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  • My role as a lead therapist for eating disorders

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    Dr Joanna Silver describes her role working with adults and children with eating disorders. An important part of her role is to work closely work with the multidisciplinary team and other health professionals to make sure the complexities of treating people with eating disorders and related conditions are understood and to ensure the patient is kept safe.


    In my current role I oversee the therapy programme for the Eating Disorders Unit (EDU) and see in-patients, day-patients and out-patients for individual and group therapy. I work with both adults and children with eating disorders, depression and anxiety, and use evidence-based therapies including cognitive behavioural therapy (CBT).

    A case study

    Lucy* is a 25-year-old interior designer who is seeking treatment for anorexia.  She was an inpatient on our EDU.

    Throughout the whole admission there is a strong focus on patient safety. One of Lucy’s goals was to gain weight to a safer weight, but the increases were very gradual to avoid refeeding syndrome. At the beginning of her stay and all throughout we carried out regular risk assessments to check her risk to herself and also to others. Lucy had her bloods monitored throughout and was regularly observed for physical symptoms. 

    In terms of the therapy, our focus was looking at the role that anorexia played in Lucy’s life. To do this we did a collaborative formulation which was continually evolving. This helped Lucy to make more sense of her illness and understand what it meant to her. Lucy was able to articulate that her anorexia made her feel ‘special’ and also was a way of managing difficult feelings such as feeling upset and angry by her parents’ divorce. Lucy was also able to identify that feelings were not spoken about in her family, so she did not have the ability to identify and name feelings.

    Lucy did very well in therapy managing both the physical and mental challenge of gaining weight. Over time, Lucy found different ways of managing her feelings such as talking to others, distracting herself and writing a journal.

    An essential part of our work is relapse management and ensuring that patients learn from their ‘blips’ instead of viewing them as failings.

    Key learning points

    I am flexible in tailoring treatment to patients’ needs and it is important to build a warm and trusting therapeutic relationship with patients. As part of my role I work closely with the multidisciplinary team and regularly present to other healthcare professionals about the complexities of treating people with eating disorders and related conditions and to ensure the patient's safety is always met. Here are some of my suggestions when treating children and adults with eating disorders:

    • It is important to remember that whilst sometimes people with eating disorders can look very emaciated and frail, at other times they can be a normal weight and look well. It is therefore vital that health professionals do not solely use weight to diagnose an eating disorder. 
    • People with eating disorders often have a great deal of shame and so may not readily disclose their symptoms and instead may present with physical problems such as bowel problems. It is helpful if health professionals ask question such as "do you ever restrict your food" or "do you ever experience guilt after eating".
    •  Treatment for an eating disorder involves monitoring both the physical and psychological health of the patient. In order to ensure the physical safety of patients, tasks include monitoring electrolyte levels, assessing for risk and assessing patients nutritional and fluid levels.
    • Eating disorders are complex mental illnesses in which patients use food in different ways to cope with difficult feelings. Health professionals should aim to build a positive therapeutic relationship with patients and should have a non-judgmental and accepting attitude towards them.

    *Name and details of patient have been changed to preserve confidentiality.

    About the Author

    I am a Lead Therapist for Eating Disorders at Nightingale Hospital, London, and have been in this role for 7 years.

    Prior to my training in Counselling Psychology, I was a secondary school English teacher. My training and experience as a teacher has been invaluable in my therapeutic work with patients and enables me to work creatively with young people and adults.

     I run a friends and family support group for the EDU at Nightingale Hospital. In this group I give presentations on relevant topics including ‘how to communicate well with your loved one,’ ‘dealing with difficult behaviours,’ and ‘moving towards recovery.’ The group is a space where attendees can share their experiences, successes, and problems.

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