Wednesday, July 31, 2013

The Job of a Therapist

A therapist's job is an odd one. In fact, my job is officially to work myself out of a job. Weird, huh? But true. My job is to support people in "getting better," however that is defined, and then watch them walk away. When I started this blog, it was called Within Four Walls, because part of what I wanted to be able to communicate was the power, and for me, joy, of working with people with eating disorders. A couple years ago, I was at a local gathering of people who treated or wanted to treat eating disorders, and I was appalled when I heard a therapist state, "Oh, nobody with an eating disorder ever gets better anyway." I had to bite back my desire to tell her to never, ever see another eating disorder patient. But, that is an a common misconception; that eating disorders are generally untreatable. So not true.

Recently, I had a final session with a woman who I have been working with for years. Obviously, I don't want to disclose details about this woman, but also want to say enough for you, the reader, to understand why the statement that people with eating disorders don't get better is so wrong. When I met this woman, she was a shell of a person, in every way.

Today, she left to move to another place to start a graduate program. And, when you hang out with someone every week, or so, for a few years, you lose track of all the changes that happen. It's not until you look back at where things started that it really strikes you, the therapist, just how much changed. I'm sure if anyone were going to, this woman fit the profile of the person who would "never get better." The severity of the illness and it's impact on her physiology, the overall impairment in functioning in her life; there was a lot going against her. When I look back, I see that it didn't look good all those years ago. But, years passed, and in reality, she has been recovered from her eating disorder for years. It has not been the focus on her therapy work for a long time and many situations have shown she truly is in recovery. Therapy became about life and rebuilding, and she did.

In the final session, she tried to give me the primary responsibility for "getting her better." Nope, that wasn't going to happen! It wasn't me. So, what was it? Well, first it was that she wanted to get better. She started the process, she continued the process, she hung in there through hairy moments and good. She drove the process. If you really think about it, what is eating disorder treatment? Sure, to a certain extent we help people "re-learn how to eat." But, really, everyone KNOWS how to eat. We don't have super Jedi mind tricks that somehow make someone eat again.

So, what is it that we do? If you look at psychology, and therapy in general, I'd hate to even try to count the number of approaches that us therapists can be trained in. There's about every cute little combination of letters in the book, all labeling some therapeutic approach that is destined to be the NEXT, BEST THING!

But a couple years ago, when I was panicking about a patient and whether I was doing things "right," and was told by some clinicians that I was doing things wrong, another clinician pointed out the research that basically says that we as therapists can do almost anything, within reason, and as long as we believe it works, and then our patients believe it works; well, it tends to work.

So, you take all those therapy approaches....CBT, IPT, DBT, ACT, ABCDEFG (that's not really one), and they all work, really. But what I believe works, what I believe therapy offers people, is a relationship. That's what therapy is, and that's what we, as people, need (except, as I always tell my clients, there is this guy that lives in a cave outside of Nederland, CO...or at least he did when I was in grad school...and there are a few people like him that seem to not need relationships....but those folks are rare). So, that's what I offered to this woman. I did not "make her better." I gave her a relationship, and she chose to use that relationship to change her life. And, in my experience, the change that comes from the power of the relationship is long-standing. So, I don't worry that she will return to her eating disorder. I truly believe she is recovered. And that puts a huge smile on my face, knowing where things started. She chose her life over her eating disorder.

So, I was reminded by this patient the true power of what happens Within these, and all other, Four Walls.


  1. I love this post.I've heard one too many times u will always have an eating disorder and that's so discouraging so I always thought why even try. I think the relationship we have with our therapists is so important. Thanks for sharing glad I read it. Its always good to hear a successful story of recovery too and see it is possible!

  2. I find this post really warm and inspiring too! I remember when I first started with you, all I could think about was when would I be done? Then I worried about getting " the boot" for doing too well. And now, I guess I'm content to participate in the journey.

  3. She is incredible, and inspires all her friends :)

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