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:
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:
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.
There are a couple of significant practical considerations:
- A Bachelor’s or Master’s degree in social work
- A license to practice or required social work certification
Credentials vary among careers, states, and territories. Licenses include:
- Certified Social Worker (CSW)
- Clinical Social Work Associate (CSWA)
- Licensed Advanced Practice Social Worker (LAPSW)
- Licensed Advanced Social Worker (LASW)
- Licensed Baccalaureate Social Worker (LBSW)
- Licensed Clinical Social Worker (LCSW)
- Licensed Graduate Social Worker (LGSW)
- Licensed Independent Clinical Social Worker (LICSW)
- Licensed Mental Health Professional (LMHP)
- Licensed Master Social Worker (LMSW)
Most of these licenses require a Master’s or Doctorate, along with additional coursework or clinical internships. ( )
A survey of 2017 social work graduates by the National Social Work Workforce Study found that social workers with Master’s degrees and Doctorates made substantially more than those with no advanced degree. ( )
- People with MSW degrees made $13,000-plus more than those with only BSW degrees
- MSWs make more in large cities or urban clusters
- People with doctorates earned $20,000 to $25,000 more than people with only MSW degrees
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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.
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:
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:
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.
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.
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:
Once you have earned a bachelor’s degree, your next steps will involve one of four paths. You may:
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:
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.
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.
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:
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:
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.
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.
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.”
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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