Lately, I’ve been hearing a lot of noise in the social media sphere about whether or not those who have recovered from eating disorders should be treating eating disorders. Some have come out on the side of saying definitely not, listing reasons like the potential for bias, countertransference (the therapist making assumptions about clients’ emotions/experiences) or triggering. Others suggest that therapists who have “been there” can empathize with patients in a way that those who have not struggled with food cannot approximate.
Tetyana blogged about the lifetime prevalence of eating disorder professionals in recovery in 2013; she wrote about a 2002 study that revealed that around 33% of women and 2% of men treating eating disorders had a history of an eating disorder themselves. I have also written on the subject before (here); I focused on a 2013 study looking at experiences that recovered clinicians held in common.
Since writing that post, my opinions on the matter have not really changed, and likely won’t surprise you if you’ve read many of my posts and are familiar with my characteristic non-answer answers: I think it is impossible to categorically say that people who have had eating disorders should or should not be in the position of treating those with eating disorders. I think that blanket statements on either side are themselves extremely problematic. It assumes, also, that the person’s history of having or not having an eating disorder is the single most important thing about them, an assertion I find overly simplistic and, frankly, insulting.
So, if I’ve written about this before, why am I writing about it again? It’s a solid question, and the answer is not that I needed content. I recently stumbled upon an interesting recovery looking specifically at how recovered professionals conceptualized recovery, and couldn’t help but become fascinated as two of my interests converged into one article.
Bowlby, Anderson, Hall & Willingham (2015) conducted interviews with 13 American women who had experiences of eating disorders and went on to treat eating disorders. They were interested in better understanding how these women understood recovery, which, as we know, is a complex and poorly understood phenomenon.
The researchers asked clinicians:
- How they defined recovery
- Whether they saw differences between “in recovery” and “recovered”
- Where they thought they fell on this spectrum and for how long
- What was challenging about recovery
- What they learned about themselves in recovery
- How they currently relate to themselves, to their bodies, and to food/exercise
Participants were from 12 different states. All were of European-American backgrounds and all were women. Average age was 41.3 years (range 30-53). 5 held doctoral psychology degrees; 8 had masters degrees. Most worked in private practice (8 of 13).
With respect to their eating disorder history:
- Average length of illness was 11.2 (range 7-19)
- Average age of onset was 15.1 (range 10-21)
- Average length of recovery was 14.7 (range 6-24)
- 6 had a history of anorexia nervosa- restricting subtype (AN-R)
- 1 had a history of anorexia nervosa- binge/purge subtype (AN-BP)
- 3 had a history of bulimia nervosa (BN)
The authors used a phenomenological approach, trying to get to the root of how participants experienced recovery by coding their responses and reflecting on how the responses fit together to form a picture of recovery as experienced by these women.
For these professionals, recovery was:
- Comprised of both external and internal components
- Centered around learning about and valuing oneself
- Related to developing an understanding of the difference between the eating disorder and one’s identity
- Tied to finding meaning and purpose in life
- Contingent on developing healthy, meaningful relationships with others
By non-linear, participants described thinking about recovery as something that was continual throughout their lives, as opposed to having a strict beginning and end. Notably, however, this is not about having to continually strive to stay in recovery or something one thinks about constantly. As one participant noted:
“I don’t feel like I have to constantly work at being in recovery … I like to look at it as I am just constantly working to be a better person; constantly working to try to find balance in my life; constantly aware of myself every day.” (p. 5)
The comprehensiveness of recovery meant understanding recovery as more than simply gaining weight. Related to other recovery studies I’ve written about, this means that recovery does not spontaneously occur once one has normalized eating and reached a certain weight.
The authors note that participants saw recovery as tied to understanding and valuing the self; participants reported reaching a point of awareness of and grace toward themselves. As one participant put it:
“Recovery is definitely about moving beyond self hate […] Recovery is when you are not driven by the negative or the self-hate or the self-loathing. In recovery you are driven by the opposite, which is self-love.” (p. 6)
Again similarly to other recovery studies, participants de-identified with the eating disorder as they recovered and the eating disorder became less of an important part of who they considered themselves to be.
Participants also saw recovery as tied to finding meaning and purpose in life; of living a life not revolving around the eating disorder. Further, they described this life as having meaningful relationships in it.
What Does it Mean?
I think it is fascinating to look at how professionals with a history of an eating disorder look at recovery. I think this not because we should be making external judgment calls about whether they are fit to provide treatment for eating disorders, but because I think it is an interesting look at recovery from the eyes of people who have recovered, and yet work every day with those who aren’t yet there. Even more than that, this is a really interesting sample whose expertise is both lived experience and clinical competency.
Looking at the themes the authors found, it’s clear to me that the group was not only a group of women who had recovered, and thus had lived experience, but that they also understood eating disorders from a research and practice standpoint. I think this is something that gets overlooked in our discussions about both recovered therapists and recovery itself: rarely do people hold only one type of expertise.
People with eating disorders and in recovery may know a lot about eating disorders; if there’s one thing that frustrates me (ok, there are many things that frustrate me) it’s that there seems to be an assumption that people with eating disorders are engaging in eating disordered behaviour because they don’t know what it is doing to their bodies. “If they only knew better” people say, “they wouldn’t be doing this.” This couldn’t be farther from the truth, in my experience. This is the kind of ridiculousness that leads to people receiving only psychoeducational treatment for their eating disorder, with the expectation that increased knowledge will necessarily lead to behaviour change.
Often all this leads to is knowing all the ways that your behaviours, which you can’t stop, could be killing you. And systems that are left unchanged; people who feel they’ve done their bit to help you.
Regardless of whether I agree with the therapists’ perspectives on recovery – and I don’t categorically agree with all of them – I think it is important to look at studies like these to understand how these various sources of expertise can converge to create a picture of what recovery is. Therapists, regardless of whether they have recovered or never struggled with food in any way, are in the position of messaging to clients around what recovery is and how to get there, which is itself a powerful position that can strongly impact a client’s experience.
One of the most interesting conclusions the authors came to was that professionals in recovery tended to see recovery as very much achievable, but also as a process. I think this has important implications for messaging about recovery: I’ve heard in my research and advocacy experience that recovery as a “place” may feel overwhelming and unattainable. Perhaps if therapists themselves are on board with a perspective of process, clients will feel more comfortable with the journey.
A discussion about the fact that therapists saw relationships as a key aspect of recovery could likely be the basis of a completely separate post, so I will leave that part for now – however, I do think that this perspective may stem from the therapists’ occupation-based perspectives: therapists may be more inclined to focus on assisting clients in building solid systems of support and thus be invested in ensuring that their clients experience relationships in recovery.
Overall, this study provides interesting insight into a small sample of recovered therapists’ perspectives on recovery. Personally, I’d be eager to learn more about the experiences of recovered therapists from different social locations and practicing from different therapeutic orientations… research for another day?
As always, we could add complexity to the work by exploring and better understanding how therapeutic factors beyond having recovered factor into the clinical experience. I’ve said it once and I’ll say it again: it is unlikely that having recovered from an eating disorder is the only important thing about you. We need to talk more about other aspects of people’s lives that inform how they live, work, and interact.
Bowlby, C., Anderson, T., Hall, M., & Willingham, M. (2015). Recovered Professionals Exploring Eating Disorder Recovery: A Qualitative Investigation of Meaning Clinical Social Work Journal, 43 (1), 1-10 DOI: 10.1007/s10615-012-0423-0