By:  Aimee Hollendieck, MS, LMHP, CPC

I never intended to treat folks with eating disorders.  It just kind of happened.  I don’t have a personal story that links me to it, I don’t have any known family members who have openly struggled.  I know what it’s like to be a female in our American society and I know what it feels like to judge and be judged.  So when I came into the world of eating disorder treatment, I had a lot to learn.  I still have a lot to learn, but I’ve come to adopt one major treatment philosophy.  I call it, staying in my sandbox.

Eating disorder treatment is complex, and there’s not a one size fits all.  Every client is an individual.  Since they tend to be complex, I fully believe that it takes a treatment TEAM to best assist them.  When I say “treatment team” that usually consists of a therapist, a registered dietitian, a medical doctor, and, if needed, a psychotropic medication provider.  In my intake with an eating disorder client I tell them they need to make an appointment with a dietitian, bare minimum, and assess if they need further appointments.  Some people would disagree with this philosophy, which is fine, but that’s also a little scary to me.  This disease has the highest fatality rate of any mental health disorder, and we think it just takes one?  Egos aside, I respectfully disagree…a lot.

I think the number one rebuttal I run into is “Aimee, what if they don’t need a dietitian?” and my response is-how do you know?  As a therapist, I can guarantee one thing, I never know with 100% certainty what someone else is thinking or feeling.  I can make educated assumptions, but beyond that, my blood is red just like everyone else’s.  I have no super powers.  Even a client who seems to have a “mild” eating disorder could easily move into the “severe” eating disorder category in the blink of en eye.  We’re talking about a bio-psycho-social disease here people, it takes a village.

I love those clients who are coming from the fitness world itself, they tell me “I know everything about nutrition already” or “what is a dietitian going to tell me that I don’t already know?”  You have to love the fear projected out there as confidence, am I right?  This is what I tell them: “because I said so”.  No, just kidding, I don’t tell people that.  I tell them that they deserve wrap around care for their disease.  I tell them that I stay in my sandbox of therapy, and to go into it with them regarding nutrition-how many calories they need and to present possible food plans is not in my scope of practice.  If I did go into the dietitian’s sandbox I don’t see how that’s any different than me saying, “Hey, I’ve seen 72 episodes of Intervention, I think I’m qualified to work with crack addicts.”  I’m not.  I rely on the teamwork of the dietitians and doctors, and their knowledge and experience to best help my clients.  Two heads, three heads or even four heads are better than one.

Here’s the best part about me operating in my sandbox, the other practitioners seem to reciprocate and stay in their sandboxes too.  This is vital to me.  Picking the people I refer to depends a lot on if they stay out of my sandbox.  I like to think that I’ve had really good experiences with this.  Part of the reason why is how often I try to stay in contact with the other members of the treatment team.  It’s hard sometimes.  We all have lives out of the office, and an hour long phone conversation every week or so to consult on cases can seem overwhelming.  But this is what our clients deserve.  If we don’t, they fall through the cracks.

Now, what research am I basing this sandbox theory from?  I’m sure it’s out there, but in all honesty I’m basing this off of the work I’ve done with clients.  I’m basing this off of the treatment models I’ve seen while visiting various eating disorder treatment facility sites across the country.  I’m basing this off what clients have told me about treatment models that didn’t work for them.  The bottom line is we need to be asking ourselves if we’re providing the best outpatient experience for our clients who are struggling with ED.  And if we’re not, we need to reevaluate and look around and start getting support from each other.  None of us have to go about this alone.  Reach out.  Consult.  Educate yourself.  And listen to the needs of your clients, they deserve that.