Serena Menken

Just before Thanksgiving 2020, my daughter Ellie summoned the courage to tell me that she had an eating disorder. It took her multiple attempts to get the words out: “I have a problem with food, Mom.”  

Ellie’s disclosure came after she had been in therapy for two months with Sarah, who was treating her for depression and anxiety. Sarah did everything right: she built trust quickly with Ellie, directed us wisely on getting school accommodations, urged us to find a psychiatrist, and knew when to recommend partial hospitalization. But eventually the painful realization came: as much as we loved Sarah, Ellie needed a therapist who specialized in eating disorders. We had to find someone else.

If you’re in the beginning stages of this journey, you might be wondering how to support a child with an eating disorder. I can’t overstate the importance of finding the right therapist for your child. While there are many great clinicians out there, you want to find the person who fits your teen. Here’s what I learned the hard way.

Find a Therapist Who Specializes in Eating Disorders

Even the best therapist in the world will be limited in how they can help your child if they don’t have a specialty in eating disorders. Treatment for eating disorders involves a complex blend of medical monitoring, nutrition management, identifying and addressing underlying conditions and emotions, and using evidence-based therapies such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT).  Eating disorder therapists are trained to assess, diagnose, treat and provide ongoing support for a variety of eating disorders, such as anorexia, bulimia, binge eating disorder, among others. So how do you find a clinician like this?

Start by reading therapist bio’s on their website and on Psychology Today. Make sure that eating disorders are listed as a primary specialty and don’t take someone else’s word for it. Once, a receptionist tried to convince me that a therapist in their group practice could treat Ellie, even though eating disorders were not listed on the bio (eventually, she admitted she was wrong). Look for relevant experience related to eating disorder recovery, such as experience in treatment centers or a professional association like the International Association of Eating Disorders Professionals.

Here are some websites that can help you search. Keep in mind that none of these sites endorse these therapists (neither do I, since I don’t know any of them) but it’s a place to start.

• Do a search on Psychology Today by going to “Find a Therapist” > add your zip code > under “Issues” drop-down tab, choose “Eating Disorders”
• ANAD (Association of Anorexia Nervosa and Associated Disorders) offers a treatment directory, along with a helpline
• EDReferral.com offers therapist referrals and information
• National Alliance for Eating Disorder’s provider directory 

Ultimately, I recommend asking for referrals, especially from those who have either recovered from an ED themselves or have a child in recovery.  Friends are the best resources because you’ll get someone’s real experiences. You can ask your pediatrician, a psychiatrist, or an eating disorder treatment center.  Online reviews are not helpful, because anyone can post anything, whether it’s true or as fictional as a Stephen King novel.

Maybe this goes without saying, but you also want to look for someone who can treat teenagers AND eating disorders. Sometimes it’s hard to find, but both are essential. Treating teenagers is a specialty in and of itself and you want your kid to feel like the therapist can understand their world.

 

Consider Family Based Treatment for Eating Disorders

Depending on your child’s needs, you might want to find a therapist who can work with you and your child together, using an approach called “Family-Based Treatment,” also known as the Maudsley Method.  It’s a method of therapy originally created by a team at the Maudsley Hospital in London in 1985. The premise is that instead of isolating a teen from the family to help them heal, a mental health clinician trains parents to be the primary caregivers in instituting an intensive outpatient treatment plan. The parents become an integral part of the teen’s recovery journey. 

Often, empowering parents is highly effective. A therapist trains parents to re-establish healthy eating patterns and hold strong boundaries to prevent a teen’s purging and restricting (note that FBT is best for treating anorexia and bulimia, not binge eating disorder). Sometimes a therapist works with the family as a whole; sometimes the therapist sees the teen for individual sessions and parents for family sessions.

Our daughter’s treatment center used a variation of FBT.  They prioritized biweekly individual therapy but also offered weekly family therapy. A nutritionist trained me in refeeding Ellie while the therapist helped us learn how to manage emotions and interactions. When Ellie was discharged, I sought both an individual therapist for Ellie and also a family therapist who would guide my husband and me. 

As I interviewed potential therapists, I asked questions such as, “How do you interact with parents when you are treating their child? Are you familiar with FBT principles? How would you support me as a parent in helping my daughter heal?”  

Many potential therapists answered in ways that demonstrated that we could partner together. On the other hand, one therapist said that sixteen-year-old Ellie would have to sign an official release for us to communicate, which raised a red flag (although this would be standard when a child reaches eighteen years old). Another didn’t seem to understand the role of the parent, which raised another flag. State laws vary in terms of how therapists can communicate with parents.

If you are interested in this method, you have options. You can look for “FBT” on therapist bios and ask in an email or phone call if they understand the method. If you want a certified FBT therapist, you can visit this website to find therapists who work by telehealth.

Ginny Jones is a coach for parents of eating disordered teens who offers many resources on her website, including a small directory of therapists who are experienced in supporting parents of eating disordered kids (may not be official FBT but similar philosophy). 

 

Prioritize Professionalism

 

Because it took months to find our ideal therapist, I interacted with a multitude of clinicians. From that experience, I learned to search for a level of professionalism that would serve us long-term.

Here’s some questions to consider:

• Does the therapist reply to communication within 72 hours?
• How are insurance claims handled? Many therapists, especially experienced ones in private practice, will not submit claims to insurance. What’s their system of sending you a superbill so you can submit it yourself?
• Does the therapist have experience partnering with other clinicians, such as a nutritionist, psychiatrist and pediatrician?
• How will the therapist discern whether a teen needs weekly, twice-weekly or every other week sessions? What will they do if their schedule doesn’t allow for the frequency a teen needs?
• How does the therapist know when to escalate the level of care?
• What is their protocol when a teen is in danger of hurting themselves?
• If the therapist is young, do they have oversight from a more experienced clinician?
• If the therapist is young, what kind of experience do they have? 

 

In my research, I found a couple of young therapists who were new to private practice. I got excited seeing an eating disorder treatment center on their resume, assuming they would be highly equipped. When I asked more questions, I realized that they had never done individual sessions with teens. Eating disorder treatment centers employ many recent grads in lower-level jobs such as behavioral health counselors (BHCs). These folks are called “therapists” and of course they have valuable experience. But their jobs may include activities like supervising meals and bathroom visits and assisting a more experienced therapist in running a group. This is not the same as individual therapy. These folks will probably have limited experience working with parents. 

 

On a positive side, they might be eager to learn, devoted to their patients, and energetic. Their youth might make them more relatable to your teens. 

 

But the flip side is that they don’t have the same experience and wisdom as someone who’s been treating patients for a decade or two. 

 

Try On More Than One Therapist

 

At fifteen years old, I summoned the courage to tell my mom that I had an eating disorder. Soon I had a therapist and a nutritionist. Before my first session, my mother said, “Pay attention to whether it’s a good fit.” 

Being brand-new to therapy, I had no idea what she was talking about. Was a therapist like a pair of jeans that feel too tight or too loose? Would I know if she was a good fit if she wasn’t weird? If she smiled at the right moments? But I was too ashamed to ask my mother what she meant. 

Unfortunately, my first therapy experience failed. We never established a trusting connection and my bulimia worsened. I wrote off therapy and isolated myself. Years later, I finally found a therapist who felt like home. I felt comfortable to share my real self with her; her advice felt like water for a parched soul.

If possible, I recommend finding two therapists for your teen to “try on”. Even though it’s exhausting to do an intake process twice, it will give them a chance to learn what therapy is. Anytime we give our teen choices, we empower them. Part of therapy is about finding the person our teens can trust to shepherd them from their most shameful places into the light. While we can offer two qualified candidates, only our teen can sense which person feels like the right guide for them. As we invite their input, they are more likely to own their therapeutic relationship.

 

Let Go Appropriately

Once your child has begun therapy, we parents need to let go. While we need to be involved in some ways, depending on the type of therapy, we also need to respect the privacy of the therapeutic relationship. Our child needs to know that what they share with the therapist is confidential, especially as they dig into the deeper causes of their eating disorder. Our child needs a safe space to explore the thoughts and feelings they’ve been afraid to say aloud, a place where they don’t have to worry about anyone else’s reactions.  It will take months, if not years, for our child to unpeel the layers of their pain. Giving them a therapist means giving them a trusted, confidential professional who can support their healing. Eventually, when they are ready, our child can share the more vulnerable parts of their journey with us. 

 

Conclusion

Take good care of yourself while therapist-hunting. Choosing a therapist for my daughter was a grueling process. I felt incredible pressure to choose the right stranger who would unlock her healing. It was discouraging to reach out to therapists, only to find out their caseloads were already full. No one took our insurance. I often felt like giving up, except I knew that this was Ellie’s lifeline. Eventually, through perseverance and a lot of prayer, we found the therapist who has been instrumental in supporting Ellie’s healing for the past three years. You will find your person, too. Just remember to take a lot of deep breaths, lean on supportive friends, and have faith.