The Guardian article regarding the suitability of coaches for working with eating disorder persons has raised a lot of angst. Out of the woodwork pour well-meaning academics, authors and persons with lived experience who regard themselves as the mouthpiece for eating disorder sufferers.
The Guardian journalist had a clear agenda for her article, and for her Editors, this was to “awfulize” the phenomenon of “untrained” coaches working with eating disorders. She targeted NCFED because we refer people to professional coaches – and nutritionists without qualifications in psychology. When she interviewed me she heard things with did not chime well with her agenda because we told her that all our Network have been thoroughly trained, supervised, properly tested and grounded in working safely. She had not expected to hear this – I think that this has caused her discomfort. But she had to follow her agenda to its conclusion and so, here we are.
I agree that there are thousands of people out there who claim to treat eating disorders who have done little or no training. Attending an eating disorder course, certificates or not does not make you a safe eating disorder or obesity therapist.
But there is no one from the counselling or psychology authorities who are prepared to say what is enough.
There is a familiar trope that eating disorder patients are “vulnerable” and “deserving only of a qualified psychotherapist with the right qualifications”. I agree with this to an extent.
There are arguably about 12 million people in the UK who qualify for having an eating disorder, most undisclosed because they are not seen to be at death’s door. This is the vast army of compulsive eaters and serial dieters including many who also purge. Among this hidden tsunami of sufferers are many not particularly vulnerable. Their dieting efforts have had unintended consequences and they are otherwise as normal as anyone else. I do not agree with pathologizing everyone who has an eating disorder. I do not want to tell my patients that they are mentally ill. Poor body image is normal and a culture-bound, not a mental health issue in most of us.
A coach who learns the basic principles of cognitive behaviour therapy applied to eating issues is a very good choice to help lead most eating disorder patients back to a better relationship with food and a flourishing life. You see, even for so called psychotherapists, eating disorder therapy is largely a coaching role. The strategies taught by the Maudsley, such as reducing rigidity are coaching tasks, framed as “behaviour therapy”.
I would even go so far as to say that coaches are BETTER trained to help guide a person toward a flourishing life. Therapists approach their patients from the perspective of “what is wrong with you!” while coaches ask the question “how can I help you to live better going forward”.
So, I am on the side of our coaches. Give them a good enough grounding in the principles of CBT and help them know when to call on additional troops and they often do better than academic psychotherapists.