When to Refer to an Eating Disorder Specialist
For therapists outside of the eating disorder world, there’s often a question about when it’s appropriate to work with someone with a disordered relationship with food, and when it’s better to refer out to someone who specializes in this area. There isn’t really one answer, as it partially depends on the severity of symptom use, other members of the treatment team, and the therapist’s comfortability with the issue, but here are some things to keep in mind:
If you’re just starting to work with a client and you’re hearing behaviors that are really concerning you can either refer out automatically if you feel like it’s beyond the scope of your knowledge or you can consult with an eating disorder specialist first. There’s plenty of eating disorder therapists and dietitians who would be happy to chat about the symptoms you’re seeing and how treatment might look moving forward. Sometimes, it really is better that they see someone with more experience working with eating disorders, but sometimes, the behaviors might actually be more on the disordered eating side of the spectrum, which, if you’re comfortable working with, does not necessarily require a specialist. Then, it’s really up to you and if you feel confident dealing with the behaviors and the underlying issues.
If you’re working with a client for a long time and have a great rapport, but you’re starting to see signs of disordered eating or a full eating disorder, you don’t necessarily have to refer them out, especially if you have a good relationship. This is where adding an eating disorder dietitian can be really helpful. They are qualified to help with the food and exercise piece and because there’s always emotions attached to that, they also know how to handle the emotional side of things too. This would leave you with space to talk about the issues underlying the eating disorder, whether that be a mood disorder, trauma, lacking connections or a sense of belonging, etc. which is well-within the scope of what you likely do as a therapist. As long as there’s open communication between you and the dietitian, it’s perfectly okay to keep that therapeutic relationship going with that client, even if you’re not specializing in eating disorders yourself.
If the symptoms are severe, including medical instability or behaviors that are impacting ability to go to work or school, referring to a higher level of care (as opposed to another therapist) is likely the way to go, as a specialist would probably make the same recommendation. Many clients do not like the idea of going to treatment, as it really does infringe on their lives, either by cutting into their evenings or requiring a leave of absence, but it really can be the fastest and most effective way to kickstart recovery. Clients receive specialized treatment from individual therapists, dietitians, group therapy, and sometimes psychiatrists depending on the program, and because they’re spending multiple hours a week dedicated to treatment, they’re likely to start improving faster than if they stayed at the outpatient level. Next week, I’ll provide a cheat sheet on how to tell if a client is meeting eating disorder criteria and when a higher level of care would be the appropriate referral!
