A Helpful Guide for Clarifying Treatment Expectations
In the approach to your first appointment with a new healthcare clinician, it is common to feel unsteady or uncertain about what lies ahead in this new interaction. We have created this page to clarify the expectations we have about working with our clients so that we can minimise any surprises that could eventuate for you.
Who we work with
We work exclusively with people who have had a diagnosed eating disorder or people with an eating problem which puts them at risk of developing an eating disorder. We accept practitioner referrals, personal recommendations, and self-referrals. Anyone, at any life stage is welcome to attend, but we don't work with infants, toddlers, or junior school-aged children. Ten years of age and up is a good guide. All our clients live with an eating problem, at least partly involving body image concerns or a severe form of fussy eating.
What can I do before I attend my first consultation?
We have an expectation that you have a set of supports in place around you during your treatment. These supports can be family, friends, carers, support workers or pets who bring comfort or practical support to you when distress arises. Think about whether you have a reliable support person that knows about the eating problem and the extent that it affects you. Do you think you can communicate this eating problem to your closest support person?
During the first two consultations, we will conduct a thorough assessment which explores your medical history, the nature of the eating problem, and a nutritional assessment. We hope that you can bring questions with you to ask throughout the first two consultations, so that you can gather as much information as you need to feel safe and supported for a great start to treatment.
We also ask that you complete a 3-day food diary so that we can get you ready to answer questions about your usual eating. Keeping a record of everything you eat for any 3 days leading up to the first consultation will be helpful in performing a nutritional assessment in your consultation.
We request that your medical stability be assessed by a medical practitioner regularly. The frequency that this is expected will change throughout treatment, but as a guide it will be requested weekly if medical instability or destructive behaviours are present, fortnightly when adequate eating is a little wobbly, or monthly when eating is adequate. Your medical practitioner will have the ultimate discretion on this frequency, so rely primarily on their advice. Your medical safety is most clearly communicated to your dietitian when you proactively share blood test results and blood pressure measures at the start of a consultation. We ask that you keep a written/photographic record of your measurements of blood pressure and heart rate (both when seated and standing). A medical practitioner, community pharmacist or nurse could provide you with the blood pressure and heart rate measures that we request.
If you have a treatment plan, pathology results or any written communication from health professionals, mental health clinicians or a hospital discharge summary about the eating problem, please bring this with you to your first consultation or email it to us ahead of time at firstname.lastname@example.org
What happens in the first two consultations?
The first 2 consultations of your treatment are a chance for us to become familiar with each other and the eating problem that you want to address. We will get to know you, explore your medical circumstances, the nature of the eating problem and conduct a nutritional assessment. It is not usual practice for us to create a meal plan during the assessment phase, so it is important that you are aware of our need to hold steady and build into your treatment in a way that fosters success. Clients commonly request a meal plan early on, but we want you to be aware that we resist providing a meal plan at the early stages of treatment.
We try to set-up self-monitoring early on in treatment. Self-monitoring is a way of recording what happens to you throughout the day. This includes records of what you eat, how you are feeling and what you are thinking. Self-monitoring records can be written on paper or logged in a recovery-focussed app that we like to use, Recovery Record. These records are incredibly supportive of recovery from an eating disorder, so their use will be very strongly encouraged.
We start each session with a questionnaire to monitor key symptoms of eating disorders. Next, we set an agenda for the consultation where we ask you to set priorities for our discussion. Self-monitoring records are then reviewed before building into the therapeutic work that aligns with your needs. Strategies to progress are set up and review appointments are scheduled.
What does treatment involve?
We treat two categories of eating disorder: those related to body image concerns and those related to severe fussy eating (ARFID).
For body image related eating disorders, treatment of the eating problem can progress across 20 sessions over 12 months and follows a natural course of building on several eating themes including eating regularly, eating adequately, eating a broad variety of foods, eating socially, and eating spontaneously. Mastery of these themes leads clients to becoming intuitive eaters, freeing the mind of preoccupying eating rules and opening space in the mind for living a more fulfilled life. To move through this process, we utilise strategies from the toolkit of Enhanced Cognitive Behaviour Therapy (CBT-E) for eating disorders, allowing our clients to see their eating as part of the bigger picture of their life, rather than a way of coping with difficult emotions here and now. We have an expectation of a minimum frequency of contact to receive good care. This is because momentum plays a significant role in building a therapeutic relationship and breaking down the eating problem. We meet with our clients fortnightly as a common guide. This is negotiable and decided collaboratively, with reviews of our progress through treatment taking place every fifth session.
For treatment of severe fussy eating, which we refer to as ARFID, treatment involves around 12 sessions over 12 months if starvation syndrome is not present and up to 30 sessions over 12 months if starvation syndrome is present. ARFID treatment will often carry-over across several years as one builds food variety into the diet very gradually. The client initially explores their motivations for engaging in the process and is asked to find foods they are interested in learning more about. The neurobiological mechanisms of ARFID are explained to help remove shame or blame about the eating problem from any pre-existing beliefs. In the clinic, tiny food exposures to unfamiliar foods are guided by the dietitian and lead to sensory experiences that are objectively described and recorded so that new memory references are created. At home exposures are encouraged and help to build variety more rapidly into the diet. Gradually, more flexibility in eating becomes apparent with ongoing commitment to food exposures.
What happens if I need support between consultations?
We are happy to receive email queries, but please note that we may need three working days to respond. Email requests can be practical in nature for clarifying clinical education or strategies that were discussed during a consultation. Email email@example.com to make a specific request from your clinician.
Do you weigh me in consultations?
Weighing on scales in our consultations is not often performed as we are clinicians who are dedicated to weight-neutral care. If a clinician in your team is weighing you, they may communicate this with us so that the measure is not unnecessarily duplicated. We acknowledge the shame triggered by weighing and prefer to minimise the emotional impact this has on our clients by using this tool sparingly. For medically unstable clients, this may be less possible, but we have the option of a blind weigh if the number creates significant distress. As body avoidance reduces, it will be helpful to therapeutically be supported through weighing oneself on the scales, so that one can be guided away from having strong reactions to uncomfortable emotions that the number can elicit. Over time, we can learn to tolerate uncomfortable emotions and learn that the scales do not have to dictate our mood or self-confidence.
If body image concerns are not present, weighing may be used to indicate progress with adequate eating in the context of ARFID treatment, but the need to know this information is guided by the client's desire to know.