For recovered Dietitians working in the eating disorder field
Navigating work in the eating disorder field as a recovered Dietitian
If you are a Registered Dietitian who has recovered from an eating disorder in the past and are now working in the field of eating disorder care, this article is written especially for you. If you are like me, you have come to this field with a deep desire to help others from a place of self-awareness and compassion. Even with these beautiful intentions at heart, you may still wonder whether others may perceive your lived experience with eating disorder recovery as worrisome, or negative. You may also wonder how your lived experience impacts the care that you provide to your patients. If so, you are not alone. As a fellow RD with lived experience recovering from an eating disorder, I have felt these things too.
The following article is a summary of qualitative perspectives of providers with lived experience and of their patients. The article starts with a summary of my own perspective as a Dietitian in the field of eating disorder care with lived experience. I hope that by reading this article, you leave feeling inspired and knowing that you are appreciated, valuable and needed within the eating disorder field. I also hope that you leave with key take away messages in terms of how to thoughtfully approach your practice as a Dietitian with lived experience in a way that best supports the clients that you work with.
Embracing your lived experience
Embracing the ways in which your lived experience makes you an amazing eating disorder dietitian is important. You bring a unique lens to your practice and I am imagining that you can deeply empathize with your clients. Being a recovered eating disorder dietitian does not come without it’s challenges, but you have so much to offer others by doing this work along side of them if it is the path that you choose.
As a Dietitian with lived experience with recovery who is now working in the field of eating disorder care, my thoughts and feelings are that I believe my lived experience has helped demonstrate genuine empathy for those I support. On occasion, my lived experience has also helped me to provide unique insight to other providers when participating in case consults, and to express thoughtfully with others of what it can feel like to struggle with an eating disorder. From my perspective, my lived experience has deepened my practice and helps me to connect with others who are struggling with the same thing in a way that feels authentic and understanding.
My personal choice has been to embrace with vulnerability sharing that I am a recovered professional with others in 1) a way that feels authentic to me 2) in a way that is thoughtful and careful 3) in a way that considers the context (why, how, when and what) in which I share. I know that other providers in the field may not agree with this approach, but for me personally, I cannot imagine existing within the eating disorder treatment space in a way that is not first deeply human and authentic. We know from the research that validation, compassion, and empathy are incredibly powerful aspects of the care we provide as professionals in the field of eating disorders (1), and I truly believe that drawing upon my lived experience supports my ability to demonstrate these things to the individuals I support.
Some interesting qualitative research
What is interesting is that the research seems to support that this is also the way that many recovered providers who are now working in the field of eating disorders feel about how their lived experience impacts their practice. While research specific to Dietitians is lacking, the following research below examines the experience of recovered therapists and their patients in the eating disorder field. Qualitative evidence from the perspective of providers with lived experience, and patients who have received treatment from individuals with lived experience demonstrate the following interesting findings.
Provider perspective:
From the studies that I was able to find and access, a clear theme was that recovered therapists overwhelming felt that their eating disorder history was helpful in providing support to others with eating disorders. One qualitative study had 139 eating disorder treatment providers complete a questionnaire that was designed to assess whether and how their personal history with an eating disorder influences treatment of patients. Results indicated that most participants (94%) believed that their eating disorder history positively influenced their treatment of patients (e.g., increased empathy, greater understanding of the disorder, more positive personal outlook). Conversely, only 8% identified ways in which it can negatively influence treatment (e.g., feeling personally triggered, over-identifying with patients).
Notably, other professionals shared this consensus, however they noted the importance of personally recovering before treating this population and monitoring one's experiences in session (e.g., notice countertransference) (2).
Patient perspective:
A qualitative study that included 205 patients and 26 recovered therapists explored the advantages and disadvantages of the utilization of experiential knowledge (lived experience) in therapy. Of the patients included in the study, 97% indicated that the recovered therapist’s experiential knowledge had advantages in therapy. Of note, patients identified that advantages were related to high therapist empathy; feeling recognized and heard; the therapist having enhanced knowledge and insight into ED; therapy safety with a relationship based on equality and acceptance, and an increased sense of hope on recovery (3).
On the other hand, 11% of the patients reported that experiential knowledge can have disadvantages in therapy. Two disadvantages emerged, namely the possibility of making a negative comparison with the therapist and getting too personal with the therapist. Overall, 93% of the participants indicated that the therapy they received from a recovered therapist had a positive effect on their ED recovery. Importantly, it was noted that to be effective, self-disclosure and experiential knowledge need to be shared thoughtfully and should not include specific details about ED symptoms (3).
Research summary:
In summary, the qualitative research indicates that overall therapists and patients alike felt as though the utilization of experiential knowledge (lived experience) was overall mostly supportive. While this is a very small portion of the research that is available, and is specific to therapists versus RD’s, I think this research highlights that lived experience provides helpful insight into recovery and eating disorder treatment and that majority of patients included in the studies found that when their provider disclosed their experience in a thoughtful and appropriate way, it was helpful. My hope is that in the future, further qualitative research specific to RD’s and their patients is collected to deepen our understanding of how lived experience impacts eating disorder treatment.
Caring for others while also caring for you
What I would like to invite fellow RD’s with lived experience to consider is how your lived experience may serve to deepen your practice as a Dietitian. It’s also important to consider how you will take care of you while working in the eating disorder field. This means practicing self-awareness, acknowledging your personal triggers, practicing self-care, and establishing boundaries in your work. You bring a unique perspective, that when combined with further education regarding nutrition counseling for eating disorders, can provide a space that is validating, compassionate and nurturing for the individuals you serve. I would also like to highlight that whether you choose to share your own experience in a professional context is again a very personal choice. It is okay to not share about your lived experience with others if it does not feel right to you. It is your choice. Know that you are valuable and appreciated in this field and that your personal experience shapes your practice as a Dietitian in many beautiful ways.
Key take away messages
1. Whether you choose to share about your own recovery experience in a professional context is a personal choice (it is okay not to share)
2. If you choose to use self-disclosure when working with a patient or colleagues, carefully and thoughtfully consider why, how, when and what. Avoid sharing specifics about your eating disorder symptoms.
3. It is important to be in a strong place in your own recovery before supporting others, and to be self-aware, practice self-care, establish professional boundaries, and be aware of your personal triggers.
4. Acknowledge the ways in which your lived experience may serve to deepen your practice such as increased empathy, insight into the recovery process, the ability to demonstrate understanding and validation of your patient’s experience.
References:
1) Geller, J., Fernandes, A., Srikameswaran, S. et al. The power of feeling seen: perspectives of individuals with eating disorders on receiving validation. J Eat Disord 9, 149 (2021). https://doi.org/10.1186/s40337-021-00500-x
2) Cortney S. Warren, Kerri J. Schafer, Mary Ellen J. Crowley & Roberto Olivardia (2013) Treatment Providers With a Personal History of Eating Pathology: A Qualitative Examination of Common Experiences, Eating Disorders, 21:4, 295-309, DOI: 10.1080/10640266.2013.797318
3) de Vos JA, Netten C, Noordenbos G. Recovered eating disorder therapists using their experiential knowledge in therapy: A qualitative examination of the therapists' and the patients' view. Eat Disord. 2016 May-Jun;24(3):207-23. doi: 10.1080/10640266.2015.1090869. Epub 2015 Oct 14. PMID: 26467023; PMCID: PMC4873721.
4) Bachner-Melman, Rachel et al. “Attitudes towards eating disorders clinicians with personal experience of an eating disorder.” Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 26 (2020): 1881 - 1891.