Once a clinician has completed a thorough assessment of the eating disordered client and established enough of a therapeutic rapport to draw the client into the treatment process, the clinician should be in an advantageous position to make a referral to an eating disorders specialist or eating disorders program. It is important to note that the time of transfer can be risky in terms of holding on to and solidifying the client's commitment to treatment.

Whereas the typical therapy client may have a certain measure of ambivalence about engaging in treatment, the eating disordered client may present with a very serious level of ambivalence - if not outright resistance to or refusal for treatment. The ambivalence may take the form of the client looking for any excuse to discontinue the therapy process – and the "abandonment" of the client by the referring clinician in order to make an appropriate referral may serve as just such an excuse.

For this reason, the clinician must proceed cautiously and with a great deal of knowledge and planning. The client's feelings of abandonment and fears about beginning over with a new clinician or program must be addressed in a manner that reassures the client and exudes confidence about the ability to effectuate a smooth transfer of care.

The clinician must always be prepared to answer any of the client's legitimate questions about the treatment that will likely be provided by the specialist or eating disorders program. This requires some knowledge on the part of the referring clinician about the treatment providers that will be taking over the care of the client: what their approach might be, what their expectations might be for the client around eating, use of a nutritionist, medication protocols, etc. It also requires some knowledge about how such practical matters as insurance might be handled.

However, the clinician must be prepared for the emergence of resistance and ambivalence as the questions are asked and as information is provided to the client. There should be a clear focus on siding with and championing the parts of the client that want to get better, with implied confidence concerning the client's ability to utilize the ongoing services, and the success of an overall treatment approach.

The clinician must ultimately strike a delicate balance between providing some accurate information about what ongoing treatment might entail, and not giving so much detail that the client feels threatened by the changes that will be sought in terms of his or her relationship with food, thereby fueling his or her ambivalence about change. If the clinician errs on the side of providing too much detail, the client may choose not to follow through with the referral. If the clinician omits too much of what may occur in treatment, the client may later feel betrayed as the full extent of the treatment program is revealed.

If the clinician has been successful in engaging the client in treatment and building a generally trusting relationship as the assessment process has unfolded, it provides some level of protection against problems in this area. Still, the clinician must not let his or her attention and commitment wane as the transfer proceeds forward.

Releases must be signed, contact must be made with the parties who will provide specialized treatment, and follow-up must be conducted with the client to trouble shoot and make sure that the client follows through with ongoing care.

The next section will provide the clinician with some general information about what the therapy process may look like, including the major models for working with eating disordered clients. This base of information should help the referring clinician be better prepared to handle some of the challenges of the referral process.




Eating Disorders Factoid

Successful recovery from serious eating disorders may take from 5 to 7 years.

Source: South Carolina Department of Mental Health

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