Tried And True, Old Yet New
By Carolyn Costin MA Med, MFT, FAED, CEDS
I have been in the eating disorder field since before it was really a field. I have seen the origin of IAEDP, ANAD, AED, and the EDC, as well as the many other organizations that are devoted to eating disorders. During my 38 years of treating eating disorders, I have learned countless things that have helped improve my therapeutic skills and outcomes. However, there are some critical aspects to my success as an eating disorder therapist that I used back in 1979 as a new therapist and I still use today.
‘Get rid of the scale and pick up a journal’
I knew as someone who had recovered from my own eating disorder that weighing myself during my illness was never a good thing, never helped me do better, or get better, and in fact caused me some very disturbing setbacks when I was on the road to recovery. Giving up the scale was a game changer and turned out to be critical in helping me recover. As a young therapist I taught my clients the absurdity of weight as a reliable measure of value and weaned them off the scale. I do the same today.
Journaling had also been important in my recovery. Writing in my journal helped clarify my thoughts and served as a way of taming much of the ceaseless chatter in my head. Journaling helped me work through and visualize things I was planning to try, and gave me a way to have a dialogue between my healthy self and eating disorder self. Writing was like being my own therapist in a way and helped me challenge my eating disorder enough to take steps that were necessary in order to get well. Teaching my clients to journal has always been a part of my therapeutic work
Fifteen years into private practice, I sent out a survey to all my former clients. Of those who responded that they were recovered from their eating disorder, approximately 85% said they did three things:
- Stopped weighing themselves
- Reached out for help at the first sign of a problem, and
- They journaled. This informal survey was proof that what I was doing was working and that teaching clients to get rid of the scale and pick up a journal helped them recover. The fact that those who were recovered were doing these two things, plus reaching out for help at the first sign of a problem, struck me as very powerful and I decided to carry on “teaching to the test.” In other words, from then on I have continued to teach clients to do all three of those things to help ensure their recovery.
Shopping, cooking and eating together
Another thing I did as a young new therapist was work directly with clients and their food. Today we call this exposure/response prevention, or exposure therapy, but no books or theories on eating disorder cause or treatment told me to do this. I knew from my own eating disorder that just talking to the client about feelings or family was not going to work. I knew that not talking about food, not dealing directly with food and eating, would be like treating someone with a snake phobia and not talking about or dealing directly with snakes.
I had clients bring in food so we could eat together, and I could support and challenge them through making eating behavior changes. Family members also came to meal sessions so I could help them help their loved one eat. I met clients at restaurants and grocery stores. I knew these were not things typical therapists did, and yes it made my work harder, but I also knew my clients were not going to get better just sitting in an office and talking to me. I was right …and partly because of this, and other reasons, I had such success as an eating disorder therapist that I was hired to develop and run several inpatient eating disorder hospital units and eventually went on to establish the first residential eating disorder clinic in the United States, Monte Nido.
The value I placed on patients needing to eat with a positive role model extended to the hospital units I developed and I required staff, including therapists, nurses, dietitians and mental health techs, to eat with the patients as part of their work. This had not been done before and caused quite a stir but I persisted and the patients’ eating improved. However, much was missing in the hospital setting in terms of being able to work with patients and their food fears, phobias and resistances. I knew that in order to really recover, patients needed to be able to shop for food, cook and portion appropriate amounts. It was unrealistic to serve food in the cafeteria hospital and then expect patients to go home after discharge and plan, shop, cook and eat what they needed to. Hence I saw far too many patients relapse.
I knew I needed to open a residential home where clients could be treated in an environment that simulates real life and gives them the skills they need to succeed in changing their relationship to food. At Monte Nido, I trained staff to eat with clients, take them shopping for food, cook with them and do all the things that would help them get back to a natural, healthy relationship to food and eating. Monte Nido’s success spurred others to open residential programs. (To see results of Monte Nido’s 1 to 10 year outcome study, see Brewerton-Costin Eating Disorders Journal of Treatment and Prevention).
Training eating disorder coaches
To this day, I am still championing the cause that to help people with eating disorders you must find a way to work directly with their relationship to buying, preparing, portioning, cooking and yes, eating food. Thus my new endeavor at The Carolyn Costin Institute is training people to be eating disorder coaches who can play a significant positive role in an overall treatment team by getting in the trenches with clients and their food. Therapists and other treatment providers do not have the time to spend at grocery stores or restaurants with several clients a day and going to a client’s home would present dual relationship boundary issues. Therefore, appropriately trained eating disorder coaches can assist clients in real life situations helping them make the specific behavior changes they are working on in treatment.
Chemical dependency coaches, or “sober coaches”, have been around for many years helping drug addicts and alcoholics by accompanying them home post discharge from treatment to be sure all alcohol and drugs are out of the house, or to parties to help them stay abstinent, or even on trips to ensure sobriety. Eating disorder coaching has only recently surfaced as an adjunct to traditional treatment and though initially met with resistance, it is growing in popularity. Both clients and their families are increasingly seeking out coaches. There are several Life Coaching programs that train sober coaches but no schools, no training or certification programs devoted to eating disorder coaching, thus The Carolyn Costin Institute was born. We have received a lot of interest from people who are not licensed professionals but recovered and want to give back, as well as from licensed professionals who have not been trained to shop or eat with clients and want to add to their skill base. For over thirty years, I have been teaching licensed and non-licensed treatment providers, as well as family members, how to help people with eating disorders heal their relationship with food. Extending this training to offer certification for eating disorder coaches is an exciting endeavor whose time has finally come.
* Learn more about Carolyn here: www.CarolynCostin.com
*Learn more about The Carolyn Costin Institute here : https://www.carolyn-costin.com/institute
* Carolyn also has created a Facebook group for Recovered Eating Disorder Professionals: https://www.facebook.com/groups/Recoveredeatingdisorderprofessionals/