The Worst Advice I Ever Gave as an Eating Disorder Therapist

While my third-grade peers were writing essays dreaming about professional baseball or working with elephants at the zoo, I was documenting my goal of becoming a psychologist. I was fascinated by people. I was hungry to understand them. Maybe I was a little weird.

When I started college, I changed my decade-long plan and decided to become a writer. I’d still analyze people, but from a safer distance. Words were my other great passion. I knew how powerful a phrase or an idea could be in the hands of someone who knew how to shape it.

Eventually I steered myself back on the path of psychology, with an even stronger conviction in how vital words can be in creating change — maybe even creating reality.

So today, reflecting many years later on some of the boneheaded things I’ve said to patients and families early in my career, doesn’t sit well.

“I did then what I knew how to do. Now that I know better, I do better.” – Maya Angelou

I’d like to believe that I follow in the late Angelou’s path of self-improvement. I like to think that I am using my acquired knowledge and experience in better service to patients and families now.

But the things that I’ve said in the past — before knowing better — still nag at me. A bitter sting of shame creeps over me when I remember sitting with patients and sharing certain words — my naiveté steering them in potentially disastrous directions.

I share some of those words with you now — not because I am looking for redemption. I share them because I hope they inspire other professionals to look critically at how our words shape our patients’ lives. I share them because I hope that people with eating disorders and their families are not still hearing these ideas laid out as truths.

Here are some of the worst things I’ve ever said as an eating disorder therapist:

1. “You have to truly want to get better; you might have to hit rock bottom first.”

Please don’t let yourself, your loved ones or your patients hit “rock bottom.” (What does rock bottom really mean, anyway?)

For some people, the worst moments of an eating disorder and associated costs can be motivation to build a life worth living. But we don’t need to let people get to the point of devastation — physically, psychologically, spiritually — before believing that they can get well.

Many people start the process of recovery not because they “truly want to get better,” but because they are (what most of us would consider) often forced into it: a loved one sets a boundary that they have to seek help, or they aren’t able to do their job as effectively anymore.

Sure, internal motivation is a worthy goal over the course of treatment. And we don’t have evidence to suggest that those people (being forced into care) do worse in the long run. But far too many people with eating disorders are too ill and consumed by the disorder to “want to get better” as a pre-requisite for wellness.

You don’t have to be able to see either rock bottom or the finish line to take the first step. You just have to take that step.

2. “Your parents seem to just create more stress for you; maybe it is better that you do this on your own.”

This one stings badly, and elicits the most shame for me.

I’ve been fortunate to stop the parent-blaming over the course of my career, but even when parent-blaming wasn’t en vogue, dismissiveness of the value of family still lingered.

There was a time, before I had the chance to work closely with families and get Family Based Treatment training, when I regularly pushed families out of the picture. I did this in sometimes subtle ways:

• Not asking enough about family or not inviting families in to be part of the process
• Aligning with the eating disorder goals to isolate the patient
• Missing or ignoring signs that my patients were longing for more support from the people who loved them most

This wasn’t intentional or even conscious on my part, necessarily. But this is what my behavior — and lack of behavior — did. And I deeply, deeply regret this.

I’m proud to say that creating systems and support for families is now a core part of my professional self. I’m proud to say that I learned how wrong I was to not understand how utterly crucial families are in recovery.

3. “You’re in a better place than where you started; that may be the best we can do.”

I absolutely hate thinking that I might have sold some of my patients short.

I believe I was well-intentioned in wanting to validate progress and not focus on perfection, but failing to hold on to hope for full recovery for my patients wasn’t the right thing to do.

The eating disorder wants us as clinicians and loved ones to back off, to be okay with weakening but not destroying it. And I have fallen prey to that before. I work hard now to not allow myself to be taken down by the eating disorder, whose tools can include things like fatigue, burnout, inertia, and overwhelm.

Statistics tell us that there are patients who do not recover, but I keep in mind that is not my role to decide who will fully recover — and who might not.

My role is to hold the conviction that each person who sits with me has the chance at full and sustained recovery.

My deep hope and intention is that I always continue to question myself and what I believe to be “true” at any given time. As the tides change and the research develops, we grow and evolve as clinicians if we pay attention. Today, I hope that my third-grade essay writing self might even be a little bit proud of the imperfect psychologist that I’ve become.

Ashley Solomon, PsyD, CEDS is Executive Director at Eating Recovery Center, Ohio.