Counseling

How to Become an Eating Disorder Therapist

How to Become an Eating Disorder Therapist
Eating disorder therapists treat patients with anorexia, bulimia, pica, binge-eating disorder, rumination disorder, and related other conditions. They typically hold a master's or doctorate. Image from Unsplash
Christa Terry profile
Christa Terry January 21, 2020

Eating disorder recovery isn't just about body image; eating disorders result in more deaths than any other mental health condition. When you become an eating disorder therapist, you'll work with many patients standing at the crossroads between life and death.

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The imperative to get and stay slim bombards us everywhere. Consider the supermarket checkout line, where the magazines all feature headlines like “How to Get a Sexy Summer Body,” “The Proven Flat Belly Diet,” and “You CAN Lose Weight!” Count the number of print, radio, television, and movie advertisements you see each day that, implicitly or explicitly, tell you that you need to lose weight. The message is constant and inescapable.

Eating disorders can have many causes completely unrelated to body image (e.g., genetics, environment, post-traumatic stress, and past abuse), but the idea that tiny is good and big is bad contributes as well. In all cases, it can compound the problem, making recovery more difficult. People with eating disorders have to live in a world where both bodies and eating habits are mercilessly scrutinized by just about everyone.

That’s why eating disorder (ED) counselors and other specialists and clinicians who work with ED patients are so important. A smoker with emphysema can quit cold turkey. Someone with an injury can immobilize the injured limb. But a patient with an eating disorder can’t avoid food and the place it occupies in our society. That can make eating disorder recovery extremely complicated.

That may be why eating disorders have such high rates of hospitalization and death. Becoming an eating disorder therapist and working with people with eating disorders is about more than helping them develop healthy eating habits and reach a healthy weight. ED recovery can be a battle that’s hard to win.

To succeed as a therapist or counselor in the eating disorder treatment space means understanding that the root causes of eating disorders like anorexia and bulimia vary considerably; that disordered eating can have nothing at all to do with limiting food intake; and, that treating eating disorders can be similar to treating obsessive-compulsive disorder, depression, or anxiety—or completely dissimilar, depending on the patient in front of you. This is a complicated condition, which means that working as a mental health professional in this field can be tough. Not everyone is up to the challenge.

If you think you are interested in becoming an eating disorder therapist, keep reading, because the qualifications required of eating disorder therapists may surprise you. In this article, we’ll answer the following questions:

  • Who are the professionals who treat eating disorders?
  • What is the difference between an eating disorder coach and an eating disorder therapist?
  • What does an eating disorder therapist do?
  • What skills are required for an eating disorder therapist?
  • What are the educational requirements to become an eating disorder counselor?
  • Do eating disorder therapists need to be licensed?
  • Are there certifications for eating disorder therapists?
  • What is the salary for an eating disorder therapist?
  • Should people with a history of an eating disorder work as eating disorder therapists?
  • How can I succeed as an eating disorder therapist?

Who are the professionals who treat eating disorders?

As you dig into how to become an eating disorder therapist, you’ll discover that for most patients, eating disorder recovery involves working with a team of practitioners. Several kinds of professionals work with people with eating disorders:

  • Eating disorder therapists (also called eating disorder counselors) are licensed mental health professionals who hold advanced degrees in psychotherapy or clinical social work counseling. They may use evidence-based treatments like cognitive behavioral therapy, family-based therapy, or other forms of psychotherapy. They are qualified to treat eating disorders and co-occurring disorders in individual and group therapy.
  • Registered dietitians are nutrition specialists who have trained in medical nutrition therapy and nutrition rehabilitation for disordered eating. They can create specialized meal plans for people with eating disorders in all stages of treatment and advise patients on healthy eating habits.
  • Doctors who specialize in treating eating disorders in adults and children can prescribe psychiatric medication for ED patients when necessary. They are involved in treating physical eating disorder symptoms, like organ damage or electrolyte imbalances caused by chronic malnutrition.
  • Medical specialists include gastroenterologists, endocrinologists, gynecologists, neurologists, cardiologists, and orthopedic doctors who may be part of the medical team helping to manage conditions associated with eating disorders.

All of these eating disorder professionals collaborate to manage care plans for patients with EDs and co-occurring disorders in inpatient and outpatient eating disorders programs. Whenever possible, they also work closely with patients’ support networks, which may include parents, spouses, children, and friends.

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What is the difference between an eating disorder coach and an eating disorder therapist?

Some people assume that ‘coach’ is just another word for therapist, but in eating disorder recovery, therapists and coaches fulfill very different functions and come from very different educational backgrounds. Eating disorder coaches can be essential members of a patient’s recovery team, though they’re typically not licensed or certified, and their training may consist of a certificate program only.

Unlike eating disorder therapists, ED coaches don’t help patients work through in-depth issues or to process the trauma behind the disorder. Instead, eating disorder coaches offer in-the-moment support and help patients find practical ways to overcome the roadblocks standing between them and their recovery goals. For instance, if a patient finds it difficult to eat enough when they eat alone, they might choose to eat as many meals and snacks as possible with a coach, either in person or virtually via videoconferencing. Many coaches visit an ED patient’s home to cook or restock the pantry. In some cases, a coach lives with a patient for a time after they are released from an intensive out-patient program or in-patient program.

What does an eating disorder therapist do?

Eating disorder therapists help patients through eating disorder recovery. They do this using proven psychological and counseling techniques (e.g., cognitive behavioral therapy, dialectical behavior therapy) to diminish or eliminate dysfunctional behavioral patterns related to food and eating and to identify and treat the underlying causes of eating disorders. Their patients aren’t always struggling with anorexia nervosa or bulimia nervosa.

ED patients also include people with disorders including:

  • Pica (craving and eating non-food items)
  • Rumination disorder (regurgitating and re-chewing food)
  • Avoidant/restrictive food intake disorder (extreme lack of interest in eating, or distaste for, certain foods)
  • Anorexia athletica (compulsive exercise)
  • Binge-eating disorder (routinely consuming excessive quantities of food)
  • Body dysmorphic disorder (a type of obsessive-compulsive disorder involving body image)
  • Orthorexia (an extreme fixation on healthy eating)
  • Night-eating syndrome (continual eating throughout the evening)
  • Nocturnal sleep-related eating disorder (commonly known as “sleep eating”)
  • Persistent morbid obesity

When you become an eating disorder therapist, you may work in outpatient and inpatient settings, including physicians’ offices and psychiatric hospitals. On any given day, you’ll:

  • Meet with new patients to understand their psychological and emotional issues
  • Develop treatment plans and treatment goals based on your findings
  • Meet with established patients to understand their current challenges and track their progress
  • Make changes to treatment plans and treatment goals as necessary
  • Develop strategies for upcoming group therapy sessions
  • Lead group therapy sessions
  • Assist with patient discharge planning
  • Confer with a diverse group of doctors, specialists, and support professionals

While it’s true that most ED patients are young women, you may work with children, men, or the elderly when you become an eating disorder therapist.

What skills are required to become an eating disorder therapist?

Just like other types of therapists, eating disorder therapists need to be attentive, empathetic, and able to see beyond a patient’s symptoms. They must be compassionate yet firm because many of the treatments for disordered eating require patients to abide by strict boundaries. Eating disorder therapists should also have some expertise in areas like anxiety, depression, post-traumatic stress disorder, the impact of abuse, and sexual assault, as these often go hand-in-hand with an ED diagnosis.

What are the educational requirements to become an eating disorder counselor?

All eating disorder therapists begin their professional journeys by earning a bachelor’s degree. While your undergraduate major may not matter in the long run, you should probably choose either a psychology degree or a social work degree if you’re serious about pursuing this career. Look for opportunities to take classes that touch on topics like:

  • Abnormal psychology
  • Body image
  • Clinical psychology methods
  • Family therapy
  • Personality disorders
  • Psychoanalytic therapy

Once you have earned a bachelor’s degree, your next steps will involve one of four paths. You may:

  • Enroll in a master’s degree program in psychology. While most states require a doctoral degree for psychology licensure, some (e.g., Alaska, Kansas, and West Virginia) don’t. You could technically become a licensed clinical therapist and work with ED patients with just a master’s degree. You may also decide to enroll in a master’s degree program because the PhD or PsyD programs you’re considering require it.
  • Enroll in a PhD in Psychology or PsyD program. Both of these doctoral programs will prepare you to become a counseling psychologist. PsyD programs typically involve much more clinical work, while PhD programs may involve more research. Some, but not all, of these programs require applicants to have earned a master’s degree.
  • Enroll in a Master of Social Work degree program. You can practice as a clinical eating disorder counselor with an MSW, and it’s possible to find MSW programs that don’t require applicants to have a bachelor’s degree in social work.
  • __Enroll in a Master’s in Counseling program__. You might earn an MA in Mental Health Counseling or an MS in Clinical Mental Health Counseling, and then go on to practice in a state that grants licenses to therapists with master’s degrees.

One thing you need to know is that there are few, if any, eating disorder programs at the bachelor’s or master’s degree levels. The best thing you can do to prepare for this career is to look for programs that include:

  • Coursework that covers topics related to eating disorders and eating disorder recovery
  • Opportunities to complete clinical internships in settings where EDs are treated

Working with patients who are struggling with eating disorders during a supervised internship will be helpful when you graduate and begin working with patients of your own.

Do eating disorder therapists need to be licensed?

Yes, although licensing requirements for therapists vary by state. No state requires a specific eating disorder therapist license or imposes special licensing requirements for psychologists or social workers who want to work in this practice. In all states, ED therapists are either licensed clinical psychologists, licensed clinical social workers, or licensed professional counselors.

Are there certifications for eating disorder therapists?

There is only one nationally recognized organization offering certification credentials for eating disorder specialists. The International Association of Eating Disorders Professionals (iaedp) offers a number of certifications for different types of ED specialist. Therapists (along with doctors and nurse practitioners) who have completed 2,500 hours of supervised patient care and completed a 1,500-word case study can earn the Certified Eating Disorders Specialist (CEDS) credential by completing four iaedp core courses and passing four exams covering:

  • Types of eating disorders
  • Medical treatments for eating disorders
  • Nutrition therapy for eating disorders
  • Therapeutic treatments for eating disorders

Practitioners who meet specific advanced degree and professional experience requirements may be able to earn the CEDS credential without completing the required courses, provided they have spent significant time:

  • Supervising the work of other eating disorder treatment professionals
  • Presenting at eating disorder-related workshops, conferences, and events for professional and public audiences
  • Working as a professor, guest lecturer, or program coordinator for a university-level ED instruction program
  • Publishing books, chapters, peer-reviewed articles, and articles for laypeople about eating disorders and treatments
  • Serving as an expert witness in court cases where eating disorders play a role
  • Participating in scholarly research into ED and its treatments

Whatever path you take, earning your CEDS certification is worthwhile in the long run. Because it’s possible to become an eating disorder therapist without specific training in EDs, this certification will distinguish you as someone with advanced training and experience in the field.

What is the salary for an eating disorder therapist?

It’s unclear how much eating disorder therapists earn. According to PayScale, the average eating disorder therapist salary is about $43,000. ZipRecruiter, on the other hand, reports that the average salary for an eating disorder therapist is closer to $89,000 and that you might earn anywhere from $46,000 to $113,000 in this role.

PayScale’s estimate is probably closer to reality, though how much you can make in this career depends on many factors. You will probably command a higher salary with a PhD or PsyD than you would if you were practicing with a master’s degree in psychology or an MSW. You may earn more working in a major metro area than in a small town or rural area. And your professional experience, additional training, and certifications will all play a role in how much employers and clients are willing to pay.

Should people with a history of an eating disorder work as eating disorder therapists?

Research suggests that many eating disorder treatment specialists have personally struggled with eating disorders or disordered eating. However, there’s still no conclusive proof that personal experience makes professionals more or less effective. There are potential pitfalls.

A therapist with a history of disordered eating could theoretically be triggered into relapse by working with clients with eating disorders. They might also lack objectivity. There’s some debate, too, about whether clinicians should share their own experiences with patients. That said, it stands to reason that an eating disorder therapist in recovery may have an easier time working with patients who are used to telling clinicians that they can’t possibly understand what it’s like.

Carolyn Costin, M.A., M.E.d., LMFT, FAED, CEDS, wrote in a piece in the Eating Disorders Resource Catalog that having once struggled with an ED made her a better clinician: “I saw my first eating disorder client in 1979 and told her I was recovered from an eating disorder. I also said, ‘If I recovered, so can you.’ She recovered and I’ve been saying the same thing to all clients ever since. Sharing my eating disorder history and serving as a role model and guide for others has been a huge aspect of my success as a therapist in the eating disorder field.”

How can I succeed as an eating disorder therapist?

Finding your way in this field may be as complex as the field itself. No two patients with eating disorders present the same way. In fact, the term ‘eating disorder’ itself is a broad one that covers many different conditions with many different causes. You may have to abandon your assumptions about what eating disorders are—and are not—to practice successfully in this specialty. More importantly, you will need to be persistent; many ED patients resist treatment. You will need to accept that there will be some people you simply can’t reach.

The statistics around ED recovery are fairly bleak. Published recovery rates vary considerably, but may be as low as 20 percent for some forms of eating disorder. Only 60 percent of patients with all forms of ED make a full recovery. And the studies responsible for finding recovery rates track only those patients who actively seek out therapy or other interventions. Without treatment, up to 20 percent of patients with eating disorders will die. That can be a hard fact to accept when your whole career is focused on helping people.

But if you’re comfortable working with patients who push back… who don’t feel like they deserve recovery… and who need more than anything else to be understood, you may just thrive in this career.

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