A client recently reflected that her confidence in her ability to recover has come from the trust she places in her treating team. And that before we collaboratively created a supportive, multidisciplinary treating team for her, she wasn’t sure she was capable of recovery.
That made a lot of sense to me. Individuals living with an eating disorder, and their worried loved ones, entrust their treating team with their lives, their well-being, their hopes, and their futures. The recently launched national Credentialing system in Australia was developed to support access to quality treatment and care for individuals living with an eating disorder for this very reason.
What is a treating team, though? Who is included, and what are their roles? A treating team is a group of individuals from multiple disciplines and settings who work together to support the recovery of an individual living with an eating disorder. The team members work together collaboratively, making sure information is shared amongst the team and that decisions consider input from all members. Also key to the effectiveness of a treating team is a person-centred approach entailing empathy and respect for the individual living with an eating disorder, their specific needs, values, strengths, culture, preferences; and of course, those of their loved ones.
The composition of a treating team will differ based on the specific treatment setting (i.e., inpatient versus day patient versus outpatient), symptom type and severity, and co-occurring medical and mental health conditions. A treating team starts, however, with the individual living with an eating disorder, their loved ones, and any other supports they identify, together with a medical practitioner and a mental health practitioner.
The medical practitioner is often a GP (or Paediatrician, for children and adolescents), or sometimes a Psychiatrist. Their role is to assess the eating disorder, regularly monitor medical symptoms and medical status, treat medical complications associated with the eating disorder, and provide referrals for the mental health practitioner and/or other members of the treating team. The medical practitioner also prescribes medications if needed and advises the individual living with an eating disorder if they need to present for more intensive medical intervention at their nearest hospital.
A Psychiatrist will also comprehensively assess the eating disorder and co-occurring mental health conditions. If needed, they will also facilitate referral for inpatient or day patient admissions for more intensive treatment of the eating disorder.
The mental health practitioner, or therapist, can be a Psychologist/Clinical Psychologist, Psychiatrist, Psychotherapist, Social Worker, Occupational Therapist, Mental Health Nurse, Nurse Practitioner, or Counsellor. The role of the therapist is to assess and diagnose the eating disorder and co-occurring mental health conditions, to develop and implement an evidence-based psychological treatment plan, and to provide psychoeducation to the individual living with an eating disorder and their supports. As well, the therapist’s role is to identify whether the treating team needs to expand to include other professionals, and whether the individual living with an eating disorder requires a different intensity of treatment in the stepped care approach (i.e., inpatient versus day patient versus outpatient treatment).
When the therapist is a Psychologist/Clinical Psychologist, they will undertake comprehensive psychological assessment, diagnosis, formulation, and treatment for the eating disorder and co-occurring mental health conditions (e.g., depressive disorders, anxiety disorders, trauma/PTSD). Psychologists/Clinical Psychologists also provide support around psychiatric risk.
Social Workers can be a part of a treating team as either the therapist/mental health professional or as an allied health professional. In the latter role, Social Workers intervene through counselling, education, and advocacy, to increase social support (within the family, community, and wider systems) for the individual living with an eating disorder.
As with Social Workers, Occupational Therapists can provide evidence-based psychological treatment for eating disorders or be involved in a treating team as an allied health professional. Allied health intervention by Occupational Therapists involves functional assessment of the individual living with an eating disorder and interventions based on assessment outcomes. This functional assessment entails determining the impact of the eating disorder upon the individual’s capacity to engage in self-care, work and/or study, interpersonal interactions, and leisure activities.
As noted above, Counsellors, Psychotherapists, Mental Health Nurses and Nurse Practitioners can also serve as the therapist on a treating team, providing evidence-based psychological treatment for eating disorders. Counsellors and Psychotherapists can also provide more general counselling for individuals living with an eating disorder and their loved ones. Mental Health Nurses and Nurse Practitioners can also provide medical care in inpatient and community settings.
Very often, a treating team includes a Dietitian. Their role is to undertake a comprehensive nutritional assessment, regularly monitor nutrition status, and implement nutrition-based interventions including structure and education, to support the individual living with an eating disorder to learn to eat regularly and a varied and inclusive food intake. Dietitians also provide nutrition-based intervention for specific needs such as pregnancy, endocrine conditions, and gastrointestinal conditions.
Treating teams are increasingly including a Recovery Coach, or Peer Mentor. A Recovery Coach or Peer Mentor has lived experience of an eating disorder and can provide invaluable insights and guidance into the process of recovery. A Recovery Coach or Peer Mentor is also a constant source of hope and reminder for the individual living with an eating disorder that recovery is possible.
When there are other co-occurring medical conditions that require assessment and intervention, a treating team can also include Endocrinologists, Gastroenterologists, Cardiologists, Immunologists, or Nephrologists, among other Specialists. Exercise Physiologists, Physiotherapists, and Speech Pathologists can also be a part of a treating team to assess and treat co-occurring conditions.
In summary, a supportive, multidisciplinary treating team working collaboratively and using a person-centred approach, can make a world of difference to individuals living with an eating disorder feeling confident enough, and hopeful, in their recovery from their eating disorder. In other words, recovery from an eating disorder ‘takes a village’.