[mistygrey]

I'm very upset and would really like some advice and reassurance.

I have a long history of disordered eating and spent some time in hospital as a teenager. I've never fully recovered however I eventually managed to get my eating problems under control enough so I could live a relatively normal life for about 10 years. Around a year, however, I experienced some stressful life events and felt myself slipping back into eating disorder behaviours, as well as feeling out of control with my life and slightly depressed.

My weight dropped to borderline underweight but I knew it wasn't low enough for the NHS to take me seriously and provide me with treatment so I decided to seek private psychotherapy.

I found a local psychotherapist via the internet who looked kind and patient and although he didn't list eating problems as one of his specialisms, he felt he could help with my low self esteem, relationship issues and depressive feelings.

I've been seeing him now for around a year and my eating problems have not improved. I've started to experience physical symptoms, such as irregular periods and hair loss. I've also started to experience suicidal feelings after bingeing and had to take some days off work sick as I've been feeling so bad.

I went to see my GP today for a smear test and mentioned my irregular periods. I admitted to having eating issues and told her that I've been seeing a therapist. She seemed very angry and said that my therapist was unethical and should have referred me onto a therapist who specialises in eating disorders. She told me I should stop seeing him immediately as he could be making me worse and that she would refer me for NHS help but couldn't guarantee the eating disorder clinic would accept the referral as my weight is not at a dangerously low level. She said 'are you sure your therapist is qualified? he's been taking money off you all this time for a problem he isn't equipped to help with'.

I feel so upset and I don't know what to do. My therapist is registered with a professional body which has a website (I've checked and he is listed) but it's not one of the well known professional bodies in the UK. I'm worried I have been conned and he hasn't had my best interests at heart but was just after the money. I don't know what to do. I don't want to just stop seeing him as even though he isn't helping much with the ed, he does provide me with some comfort and makes me feel listened to and understood sometimes. I feel guilty and like this is my fault because I went to see him knowing he didn't specialise in eating disorders.

I really don't know what to do - should I just email him and cancel my appointments or should I go next week and explain what has happened and tell him I won't be seeing him anymore? If he is a conman, maybe he will get angry with me and hurt me? I see him at his home. so it's not like we will be in a public place with people around. I don't want to leave him and have no support at all. I won't be able to cope.

I would be very grateful if anyone has any advice. Do you think he has been unethical or is my GP overreacting?

[guilloche]

Does he actually know that you have an eating disorder? Have you talked to him about this?

If not, I'd go to one more session, tell him about it, and ask if he knows anyone that he can refer you to. Tell him that it's getting worse, and you're now having physical symptoms that have concerned your doctor.

If he already knows, and you've talked about it - yes, I think it could be considered unethical, but I'm not 100% sure if it's actionable (or how it works in your part of the world). In general, my understanding is that therapists are not supposed to continue seeing someone that they are not qualified to help, or that is not responding to their treatments. But, with therapy, that leaves a whole lot of gray space.

In your case... you know what's going on with your body, you're aware of it and have been down this road before... I'd start looking for someone that has the experience to really help you. You've already lost a year, and EDs (as you know) can have serious physical consequences... you deserve someone who knows what they're doing and can help!

Good luck...

[HazelGirl]

How is he helping you? What type of therapy does he practice?

[mistygrey]

Originally Posted by guilloche

Does he actually know that you have an eating disorder? Have you talked to him about this?

If not, I'd go to one more session, tell him about it, and ask if he knows anyone that he can refer you to. Tell him that it's getting worse, and you're now having physical symptoms that have concerned your doctor.

Good luck...

Thanks for your reply. Yes, he does know I have an eating disorder. I declared it pretty much from the start - certainly by our second or third session.

He knows it is affecting me a lot and we do discuss it a lot in sessions.

[mistygrey]

Originally Posted by HazelGirl

How is he helping you? What type of therapy does he practice?

He is an integrative psychotherapist and we do discuss my eating disorder a lot. He thinks I can manage to keep myself on track. I told him the other week that one of my concerns is that I might get to the point where I completely stop eating and he said that wouldn't happen as something would always prompt me to eat like someone making me or my hunger would overtake my decision not to eat.

He thinks I manage my eating disorder well as I do look reasonably healthy (if a bit on the skinny side).

[Leah123]

You started seeing him knowing he had no experience with eating issues, so, that was your choice. He wasn't conning or taking advantage of you- you picked him over someone who specialized in this issue.

You chose to focus with him on three things that you list above: self esteem, relationships, depression.

How are you doing in those areas? Is the therapy helping?

I don't think this is necessarily anything to do with ethics unless there are more issues than you've mentioned above.

If he's not helping you, then you can certainly move on to another therapist who is better suited to the work you need to do, and I encourage you to do that since your disordered eating is becoming concerning! If you love the current therapist because you're making progress in other areas, well, you might consider seeing two or consulting with someone to help you transition away, something to make it easier for you emotionally.

[Depletion]

I think that there is a possibility, although it is expensive, that you could see a second therapist for ed, and keep seeing the T you have now as main T. I have some eating issues, they aren't super sever, but I've gained quite a bit of weight since I was assaulted 5 years ago. The T I see now recommended a weight loss T because she does not specialize in disordered eating. I've decided not to go to the referral for now because I'm already planing to go to couple's therapy, and a group, so I can't really afford it, but I might consider it after the group is over, if I'm still struggling.

I think its important that you find someone who can help you with is issue specifically, and your T should be able to make a referral. Maybe a nutritionist would also be a good idea too (although I'm not sure how judgywudgy they are about eds).

[kaliope]

I don't believe he conned you...I see your gp's point but feel she is over reacting...you knew he didn't specialize in ED...that was out in the open...it was clear what he was treating you for..he wasn't trying to treat you for your ED...but now that your GP as identified the ED as a serious issue you need treatment for, then you need to find a provider for that. so continue to see your current provider until you do so. let him know your gp thinks you need the specialty and can he recommend someone. take care.

[Lauliza]

I am inclined to agree with your GP in that he should have referred you to a specialist and it could be seen as unethical of him not to. It sounds like he has good intentions but doesn't have the knowledge and experience to help you and to identify that you werent doing well. Yes, he did tell you he wasn't a specialist but i still think he should have checked in regarding your symptoms considering your history. I dont think it neccessitates reporting him or anything like that, but I'd let him know what your GP said and that you are going to see a specialist for your ED. You can always see him for talk therapy also, but yoiu should see someoene specialized to help you with your ED.

[amandalouise]

Originally Posted by mistygrey

I'm very upset and would really like some advice and reassurance.

I have a long history of disordered eating and spent some time in hospital as a teenager. I've never fully recovered however I eventually managed to get my eating problems under control enough so I could live a relatively normal life for about 10 years. Around a year, however, I experienced some stressful life events and felt myself slipping back into eating disorder behaviours, as well as feeling out of control with my life and slightly depressed.

My weight dropped to borderline underweight but I knew it wasn't low enough for the NHS to take me seriously and provide me with treatment so I decided to seek private psychotherapy.

I found a local psychotherapist via the internet who looked kind and patient and although he didn't list eating problems as one of his specialisms, he felt he could help with my low self esteem, relationship issues and depressive feelings.

I've been seeing him now for around a year and my eating problems have not improved. I've started to experience physical symptoms, such as irregular periods and hair loss. I've also started to experience suicidal feelings after bingeing and had to take some days off work sick as I've been feeling so bad.

I went to see my GP today for a smear test and mentioned my irregular periods. I admitted to having eating issues and told her that I've been seeing a therapist. She seemed very angry and said that my therapist was unethical and should have referred me onto a therapist who specialises in eating disorders. She told me I should stop seeing him immediately as he could be making me worse and that she would refer me for NHS help but couldn't guarantee the eating disorder clinic would accept the referral as my weight is not at a dangerously low level. She said 'are you sure your therapist is qualified? he's been taking money off you all this time for a problem he isn't equipped to help with'.

I feel so upset and I don't know what to do. My therapist is registered with a professional body which has a website (I've checked and he is listed) but it's not one of the well known professional bodies in the UK. I'm worried I have been conned and he hasn't had my best interests at heart but was just after the money. I don't know what to do. I don't want to just stop seeing him as even though he isn't helping much with the ed, he does provide me with some comfort and makes me feel listened to and understood sometimes. I feel guilty and like this is my fault because I went to see him knowing he didn't specialise in eating disorders.

I really don't know what to do - should I just email him and cancel my appointments or should I go next week and explain what has happened and tell him I won't be seeing him anymore? If he is a conman, maybe he will get angry with me and hurt me? I see him at his home. so it's not like we will be in a public place with people around. I don't want to leave him and have no support at all. I won't be able to cope.

I would be very grateful if anyone has any advice. Do you think he has been unethical or is my GP overreacting?

if you were here in america neither treatment provider would have been considered unethical nor over reacting. this is because here in america we have the freedom to choose our own treatment providers, decide for ourselves whether that treatment provider can help us with our problems, and ask for a referal if we think a treatment provider is not qualified. treatment providers in america are not .....required..... to refer a patient on to other treatment providers but most do recognize the need to have a patient see a specialist when needed... aka if a patient has a problem with depression, or what ever the primary care physician can either treat them their self or refer that patent to a mental health agency or a specialist.

here in america mental health agencies generally are able to treat all mental disorders recognized in the DSM 5, though some patients/clients ask for a specialist and the therapist or psychiatrist can if they wish refer them to someone else. because they want to not because they have to due to law or ethics. I mean treatment providers dont force their clients to stay in treatment with them if they dont want to here in america. its just how our freedoms to health care works. everyone gets to choose who they want to be in treatment with.

but your profile says you are in the UK so in order to get your answers according to the UK standards you will need to contact your locations governing agency that over sees what the mental health ethics laws are where you are located.

[MoxieDoxie]

There is no special certification just for eating disorders that I know of here in the USA. Besides eating disorders are a symptom of something else. Mine is a symptom from cPTSD and BPD. Treat those and my symptoms subside. Since your weight was not low enough for the usual clinic where would he have sent you?

[Lauliza]

Originally Posted by amandalouise

if you were here in america neither treatment provider would have been considered unethical nor over reacting. this is because here in america we have the freedom to choose our own treatment providers, decide for ourselves whether that treatment provider can help us with our problems, and ask for a referal if we think a treatment provider is not qualified. treatment providers in america are not .....required..... to refer a patient on to other treatment providers but most do recognize the need to have a patient see a specialist when needed... aka if a patient has a problem with depression, or what ever the primary care physician can either treat them their self or refer that patent to a mental health agency or a specialist.

here in america mental health agencies generally are able to treat all mental disorders
recognized in the DSM 5, though some patients/clients ask for a specialist and the therapist or psychiatrist can if they wish refer them to someone else. because they want to not because they have to due to law or
ethics. I mean treatment providers dont force their clients to stay in treatment with them if they dont want to here in america. its just how our freedoms to health care works. everyone gets to choose who they want to be in treatment with.

but your profile says you are in the UK so in order to get your answers according to the UK
standards you will need to contact your locations governing agency that over sees what the mental health ethics laws are where you are located.

The OPs T would have been ethically required, not legally required, to refer her to someone else who has expertise in EDs. It is the therapist's obligation to work in the best interest of the client and to provide the best care possible. If they can't, ethical guidelines require the refer the client to another, more qualified T. The OP said that she her weight was low enough to cause hair loss and she wasn't menstruating, so this is serious.

There is no specialized training to work with someone with an eating disorder, but clinicians gain expertise through hours of experience. You can say you counsel people on the Autism spectrum, and you don't need special certifications to do so, but most would agree people on the spectrum will benefit most from a T with a lot of experience and knowledge. And it sounds to me from the OPs post that this is a significant issue that needs prompt attention (hair loss and missed periods are signs that her body is suffering). Of can you have the right choose your own treatment, but it also sounds like the OP wanted more direct help than she was getting.

[Mully]

I don't think it's unethical. I'm from a different country from you but had a similar experience. I had an eating disorder for many years, and the public system dumped me after a residential stay and an extremely short follow up. My public T referred me to my current one who has limited experience with eating disorders but an amazing expertise in trauma, dissociation and women's issues. Honestly she's been a great fit for me despite the lack of ED knowledge; it's been refreshing to work with someone who is helping me look beyond the same old eating issues over and over again. I think it's more an issue as to how you feel. Is your T helping you enough, or do you need to take charge of your treatment and find someone to focus more on ED issues? I think it's more about being honest with yourself and finding what you need. (I will say, though, that it is super frustrating when public programs don't take people seriously due to ridiculous specifics, I have had the same problem). Good luck to you!

[guilloche]

Originally Posted by amandalouise

here in america mental health agencies generally are able to treat all mental disorders recognized in the DSM 5, though some patients/clients ask for a specialist and the therapist or psychiatrist can if they wish refer them to someone else. because they want to not because they have to due to law or ethics. I

That hasn't been my experience. I've had a therapist that I had worked with for a year, gotten nowhere, and was sent for a conslutation for dissociative disorders. Was diagnosed, and my T refused to work with me anymore - because he had no experience with dissociative disorders (even though they are in the DSM).

I don't think it was a legal issue, but he was clear that it was an ethical one - if a T (in America) doesn't feel they have the expertise to treat you properly, my understanding is that they are ethically supposed to refer you out. Even my current T has said that if he thought I had a serious dissociative disorder (he doesn't at this point), he would *have* to refer me out (his words, not mine), because he doesn't have the expertise to treat that.

My understanding from reading here (and I could be wrong) was that eating disorders were one of those things where having specialized treatment makes a big difference.

Good luck to the original poster... whatever you decide to do!

[growlycat]

If your T did not know you are starting to have severe physical problems due to the ED, I don't think he was unethical. However, if he knew things were worsening he should have referred you out.

I do think it is unethical and would be even in America.

[mistygrey]

Thank you all for your thoughts and advice. Still not really sure what to do. I do feel attached to my therapist although I think i now have some feelings of mistrust and anger towards him. I don't want to stop seeing him really as I feel like I would sink emotionally with no help.

I do feel the therapeutic relationship has messed me up in some ways more than I already was!

[HealingTimes]

I think it was wrong of your GP to tell you that your T is being unethical!

When I went to my GP in regards to my ED, he asked if I wanted therapy in the NHS and I told him that I was already having therapy privately.
He said that was fine and that they would just keep an eye on me (regular weighing and BP- which I declined anyway).
BUT I didn't have major physical issues because of my ED at that point. Maybe you need to accept that although your T isn't being unethical he should either be working with you more on your ED, or refer you to someone who knows how to 'handle' EDs and has more experience.

[amandalouise]

Originally Posted by Lauliza

The OPs T would have been ethically required, not legally required, to refer her to someone else who has expertise in EDs. It is the therapist's obligation to work in the best interest of the client and to provide the best care possible. If they can't, ethical guidelines require the refer the client to another, more qualified T. The OP said that she her weight was low enough to cause hair loss and she wasn't menstruating, so this is serious.

There is no specialized training to work with someone with an eating disorder, but clinicians gain expertise through hours of experience. You can say you counsel people on the Autism spectrum, and you don't need special certifications to do so, but most would agree people on the spectrum will benefit most from a T with a lot of experience and knowledge. And it sounds to me from the OPs post that this is a significant issue that needs prompt attention (hair loss and missed periods are signs that her body is suffering). Of can you have the right choose your own treatment, but it also sounds like the OP wanted more direct help than she was getting.

the key here is whether the treatment provider feels they.......are .....capable of treating the client they do not .....have ... to refer the person to someone else....ethically nor legally.

kind of strange for a treatment provider to sit down with a client and say yes I can work with people with eating disorders and Im qualified to do so but Im going ot refer you to someone else anyway...

thats like telling someone who was raped yes we can work on your having nightmares about your rape I can do that for you but even though Im a state licensed therapist qualified to treat all kinds of mental disorders and problems Im going to send you on to someone else who also works on this. good bye....

whats the sense in being a mental health treatment provider if you are going to refer your clients off to someone else even though you know you are qualified and can work with the problems brought to you. no sense at all. thats why here in NY it is not an ethical problem nor a legal one for treatment providers to decide yea this is something I can work with. Here in NY treatment providers are trained to work with all mental disorders, all issues like depression eating disorders, what ever. Sure we have a limited few, probably about as many places as you can count on one hand that are inpatient facilities that treat one or two mental disorders but over all here in NY treatment providers must be qualified to work with all mental disorders, they can choose if they want to who they are going to work with and who they arent, just like the patients/clients can choose who they want to work with given their financial means.