Eating disorders (EDs) come in many different forms—anorexia, bulimia, binge-eating disorder, pica, and rumination disorder are just a few of the conditions that fall under this broad umbrella. Their causes are just as numerous—while many people assume that body image and vanity drive these patients, their conditions may in fact spring from post-traumatic stress, substance abuse, sexual abuse, borderline personality disorder, depression, anxiety, and even genetic causes. Regardless of type or cause, EDs can be lethal: the estimated mortality rate for anorexia, for example, is 10 percent.
EDs are notoriously difficult to treat. Some patients are ready to put in the work it takes to develop a new relationship with food. Many others, however, want to be anywhere other than in an in-patient treatment facility or intensive out-patient treatment program. Eating disorder therapists (sometimes called eating disorder counselors) have a tough job that requires specialized skills and knowledge. That’s why it’s so surprising that the qualifications necessary to become an eating disorder therapist aren’t especially rigorous. Yes, you’ll need to complete years of schooling to become a clinical therapist or counselor, but you won’t necessarily be required to complete any specialization training in treating eating disorders. Any licensed therapist can legally treat a patient with an eating disorder.
In this article about eating disorder therapist qualifications, we’ll answer the following questions:
Not all professionals involved in the treatment of eating disorders are therapists or counselors. Patients with eating disorders are frequently cared for by teams that include medical doctors, psychologists and other mental health professionals, nutritionists, support coaches, and family and friends. This approach can be necessary because eating disorders are so complex.
A patient with a less-severe eating disorder might work with a counselor and a nutritionist in addition to a doctor. In contrast, a person whose eating disorder behaviors cause serious complications might work with a team that includes:
Not at all. While eating disorder therapists and medical doctors need advanced degrees, nutritionists and eating disorder coaches may have a bachelor’s degree or no degree at all. The education required to become an eating disorder specialist depends mainly on the scope of each specialty’s responsibilities. Coaches and nutritionists can’t claim to be able to treat or cure EDs, so they don’t need advanced degrees (though it’s worth noting that they each support patients with eating disorders in significant ways). A medical doctor has the educational background to prescribe an antidepressant and treat organ damage caused by malnutrition. Dietitians can create prescriptive diets and will soon need to hold at least a master’s degree.
The quick answer is that the people most likely to become eating disorder therapists are those who believe that recovery is possible. That was a big part of what drove Dr. Margherita Mascolo, a medical doctor and certified eating disorder therapist, to choose this profession. In a blog post on the Alsana website, she wrote: “I believe that there is hope for everyone that chooses to walk this journey of recovery and do the work that is required to have a different relationship with themselves, their body, and food. As an eating disorder therapist, it is my job to hold that hope, while the client continues to grow and fuel their own sense of hope in their recovery.”
Perhaps unsurprisingly, many eating disorder therapists have struggled with their own eating disorders in the past before becoming clinicians. There’s some controversy about whether therapists who have recovered from eating disorders can be truly objective or are possibly at risk of relapsing.
That said, some clinicians maintain that having overcome an ED makes them better at what they do. Alli Spotts-De Lazzer, MA, LMFT, LPCC, CEDS, certainly feels that way. She wrote in a piece in the Eating Disorders Resource Catalog: “I can wholeheartedly say that both having learned appropriate parameters about, and having had permission to disclose, my status of being recovered has helped many of my clients to believe that freedom from an eating disorder is possible—AKA ‘hope.'”
All eating disorder therapists have at least a bachelor’s degree and a master’s degree, and many also hold a doctorate. The reason that there’s not one straight-line educational path for eating disorder therapists is twofold. First, different states set their own requirements for licensure. In some, a master’s degree is enough to practice clinical psychology, and for social workers, the master’s is the clinical degree. Second, “therapist” is an umbrella term for a few different types of provider, and there are quite a few different credentials that can make one a therapist. A therapist might be a:
What this means is that while all eating disorder therapists begin their professional journeys by earning a bachelor’s degree, there’s no one specific bachelor’s degree ED therapists must have. You might choose a psych degree or a social work degree, but you can also pursue a sociology degree or a biology degree. The most important thing that aspiring eating disorder therapists can do during their undergrad years is:
From there, it gets more complicated. After earning a bachelor’s degree, an aspiring ED therapist might enroll in a master’s degree program in psychology, mental health counseling, or marriage and family therapy and stop there. That’s because some states allow psychologists to become licensed clinical therapists without a doctorate.
Most states, however, require that candidates for psychology licensure have a doctoral degree, which means that most future eating disorder therapists go on to enroll in PhD or PsyD programs that prepares them to become counseling psychologists. Many clinical therapists earn a master’s degree before enrolling in a doctoral program, but it’s possible to go straight from a bachelor’s degree program into a PhD or PsyD program at schools like Loyola University Maryland and the University of Indianapolis.
It’s also possible to become a practicing eating disorder therapist with a Master of Social Work (MSW). Students don’t need to have a Bachelor of Social Work or even a bachelor’s in psychology to enroll in many MSW programs, which makes this pathway a good option for people who earned an undergraduate degree in an unrelated discipline before deciding that they wanted to go into clinical counseling.
Unfortunately, no. There aren’t really any master’s degree programs or doctorate-level programs specifically designed for therapists and counselors who work in eating disorder recovery. The best thing aspiring eating disorder counselors and therapists can do is find programs with courses that touch on topics related to eating disorders and the behavioral therapies commonly used to treat them. They should also seek opportunities to complete one or more clinical internships in settings where ED patients are treated. Being able to work with people with eating disorders under the supervision of experienced clinicians can be hugely valuable.
Eating disorder therapists aren’t legally required to hold or pursue any specific certifications, but employers may prefer to hire job seekers who have earned voluntary credentials. There is currently one nationally recognized organization offering certifications for professionals who work with eating disorders patients: the International Association of Eating Disorders Professionals (iaedp). The iaedp offers a handful of certifications for different types of ED specialists, including therapists, medical doctors, nurses, and dietitians. ED therapists can earn the Certified Eating Disorders Specialist (CEDS) credential. Getting certified means successfully completing four courses that cover:
There is also an alternative route to certification for therapists and other professionals who meet specific advanced degree and professional experience requirements. Practitioners and scholars who can reasonably be called eating disorder experts are granted the CEDS credential on a case-by-case basis.
All 50 states require therapists and counselors to hold a current license to work with patients, though licensing requirements vary by state. There are no specific licensing requirements for psychologists or social workers who want to work with ED patients, however. Eating disorder therapists may be licensed professional counselors, licensed clinical psychologists, or licensed clinical social workers.
It’s hard to say how an eating disorder therapist’s qualifications impact how much they can earn because it’s not easy to estimate how much eating disorder therapists make. The US Bureau of Labor Statistics doesn’t track pay for ED therapists specifically. Its median pay estimates for behavioral disorder counselors (a category that includes eating disorder therapists) also include pay rates for substance abuse counselors and mental health counselors. PayScale reports that the average eating disorder therapist makes about $43,000 while ZipRecruiter indicates that the average salary for an eating disorder therapist is closer to $89,000.
That big range may have to do with the fact that it’s possible to become an eating disorder therapist with so many types of degrees. An ED therapist practicing in a state that allows therapists and counselors to work in a clinical capacity with only a master’s degree in psychology may make less than one who has earned a PsyD or PhD. Clinical social workers counseling eating disorder patients will almost certainly earn less than an eating disorder therapist who is also a full-fledged psychiatrist. Many other factors can influence a professional’s earning potential, like location, years of experience, and certifications.Still, it’s worth considering that degree type may play a larger-than-usual role in this particular discipline.
Of course, most therapists do what they do because they want to help people. For those practitioners, a regular paycheck is good; the knowledge that they’re helping people is better. Dr. Mascolo, quoted above, is frequently contacted by past clients, who may or may not be in recovery, and is reminded in those moments about why she chose this profession.
“Sometimes it is positive about how they are living life now and not just surviving life and sometimes the calls are about struggles,” she wrote. “Regardless, I’m reminded in those moments of why I do what I do. I do it because somewhere along the way we all need someone to believe, hope, and trust that recovery is possible and continues to be possible. We need to know that someone believes in us and the full life that we deserve.”
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