Once you decide you're willing to try therapy, the next step is to find the right kind of help. If you're a teenager or young adult, your parents or guardians will help you do this. They've probably made most decisions about your health care, to date, and it's possible you've never before had a voice in this process. But this is one time where your input is both desirable and important. How do you begin? What are your options?
h Find a qualified therapist who has special training in working with anorexics and bulimics.
The Academy for Eating Disorders (AED) (703/556-9222; www.aed-websOrg) and the International Association for Eating Disorder Professionals (IAEDP) (877/540-5691; www.iaedp.com) maintain memberships lists of qualified therapists. Both of these organizations have stringent requirements for professional training before they will allow health care professionals to become members. (This doesn't mean the therapists who aren't members of either group are untrained or unprofessional. It may just mean that they have not applied for membership or haven't yet fulfilled all the continuing education and training requirements for membership.) The AED also publishes an annual directory of health care professionals with information about each member's practice (the geographic location of the office, if they work with children and adolescents or adults, if they do individual, family, or group therapy, how to make contact by phone, fax, or email). A number of other directories also exist online at websites such as the Eating Disorders Referral Center (www.edreferral.com) f Something Fishy (mvw.something-fishy.org) and Pale Reflections (www.pale-reflections.com). In addition, most hospitals with inpatient eating disorder units as well as other independent eating disorder treatment facilities list their staff members as part of their website information.
Since finding the right therapist is such an important part of recovery, call and/or interview as many people or places as you need or want to before making your decision. This is a common practice which is expected by most therapists. A family member might help you do the ground-work, but the more you're involved in this process, the greater will be your commitment to therapy.
In a way, this is similar to beginning a class in school that you're initially hesitant about. Maybe you're afraid you'll be bored or worried it will be too hard. If you sit in the back of the room, never answer questions, rarely participate in discussions, then those negative expectations will probably come true. But if you sit up front, raise your hand a lot, and get involved in activities, you might like the class so much that you want to come back to the next session.
3. Make a "shopping list" of the qualities of the professional "helper" or "helpers" with whom you see yourself succeeding.
Answer the following questions:
• Does the gender of the doctor or therapist matter to you? Why?
If you are a girl, would you prefer a female practitioner? If you are a boy, would you prefer a male doctor or therapist? What are the reasons for your preference? Have you had a particularly good or bad experience with a same-sex or opposite-sex health care provider in the past that has caused you to feel this way?
• Would the age of the doctor or therapist alter your willingness to work with this person? Why?
For instance, could you discuss your problems more openly with a young therapist because you'd feel more in sync? Do you think you'd have more confidence in someone older who had more professional experience? Is your reasoning based on actual past experiences with older versus younger teachers or doctors? Is your reasoning based on gut feeling?
• Does the therapist's style of working with patients matter to you?
Do you feel so overwhelmed at this moment that you think you'd prefer a directive, authoritative therapist with a clear-cut approach? Or would you like someone with a more flexible approach? Are you looking for someone who is willing to give you all the time you need to tell your story and explore your problems? Or do you want to work with someone who will dive right in and try to get things resolved quickly?
• Would you be willing to be seen by a health care provider who had worked with and was recommended by one of your friends or relatives, or would you prefer going to someone unknown by anyone else in your network of relationships? Why?
Some people find that knowing about a therapist's personality and reputation from the firsthand experience of a friend or relative eases the tension of initial visits and makes the thought of therapy a bit less unnerving. What qualities match the items on your own "therapist shopping list"? On the other hand, you might be concerned about privacy and confidentiality, and feel threatened by the thought that someone else who knows you also knows your therapist. Perhaps you're concerned that you won't be able to speak openly and honestly with a therapist who has a connection to your family or peers.
• Is there a chance that the location of the office might affect your willingness to work with the doctor or therapist?
As odd as this question might seem, many people are put off by the location of some offices. This is often the case when appointments take place in hospital-based offices, because some people find hospitals to be intimidating. Perhaps the location is hard to get to: maybe it isn't within walking distance from home, school, a bus or subway stop, or is so far from home that driving there and back takes a long time. Lots of people get sloppy about keeping appointments if getting to them is such an effort that the payoffs don't seem to outweigh the inconvenience involved. Think about this ahead of time so that the office's location won't turn into your excuse to avoid or stop therapy after you've begun.
4. Make a list of anything you would want to ask a therapist.
Here are some questions I'm frequently asked by prospective clients.
• What is your educational background?
• How long have you been a therapist?
• How and why did you become an eating disorder therapist?
• Do you or did you have an eating disorder?
• Are you a licensed professional?
• What is your preferred treatment approach?
• How much does a session cost? Do you accept insurance? Do you have a sliding fee scale if I don't have insurance that will cover your services?
• Do you prescribe medications? How do you decide what medications to prescribe?
• Will you work with me alone and have my family work with another therapist, or will we all work with the same therapist or therapy team?
• Do you offer group therapy?
• How often would we meet? How do you decide how many times we will meet?
• Can I contact you between our scheduled sessions if I need to? Will those interactions be confidential?
• Can I communicate with you by email? Will those emails be confidential?
• What will you do if I disagree with your suggestions during therapy?
• How long will it take me to know you're the right therapist for me?
• What if you and I don't click? Can you refer me to someone else? Will you be angry with me?
• Can I be forced into treatment against my will?
Any concern you have is valid; it's better to ask too many questions than too few.
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