Being Recovered &
Current research indicates that a significant number of eating disorder treatment professionals have personally experienced an eating disorder. Reports range from 25% to 55%. Many of these therapists desire positions in the eating disorder field where they can use their personal experience but most don't feel safe revealing their history. The pros and cons of clinicians, with a personal history of an eating disorder, working with eating disorder patients has been a topic of discussion for many years. Those in favor and those against have been unable to come up with any kind of consensus or guidelines.
Carolyn: "Since I began treating eating disorders in 1979 I have always referred to and utilized my own recovery from anorexia nervosa. In fact, my first referral came from a high school principal who referred me the client because he knew I had suffered from my own eating disorder and thought this would help me in relating to the young woman. He also told her the same. Therefore, "the cat was already out of the bag" so to speak. I told the client I was recovered and that if I could do it, so could she. Since that day I have been open about my own experience with an eating disorder and that people with eating disorders can be fully "recovered." This fact has been in my resume, in my books, and in the brochure for the treatment program I founded, Monte Nido, where over 20 years as clinical director I hired and supervised hundreds of staff members who came seeking employment with the desire to give back."
Advantages of Recovered Clinicians
I learned not only from my first client, but every subsequent client thereafter, that I had a unique vantage point to offer. I had lived with a brain that was once hijacked by an eating disorder, and had successfully gotten my real brain back. Having been through it, I could explain, to clients and loved ones, as well as other clinicians, the mind set of someone with an eating disorder. I found that I could empathize in a deeply connected and personal way with the client's "need" for their eating disorder behaviors and their fear of giving them up. But I could also easily confront and challenge clients in many important ways that were necessary in order to help them get better. For example, if they suggested the eating disorder was more powerful than they were I readily replied that this was impossible, because just like I had in the past, they were the ones giving the eating disorder its power and they could learn to stop doing so. I also was spared what so many colleagues report hearing from their eating disorder clients; "You just don't get it," or "Unless you've been there you can't understand."
Over the last three decades I have hired and trained countless recovered clinicians to work with me at various levels of care, all the while receiving consistent reports from now thousands of clients and families describing how working with a recovered therapist was a significant factor in their or their loved ones treatment success.
In an article titled, "Been There, Done That" (2002), Craig Johnson and I delineated the advantages and disadvantages of clinicians with personal recovery. Since then others have noted advantages similar to those we described: increased relational understanding, empathy, client's feeling safe, insight and knowledge of the disorder and messengers of hope. In our article we concluded that the advantages were great enough that the field needed to work together to come up with guidelines for clinicians with personal recovery to use. Today, 14 years later this has not been done.
Potential Pitfalls of Clinicians With Personal Recovery
The most commonly cited downfalls regarding clinicians with a personal eating disorder history working with eating disorder clients include various kinds of counter-transference issues such as over-identification, e.g., clinicians having narrow views of how recovery takes place, or a high sense of personal mission that could lead to over involvement. What is also always brought up is the risk of therapist's getting triggered or relapsing.
Indeed in a study by Barbarich (2002), 28% (27 out of 97) of eating disorder professionals with a history of an eating disorder, reported relapse after entering the field as a professional.
There are many questions to be asked about the Barbarich study;
1) Were the therapists really "recovered", did they describe themselves as "recovered?"
2) Did the therapists have at least 2 years of being recovered before working in the field, i.e., were they recovered enough?
3) How many of these therapists kept their personal histories hidden from colleagues and/or patients thus receiving no guidance or supervision in how to use their personal experiences in their work?
I have worked with recovered clinicians in various treatment settings for 30 years following these guidelines:
I only hire clinicians who can say they are "recovered" ( see my definition below)
I only hire recovered clinicians if they have been "recovered" for at least 2 years.
I consistently provided specific guidance and supervision for recovered staff
My policies resulted in only 1 case I know of where a recovered staff member relapsed.
If the field could establish guidelines and come up strategies and topics for supervision, clinicians can be prepared to use their personal history and prevented from letting it get in the way.
The Terms Recovery, Recovering and Recovered
Other than using the term "recovered" some people describe themselves as "recovering" from an eating disorder or say they are "in recovery". What does this mean? There are no universally accepted definitions for any these terms. Many people think that the terms recovery, recovering and recovered are just semantic issues, not to be bothered with. However, there are problems with these terms that are specifically related to how people might view clinicians with eating disorder histories. If we need to determine when a clinician is recovered enough to work in the field and try to minimize relapse, then a solid definition of "recovered" is important.
Early on in the eating disorder field professionals and patients started applying the 12 Step treatment model and language to eating disorder treatment. Though Bill W., in the Big Book of AA, uses the term "recovered" several times, substance abuse and chemical dependency circles left the term behind long ago since "recovery" or "recovering" work better to explain the 12-step disease/addiction model, of a lifelong illness where one needs to keep abstinent one day at a time.
Problems arise when applying the 12-step addiction model and language to eating disorders. First, one cannot abstain from food and second, there is no consensus that eating disorders are a disease that the person has for life. Furthermore, the terms recovery and recovering are too vague and ambiguous, when applied to eating disorders. If a former drinker says I am a recovering alcoholic it means he or she is not drinking but still acknowledges a lifelong illness. When a person with an eating disorder says, "I am a recovering anorexic" or "I'm in recovery from anorexia" what do they actually mean? The truth is they can mean any number of things such as the person is in residential treatment, the person has just discharged from a treatment program, or the person has been well and normal weight for 10 years. The term recovered can be defined specifically to denote that the eating disorder is gone, healed, over. "Recovered" is a term used by individuals who feel that it is possible to fully overcome an eating disorder and leave it behind. The problem with the term "recovered" is how exactly to define it and who decides when an individual has reached this state.
I have used the term "recovered" and spent my entire career as an eating disorder therapist defending it... i.e., working hard to establish a consensus in our field that indeed a person who suffers from an eating disorder can become fully recovered.
Since the field does not have a definition for this term I decided to come up with my own which was first published in my book, 100 Questions and Answers About Eating Disorders and then in 8 Keys To Recovery From an Eating Disorder:
"Being recovered is when the person can accept his or her natural body size and shape
and no longer has a self destructive or unnatural 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 a scale.
When you are recovered, you do not use eating disorder behaviors to deal with, distract from,
or cope with other problems."
Even though not all clinicians and thus sadly not all clients, believe that being fully "recovered" is possible, using my definition, it certainly seems like a good goal to aim for with clients and that therapists who have reached this goal would be a welcomed addition to the field. How clients and clinicians view the disorder and the end goal of treatment can affect, not only the nature of the treatment, but the actual outcome itself. If both believe that those suffering from eating disorders can be fully recovered, this will help them pursue "being recovered" as an end goal, not settling for less or ending treatment before this is accomplished. Clients find much needed motivation and hope when they see clinicians who were once seriously ill and now recovered and at peace with food and their bodies.