After I published my Questions For Counsellors piece I was approached by Fenella Lemonsky (@organiclemon) about hosting a guest post on treatment for eating disorders. This is such an important topic, where specialist knowledge is vital, I was honoured to. Many Thanks to Fenella for writing this. 

Content note; Eating disorder, anorexia, bulimia, food.

We have just had National Eating Disorders Week 2015. It was organised by BEAT the national charity for eating disorders. I am a group facilitator for Beat and set up 13 years ago the North London EatingDisorders Group. I take on psychology graduates or therapy trainees to help me in the group. My group is funded by my local authority plus I receive donations and a small fee for people outside the area. We support anyone with any type of eating disorder.

Over the last five years binge eating disorders have become more prevalent in asking for help. However we also see anorexia, bulimia and atypical eating difficulties. We are not a diet group and we don’t ever talk calories. Most who come have been in treatment or on a waiting list. Many are also in private therapy or counselling.

I thought it may be useful to say something about this as there are so many models on offer to people yet how do lay people know what type of therapist to choose or what to ask for in an NHS clinic. Therapy may come in group form or individual work. Long or short term. In the NHS bulimia and binge eating programmes tend to initially offer CBT group work as there is a good evidence base for this then if you need more therapy you sit on a long waiting list for a psychologist for either psychodynamic type work or behavioural work.Anorexia tends to be individual work but group work such as creative therapies are used successfully. Creative therapies also help bulimia and binge eating.

Privately people need to ensure that any therapist is trained and experienced in eating disorders and has had good experience in an NHS team. This ensures they have a minimum standard. Very important is to ask about supervision as all therapists and counsellors must have regular supervision with someone more experienced than themselves.

Newer therapies are now available for people with more complex issues such as self harm and borderline personality disorder. The most popular and evidence based is Mentalization Based Treatment. MBT for short. It was developed by a psychiatrist /psychotherapist and a psychologist, Anthony Bateman and Peter Fonagy at University College London. If you google either name and Mentalization you will find lots of information. Training for this treatment is also available for professionals who are at postgraduate level. Mentalization looks at helping you see the world in a way that takes in how the other person may feel about what you say. This is because those with BPD struggle to see the world as neutral but rather as a distorted view based on only their view. This stems back to childhood and disturbance in attachment when there was an experience of strong distrust and invalidation and rejection by a parent figure that meant that person as a result struggled to see things in a balanced way. Mentalization is very good at correcting this so that people can see the world from a full perspective not just a singular view- ie it’s my view and I am right. Rather yes I can see it from that point of view. The other important aspect is that it helps stop impulsive self destructive behaviour so before you self harm or binge you can stop and think what could I do instead to manage this distress.

This is hard work and takes a lot of therapy to reach that point however it has consistently been shown that it does work! Some units offer other therapies however I don’t have the space to go into those here. Straight forward counselling from counsellors who are not postgraduates is helpful in cases without complex difficulties and when the eating disorder is not advanced. However the evidence base for eating disorders is team treatment rather than one therapist alone as someone needs input usually from a doctor, dietician etc who all liaise together.

All NHS Trusts have eating disorders services however the waiting lists do vary. Many do not offer much for binge eating disorder however BEAT are now running some binge eating support groups which are just for binge eating.

Don’t be afraid to ask your GP for help, it is your right and the earlier you ask for help the better the outcome. If you work for a large organisation they may have some in house counselling you can ask for though occupational health.

Finally having an eating disorder is hard as the stigma and fear that people feel is immense especially around meal times. If you need more advice and information visit the BEAT website, where there is lots of information and contact numbers and a Helpfinder. http://www.b-eat.co.uk