Top Tips for Working with Eating Disorders: Are You A Coach or Therapist?

This point was raised in CBT Today Dec 2010 by Prof Waller. I introduce all my eating disorder trainings by asking this question. Eating disorders are usually treated by people who describe themselves as therapists because, after all, therapy is about healing the sick, or making ill people well. And therapists do therapy, which is what they are trained to do.
I don't like regarding all people with eating disorders as fundamentally sick. Much of their behaviour makes sense. The person with anorexia sees most women trying to lose weight. Fat people get such a bad break in our society that it almost makes sense to purge if you have eaten too much so that you can stay in control of your weight. It is quite normal for a binge eater to have cravings because dietary chaos makes their blood sugar very unstable.
Prof. Waller suggests that we should coach people to be "her (or his) own CBT therapist" so that the client can make good use of the hours they are on their own, over and above the hour or so they have in the room with their counsellor. I agree and yet feel that this means a great deal more than being a coach.
Do we concur with the view that CBT in its many guises is the best we can do so far for working with eating disorders? Yes, since we are working to change behaviour, and to change the eating disorder mindset and the emotions which inform behaviour, whether this refers to starving or binge eating on chocolate.
Changing the eating disorder mindset requires us to be a guide, to help our clients cope with their lifestyle, and a teacher to provide useful information to deal with myths about nutrition and calories.
But information on its own is only useful when a person has the skills to use it appropriately - so we may need to teach some basic skills such as relaxation or problem solving skills and communication skills to help people become more effective and able to use the information which we have given to them.
When we work on the eating disorder mindset, we also confront some important barriers to change such as how much you feel you need to weigh in order to accept yourself. To do this, we have to help a person to know and realise their deeper aspirations in life rather than simply attend to the eating disorder aspirations of being in control of food and weight. This subtle task is more about being a mentor for change by opening out possibilities which were not there before.

So, coach or therapist? Definitely both and more, and even being a bit of a magician wouldnt come amiss, although the evidence base for conjouring is not yet there.