Top 5 Skills Every Therapist and Dietitian Needs for Treating Eating Disorders
Eating disorders are complex, multifaceted conditions that require a nuanced and highly specialized approach to treatment.
Whether you’re a therapist or a dietitian, working with clients who struggle with disordered eating means addressing not only their physical health but also their emotional and psychological well-being.
To competently support clients in their recovery, professionals need a unique set of skills that go beyond general mental health or nutrition knowledge. In this blog, we’ll explore 5 skills that every therapist and dietitian needs in their tool belt when working with clients with eating disorders. These actionable insights will help you provide more comprehensive, compassionate, and effective care.
1. Trauma-Informed Care: Understanding the Connection Between Trauma and Eating Disorders
Trauma and eating disorders are often closely linked, as many individuals use disordered eating behaviors as a way to cope with unprocessed trauma symptoms. Research indicates that individuals who have experienced trauma, such as relational, emotional, or physical abuse, are more likely to develop eating disorders as a way to cope with unmanageable or intolerable emotions, sensations, thoughts, or memories that are held in their bodies.
Eating disorder behaviors can “help” our clients to regain a lost sense of control over their bodies and/or lives (American Psychiatric Association, 2013). Of course, we understand that this only makes things worse for the client, as the eating disorder behaviors actually spin their lives more out of control, but it is important to understand that they also help.
Trauma-informed treatment means creating a safe, non-judgmental, and empowering space where clients feel supported in confronting the feelings and body sensations they use ED behaviors to avoid. Implementing trauma-informed therapeutic modalities can also help clinicians and clients recognize how traumatic experiences may be contributing to disordered eating behaviors currently in the client’s life. This allows for deeper and more sustainable recovery work, as the goal of treatment is to put the eating disorder out of a job.
Actionable Insight:
Create a treatment environment is emotionally safe, has furniture to comfortably support all bodies, and is free of judgment. If you have proper training, incorporate trauma-focused modalities (e.g., EMDR, Somatic Experiencing, IFS, etc) into the treatment plan to address deeper underlying wounds that keep the eating disorder alive. If you are not trained in trauma modalities, you can encourage the client to add this into their treatment as an addition with a trained clinician. Remember that asking the client to verbally relive traumatic experiences is most often contraindicated, as it can re-traumatize the client. Provide the client with plenty of skills and tools to use instead of their eating disorder, when they can.
2. Cultural Competence: Providing Inclusive and Antiracist Care
Eating disorders do not discriminate — they affect individuals of all races, ethnicities, genders, and socioeconomic backgrounds. However, many treatment approaches have historically been developed with a narrow focus on specific populations, often overlooking the diverse experiences of clients from marginalized communities.
Cultural competence is the ability to understand, appreciate, and interact with people from different cultural or socio-economic backgrounds. For professionals treating eating disorders, this means being aware of how factors like race, gender, body size, and cultural norms can influence the development and expression of disordered eating behaviors.
Actionable Insight:
Educate yourself about the racist and fat phobic roots of eating disorders, and how to speak to it well in session with clients. Because eating disorder recovery requires our clients to rebel against diet culture, being able to inspire clients and articulate what is needed to move toward eating disorder recovery is a game-changer in session.
Take time to learn about the cultural backgrounds of your clients and how their experiences may influence their relationship with food and body image. Avoid making assumptions based on stereotypes and ensure that your treatment approach is inclusive, respectful, and tailored to each client’s unique needs.
3. Interdisciplinary Collaboration: Working as Part of a Team
Eating disorder treatment often requires the collaboration of multiple professionals, including therapists, dietitians, medical doctors, and sometimes psychiatrists. No single professional can address all the complex aspects of an eating disorder alone. For effective treatment, it’s crucial to work as part of a multidisciplinary team, with each specialist providing expertise in their respective areas.
For therapists, this means working closely with dietitians to ensure that clients are receiving both emotional and nutritional support. For dietitians, it means understanding the psychological aspects of eating disorders and collaborating with mental health professionals to address underlying emotional issues.
Actionable Insight:
Develop strong communication skills and regularly collaborate with other professionals involved in your client’s care. Make sure you’re aligned on treatment goals and interventions, and share relevant information to provide comprehensive support. For example, a dietitian might share how a client is progressing nutritionally, while a therapist can provide insights into the client’s emotional and psychological well-being.
4. Behavioral and Insight-Oriented Therapy Techniques: Addressing Eating Disorder Behaviors Holistically
The complexity of eating disorders requires a comprehensive and individually tailored approached in treatment. Specifically, an insight-oriented modality and a behavior-oriented modality are needed in the treatment plan. This strategy, put simplistically, is centered around a holistic approach in which a client is supported to both understand the function of the eating disorder and to learn and implement tools and skills, to reduce and eventually stop eating disorder behaviors.
Actionable Insight:
Learn about different treatment modalities and incorporate them into your work with clients.
Examples of insight-oriented approaches: Psychodynamic, Internal Family Systems (IFS), Emotion-Focused Therapy (EFT), Acceptance and Commitment Therapy (ACT), Somatic Experiencing (SE).
Examples of behavior-oriented treatment modalities: Dialectical Behavior Therapy (DBT), Radically Open Dialectical Behavior Therapy (RO-DBT), Cognitive Behavioral Therapy (CBT).
Some overlap between the two above categories is to be expected.
5. Validation & Autonomy: Building Trust and Connection with Clients
Working with clients who have eating disorders requires clinicians have a high level of tolerance for both ambiguity and distress. This is due to the nature of eating disorders, as they are often very complex, can be dangerous medically, and recovery is most often a long-term process that involves relapse.
Many clients with eating disorders feel out of control or invisible in their lives and bodies. Therefore, ED treatment needs to center client autonomy and Harm Reduction (when safe). People with eating disorders require a sense of safety with the treatment team both environmentally and emotionally, as there is often a history of trauma within this population.
Establishing trust and rapport will help clients feel more safe in sharing more about their inner worlds, which is often fraught with shame.
Actionable Insight:
Clinicians can both validate the clients’ need for their eating disorder and encourage recovery at the same time. Empower clients to summon the courage to recover by both honoring their autonomy and validating their emotions. Educate yourself on Harm Reduction practices for eating disorders, and learn more about what it means to give autonomy to clients as much as it si safe to do so.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
National Institute of Mental Health. (2021). Eating disorders. Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Trauma-informed care in behavioral health services (Treatment Improvement Protocol (TIP) Series, No. 57). Rockville, MD: SAMHSA.
Legal Disclaimer:
The content provided by Inclusive Eating Disorder Education, PLLC is for educational purposes only, aimed at helping clinicians and professionals learn about eating disorder treatment. This information is not a substitute for clinical supervision, professional training, or medical, psychological, or nutritional advice. Clinicians should always rely on their professional judgment and consult relevant healthcare providers when treating clients. IEDE assumes no responsibility for any errors, omissions, or outcomes related to the use of this information in practice.