You might feel very conflicted about seeking professional help for an eating disorder. Not knowing where to begin can make the process even harder. This blog will run through the process of finding a good eating disorder therapist in the UK.
I hope this information helps you take a step towards recovery and heal your relationship with food.
NHS Eating Disorder Services
Most areas in the UK will have a specialist NHS eating disorder service through which you can access treatment free of charge. The first step is to contact your GP, explain the difficulties you are experiencing and request a referral to your local eating disorders team. You might find it helpful to bring a list of the symptoms you are experiencing, or bring someone with you who can help support you. Some GPs are more knowledgeable than others about eating disorders. The eating disorder charity BEAT have produced a helpful leaflet to provide guidance on getting a referral.
You shouldn’t be refused a referral on the basis of how long you have been experiencing disordered eating. We know that it is far better to begin treatment for an eating disorder quickly. There is no need for a “watch and wait” period. Your GP should refer you to a specialist team who can do an assessment to determine whether eating disorder treatment is needed. In the UK the First Episode Rapid Early Intervention for Eating Disorders (FREED) program is being gradually rolled out into NHS eating disorder services. This treatment approach aims to help young people (usually aged 16-25) access eating disorder treatment as quickly as possible.
You shouldn’t be refused a referral based on your weight. We know that about 85% of people with an eating disorder are not underweight. Each service will have their own referral criteria, but your health and wellbeing should be considered in the round (not just on the basis of your weight).
If you (or your child) are aged under 18, the Access and Waiting Time Standard for Children and Young People with Eating Disorders states that NICE recommended treatment should start within 4 weeks for “routine cases” and 1 week for “urgent cases”. Whilst services may not always be able to meet these standards, it is sometimes the case that waiting times may be less than you had initially anticipated.
Private Therapy Options
Some people will consider seeking therapy privately, usually because their NHS service still has long waiting times or are unable to offer particular types of therapy. While this option may involve additional costs, it offers more control over your treatment timeline and the therapist you see. You can read more about the price of eating disorder therapy here.
If you chose to seek private therapy, you can use these steps to help you find the right person:
It is important to make sure that your therapist is appropriately qualified and registered with a recognised professional body. In the UK, the title of ‘psychologist’ is not protected, nor are ‘therapist’, ‘counsellor’ or ‘psychotherapist’. As many people don’t know this, it can make finding a suitably trained clinician really difficult.
To ensure your therapist is qualified, make sure that they are registered with the appropriate body: The Health & Care Professions Council (HCPC); British Association for Counsellors and Psychotherapists (BACP); UK Council for Psychotherapy (UKCP); The National Counselling Society (NCS); British Association for Behavioural & Cognitive Psychotherapies (BABCP).
Clinical Psychologists undergo substantial training: 6-7 years of academic study and a minimum of 1-2 years clinical experience (often more) before qualifying. They train in a variety of therapy models which enables them to create an individualised treatment plan and draw upon different types of therapy to best match the person’s needs.
Eating disorders require specialist treatment and it is very important that your therapist has experience working in this area. Eating disorders are mental health difficulties, but they have physical health consequences that can maintain the difficulty. Your therapist therefore needs to have an understanding of the interaction between eating, mental health and physical health.
Make sure you ask what experience your therapist has with eating disorders and whether they are trained in eating disorder specific models of therapy including: Cognitive Behaviour Therapy for Eating Disorders (e.g., CBT-E; CBT-T) and the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA). They should also be aware of the NICE (2017) guidelines for eating disorders.
3. Adult vs Child
Eating disorder therapists will usually specialise in either children or adults. This is because the recommended treatment for adults and children has differences (although there are large overlaps). It is therefore important that you ask your therapist whether they work with adults or children (some may have experience in both).
For children and adolescents, the first-line recommendation is eating disorder focused family therapy. Not all therapists are trained to deliver family therapy, so it is important that you find someone is. A commonly used approach is called Family-Based Treatment (FBT) for eating disorders. For adults, the recommended therapies are CBT for eating disorders, MANTRA (for anorexia), or Specialist Supportive Clinical Management (SSCM) (for anorexia).
4. The Therapeutic Relationship
As well as finding someone who has the right qualifications and experience, it is equally as important to find a therapist you feel comfortable with. Research tells us that building a good therapeutic relationship is one of the most important aspects of therapy, no matter what type of therapy is being offered.
You need to feel comfortable sharing your thoughts and feelings with your therapist. Whilst it is normal for it to take time to build trust with someone new, if you find yourself unable to be open and honest with your therapist (maybe you do not feel safe or comfortable enough to do so) then consider looking for a different therapist who may be a better fit for you.
5. Red flags
Whilst every therapist will have their own style, there are a few red flags to watch out for:
a. Promising weight loss
A reputable therapist will be explicit that eating disorder therapy does not focus on weight loss. The goals of weight loss and recovering from an eating disorder are incompatible. Whilst weight loss might be an appropriate goal for you (if you are considered medically overweight), before this can happen it is important to heal your relationship with food and address any underlying emotional factors.
b. No discussion of weight or food at all
Discussion of your current patterns of eating and fears around weight should be included in your therapy. Some people believe that if you address wider psychological distress and this is resolved, then the eating disorder will resolve without direct treatment. Unfortunately, the evidence tells us that this is not true and discussion about food, eating and weight are a necessary part of treatment.
You may have had a bad experience of treatment in the past and felt that it was solely focussed on meal plans and weight. A good therapist will be able to integrate this with the important emotional links and be able to discuss with you how you are finding the therapy.
c. Stepping outside of competency
A therapist should work within their professional boundaries and refer you to other specialists, such as dietitians or medical professionals, when necessary. A good eating disorder therapist will have an understanding of the link between physical and emotional health and the importance of regular eating. However, if a therapist tries to handle aspects of treatment beyond their expertise, it is a red flag.
d. Unwillingness to collaborate
For many people, collaborative care with other professionals (such as a dietitian or your GP) will be crucial for holistic care. Your therapist should be willing to work collaboratively with others wherever necessary.
e. Violating boundaries
Your therapist should always maintain an appropriate and professional relationship with you. Red flags include any sexual contact, asking for money that isn’t payment for sessions, asking for ‘favours’ (e.g., if the patient is an accountant, being asked by their therapist to do their accounts), inappropriate contact between sessions (e.g., asking to follow your social media accounts), excessive self-disclosure (where the session becomes about the therapist, or the information is being shared for the benefit of the therapist and not the patient).
6. Where to find an eating disorder therapist
You might find a therapist by word of mouth, and often people ask for recommendations (e.g., from a GP or other professional). If you’re reading this, you probably are looking for someone online. Below is a list of popular directories:
If you think we might be a good fit for you, please do get in touch to arrange a free consultation.
If you are on the waiting list for therapy, or not yet at the stage of seeking professional help, you mind find this list of eating disorder recovery books helpful.
We know that not everyone feels ready to recover from their eating disorder. I have written a post for people who do not feel ready to recovery from bulimia here, including steps to move forward.