SWEDA Somerset & Wessex Eating Disorders Association 18-25 Project
"serving those affected by eating disorders"

Finding

A Therapist

How do I find a therapist?

This information looks at "What should I look for when I choose a therapist?"

• How do I know the therapist is genuine?
• What may be the warning signs that this is not ok?
• How do I know the therapy / therapist ok?
• How do I select a type of therapy for me?
• What types of therapy are there for people with eating disorders?
• What is right for me?
• How much can I expect to pay?
• Questions for interviewing my therapist - checklist.

In looking for a therapist you need to make sure:-

That the therapist or health profession you see is registered therapist with their professional body, check for links on search.atomz.com/search/?sp-q=professional%2Bbodies&sp-a=sp092b3400

• UKCCP - UK Counsellors www.studentcounselling.org
• BACP-UK psychotherapists and counsellors ( UKCC registration) http://www.bacp.co.uk
• Health Program Council e.g. Art, Drama, Music therapist, OT, Physiotherapists, Dieticians these are Professions allied to Medicine www.hpc-uk.org
• BAAT (Art Therapists) www.baat.org
• BADTh (Drama) www.badth.ision.co.uk
• APMT (Music) www.apmt.org
• Dieticians www.bda.uk.com
• OT www.cot.co.uk
• Physiotherapists www.csp.org.uk/physio2u.cfm
• Psychologist www.bps.org.uk
• RCN – Nurses www.rcn.org.uk
• Doctor, Psychiatrists. A page called "What do psychiatrists do?"www.rcpsych.ac.uk/info/faq.htm
• Doctors’ medical council www.gmc-uk.org

People may have an additional specialisation in CBT, CAT, DBT, IPT, but should have a main professional body to give them clinical practioner status. You can look up in The Nice guidelines

www.nice.org.uk and use the advanced search for "Eating Disorders" to find the NHS recommendations of treatment of Eating Disorders

The definitions of these can be found on the talking therapies website www.phobics-society.org.uk/talkingtherapiestext.html

Types of therapy are also listed www.find-a-psychiatrist.com/modules.php?op=modload&name=News&file=article&sid=60

There is also a lot of information on www.mentalhealth.org.uk/index.cfm

The National Eating Disorders Association has a site that gives practitioner lists in each area of the country, which you may wish to look at www.edauk.com/list/index.htm

The first meeting

You can ask to see your prospective therapists;

• Qualifications
• Insurance
• Registration number
• Information of the professional body
• Ask them what to do if you aren’t happy with therapy
• If they are registered, approved of and insured for private practice
• Do they have regular supervision?

You can ask to arrange an initial assessment meeting where you talk to the therapist about your situation. You can ask them about their work, style, qualifications and decide if you feel comfortable with what they can offer you. They will also assess whether they think they can offer you what you need. If not they may well make suggestions of where and who may be more helpful to you. If you gut feeling say 'no' don't sign up for the session talk to a friend, your nurse or doctor your family and look for another therapist.

1. You can expect to be offered a regular weekly session of 50 minutes - 1 hour on the same day and same time each week, or more regularly if required. This may be different if you need to arrange therapy around shifts at work and college training sessions if the therapist is able to offer you this flexibility. Not all therapists can or will do this.
2. Make sure you know how much it will cost and how you are expected to pay e.g. monthly, weekly, with cash or cheques and if you can have a receipt

Also check:
If there are any additional costs e.g. phone calls, invoices, and receipts.
What happens if you are sick and cancel?
What happens if they are sick?

3. Ask about length of term of work (short/long and what that means) and check how often this will be reviewed and what to do if you do not like the sessions. Some people like to set up 6 or 8 sessions to see how it goes before engaging in long term therapy.
4. Do not part with anything such as direct debits, credit cards, bank details, passports, driving licences, benefit books etc. This is ethically inappropriate for a therapist to ask you to surrender any personal items, even if it is to help you "stop bingeing." You will find a way to binge and unless you are ready to stop, so taking away money will not help.

If you want to have limited access to money make an agreement with a very best friend, your bank or your family.

Professionals are not allowed to look after clients’ money or valuables. If you are asked to do these things please report it to their professional body or ask someone to do this for you. Even if you don’t think it is a problem it could be for someone else.

If you are asked for these say you need to think about it then talk to their professional body, your G.P or SWEDA www.swedauk.org, or www.nhsdirect.nhs.uk or ask in Citizens Advice.

Hospitals will have a secure system in place with regular policies and procedures around looking after inpatients valuables. Make sure you read and understand any forms you are given before signing them. Remember to keep a copy of the form and a list of all the things and values of things you give in for safe keeping. Check you have everything back afterwards. If not ask about how to log this and register a complaint.

5. Therapy should be a non-judgmental supportive space for your own life journey. The work comes from you so do not expect to be told what to do or to be instructed on how to recover. Some therapists may help you with weight and food management/diaries/binge management and may set you tasks to do in between sessions. In order to make the most out of your therapy you have work hard!

Through your therapeutic journey you will build trust with your therapist and should then feel able to talk about how things truly are for you. If you are not able to do this it would be good to explore why not. Then work with your therapist to see what you can both do about this situation whether it is working together or finding someone else who you can work closer with. It is best to not scarper because you can not say something, try and work it out together.

6. If a therapist begins to tell you things that don't fit for you, you need to be able to say "no", that is not my truth/how it is/was for me.
7. Check their policy of confidentiality and make sure you understand it. If not ask them to explain it and to explain when they may break this. For example if they feel you are at significant risk. Then ask how they would work with you on this, maybe you would look to call your G.P. together. In most circumstances a therapist will support you to tell an appropriate person how things are so that you get the best help for you. They should definitely tell you if they are significantly concerned and ask for your consent to tell your doctor.
8. You may be asked to go to your GP health centre to be physically monitored for your own and the therapist's safety. Some therapists/counsellors may have a BMI cut off for safe working. Check this out before you engage in therapy so you know their baseline and agree to work within these boundaries.

Some counsellors will ask you to go to your doctor to have your weight, bloods (potassium levels), heart, bone density checked. They may feel that this is an appropriate way to see if they should be offering you therapeutic work or if you need a more specialized service. You may agree with your therapist for them to have consent to talk to your GP, and to ask your G.P. if you become at a physically unsafe place. Ultimately it is your choice to decide how you wish to work. Some counsellors/therapists will not be happy working alone with you if you are at a critical place in your personal safety. This may be very low BMI or potassium levels or if you have apparent poor physiological health.

You may be relieved that someone is interested in your personal and psychological safety. This may also terrify you right now. It may make you feel angry and rejected that these measures of physical health seem to come before how you feel. Talk to the therapist / counsellor and your G.P. about this.

Again you have the choice of whether to engage in therapy and can always ask advice from the NHS www.nhsdirect.nhs.uk for support via GP and secondary Community Mental Health Team or specialist Eating Disorders Service. "Tough love" and firm boundaries are for your own safety even though it can be painfully hard to hear and accept this and to work within someone else’s limits.

9. Even if the therapist you find is state registered or nationally accredited they may not be the right therapist or be offering the right therapy for you so shop around, look at several before you decide what you need.
10. Before embarking on private therapy/counselling, make sure you have

• The money to sustain therapy (2004 Price Scales £25 -£50 / hour. Sometimes there are sliding scales for students)
• The time to do therapy
• Reliable transport to get there.

It is really important to give yourself enough time to end a therapeutic relationship. Sudden endings can be very difficult and make things hard for you now and in the future. You may also want to check with the NICE guidelines 2004 to make sure if your GP/secondary service should be offering you an NHS service, and if what it suggests could be right for you. The options range from self-help to inpatient work. www.nice.org.uk/cat.asp?c=101239

SWEDA re setting up a supported self help package with a helpline supporter so you can access support in your college or home. Please contact the SWEDA admin line and ask for information. 01458 448611 or "18-25’s" 01458 837900

What therapy to choose

There are various therapies that people with eating disorders choose, some of these are very structured programmes others are very client centred, which means that the therapist follows where you need/want/choose to explore.

Some therapies are "proven" to be useful with certain types of eating disorder e.g. bulimia and CBT. There are also many therapies which are effective but have not been clinically run as I wonder how you would measure recovery your from an eating disorder? What we know is that it is more than weight gain/management and behaviour modification but how your relationship is with yourself and how if feels to be you and how your inside world is.

The usefulness really comes from you and the relationship you create with your therapist and the timing of the intervention i.e. when you are ready and motivated to use the type of therapy.

Types of therapy

You may want to check our information on finding a therapist home.btconnect.com/18-25/therapy.htm

Make sure that the therapist or health profession you see is registered therapist with their professional body, check for links on www.webhealth.co.uk/professional_bodies.html

People may have an additional specialisation in CBT, CAT, IPT, but should have a main professional body to give them clinical practitioner status. You can look up in The Nice guidelines www.nice.org.uk and use the advanced search for eating disorders. This will give you the NHS recommendations of treatment of Eating Disorders

The definitions of these can be found on the talking therapies website www.phobics-society.org.uk/talkingtherapies.html

There is also a lot of information on www.mentalhealth.org.uk/index.cfm

The National Eating Disorders Association has a site that gives practitioner lists in each area of the country, which you may wish to look at www.edauk.cam/list/index.htm

If in doubt check it out.

Voluntary Organisations - there is a register of voluntary organisations/charities bubl.ac.uk/uk/charities/s.htm and web pages of directories of professional registered and accredited therapists www.hpc-uk.org and others on home.btconnect.com/18-25/therapy.htm.

By using this you can check out their legitimacy, code of ethics and conduct before using a service. Sometimes there are organisations/therapists who do not work within the guidelines of their professional codes of conduct and in your interest so feel able to check them out!

Do I really need therapy?

Not everybody chooses to engage in therapy to find recovery from their eating disorder. Sometimes people find something new to do and refocus their energy - and give them an alternative coping strategy. There are many ways to find recovery and the life you want to live.

So seek support to find what you want and need. At different times in our life journey we have different needs; there is no shame in needing support and therapy. It takes a lot of courage to do this.

This may seem to feel harder and more in your face as you begin to engage in a process. This is normal. Talk about it! Do you remember as a child learning to paint and how messy that got before you learnt to use brushes and paints and gradually the picture became recognisable?!!

Sometimes if we knew how hard things were going to be it may stop us giving it a go and stop us finding what there is to discover and enjoy!

We may also do therapy for a while get to where we need to for now and stop. Then after a break you may choose another form of help/support for the next part of your journey.

Remember there are similar things in people's journeys, but each journey is individual and no two journeys are the same. So do yours the way you want/need to.

When am I ready to use help?

I am ok I don’t have a problem

Perhaps you are in a stage where you are living with your eating disorder and do not feel it is getting in the way of your life. Maybe you don’t have a problem with it. Perhaps it feels like other people seem to have the difficulty. Maybe at this time you are not thinking about making any changes but a G.P. or nurse may ask to monitor your physical safety.

I am fed up of it all and scared

Maybe you get to a stage where you begin to get fed up of people trying to help you. You begin to see how your eating disorder is getting in the way of your life, your studying and having fun and are not quiet sure how you would manage without it. It has been a familiar friend but now is a bit in the way and you are afraid not to have it by your side incase things go wrong. You may be thinking about making some changes and not sure how to do this. A therapist may be helpful to listen to your thinking and help you think about what you want and need in your life right now. Together you may be able to think about how to get what you want in your life.

I have had enough of it. My Eating Disorder is getting in the way of my life.

Enough is enough. I will not let it steal my life any more.

Now you may think you really have had enough. You may seek active support to make changes in your life style. This help maybe from a specialist team, your GP and mental health team or another health practitioner. This will be a tough and rewarding part of the journey. You may feel that in order to do this you need to take some time out of studying and defer for a year in order to sort out your inside world and outside life style. Ask your student welfare workers for advice on this. You may ask for more support to do this therapeutic journey alongside your studying.

Sometimes you may think I am exhausted this is all such hard work. Is it worth it? Then you may temporarily blip and dip back into living in the "problematic Eating Disorder rules of life." All journeys have ups and downs. The road to recovery is not a straight line.

Perhaps after awhile you will see what is happening and seek help to actively get out of the clutches of your eating disorder again. This time you will learn something new and find how strong you were to get back on the road again. Do seek the active support you need and go for it!

The journey has many dips and peaks; it is all part of finding the richness of your life.

Mastering Life without hurting myself

Living in the solution of your life without food problems takes again energy and can be really hard with the temptress of dipping back in to the problem way of life. It may feel like that would shelter you from all that you now see and feel and think. It may seem like you want protection from facing the outside world, like:-

• Eating with people
• People seeing you
• People commenting on your body
• People noticing your health changes
• People seeing the emerging you

Often in making these steps to maintain the solution you will need even more support and encouragement form friends and professionals to keep well. This step will involve facing things that you have not been able to manage for a long time.

Contacts

Somerset and Wessex EDA
Admin./Fax 01458 448611
email: seda@ukonline.co.uk
www.swedauk.org
01458 448600
an answerphone is available when the helpline is closed.

Mindinfoline 08457660163

NHS direct 08454647

Saneline 08457678000

Samaritans 08457909090

Mindline 01823 276892

Mental Health South West 01823 337879

National Self Harm Network PO Box 16190 London, NW1 3WW Rethink 02089746814

PAX 02089746814

No Panic 01952 590545

Eating Disorders Association 0807703256

Checklist for clients looking for a therapist.

• Are they registered with professional body? Yƒ N
• Are they insured for private practice?
• Are they approved private practitioners?
• Do they get regular supervision?
• What does supervision entails
• Can they offer you a regular time(s) and day(s) each week?
• Do you understand how therapy works
• Have you made a contract with them
• How many sessions have you agreed to
• When will you review therapy?
• What is their confidentiality policy, when would that be broken?
• What happens if you are ill/cancel/die?
• What happens if they are ill/die/cancel?
• Do they keep records/notes? Where are they stored?
• How much do they charge?
• How do you pay?
• What happens if I need support in between sessions?
• Do they have experience of working with eating disorders?
• How does that change the way they work?
• How/to whom do I complain if I am not happy with what you offer me?