapist’s responsibility to maintain the focus on treatment, your well-being, and uphold professional boundaries and confidentiality.
In Conclusion
Trust your intuition. During the process of therapy it is likely you will have many reactions. If you do not feel comfortable with what is happening, trust your gut and speak up. Most good professionals welcome and respond to feedback. If you do not feel you are making strides in your healing process, it is appropriate to consider having another consultation.
Judith Ruskay Rabinor, PhD, is the Director of the American Eating Disorder Center with offices in Lido Beach, Long Island, and in Manhattan. She is the author of A Starving Madness: Tales of Hunger, Hope and Healing in Psychotherapy (Gürze Books 2002).
