2. INDIVIDUAL THERAPEUTIC SERVICES Therapy is available to individuals across Queensland aged 16 years and over and can be provided either face-to-face or via telehealth. Clients do not require a medical diagnosis of an eating disorder to access the services at EDQ. Therapeutic support allows people to explore their underlying issues with skilled practitioners in a safe, therapeutic and confidential environment. 9. Safety is always a priority: the therapeutic relationship. Workers must consistently facilitate a safe therapeutic environment. Given that many clients who have experienced an eating disorder have a history of childhood trauma, safety is of paramount importance. One of the most effective ways of establishing safety in the sessions is through developing a strong therapeutic alliance. There should be clear communication and transparency in the therapeutic relationship where the counsellor is authentic, empathic, compassionate, flexible and kind. This is one way that we ensure that we can facilitate safe exploration for the client. In Judith Herman’s stages of recovery, the first stage is safety, especially the relational safety found in the therapeutic relationship.
The first task of recovery is to establish the survivor’s safety. This task takes precedence over all others, for no other therapeutic work can possibly succeed if safety has not been adequately secured. No other therapeutic work should even be attempted until a reasonable degree of safety has been achieved .16 10. Safety is always a priority: risk assessment and safety planning. A key part of ensuring safety for the client is to undertake thorough risk assessment and safety planning with the client. This is an ongoing process that continues for the duration of the therapy in recognition that the level of risk may change throughout the course of therapy17. It is also important to ensure that
Eating Disorders Queensland (EDQ) provides quality therapeutic services to individuals through several different funding streams – Queensland Health funded services, Medicare counselling services and NDIS funded packages.
confidentiality issues and issues of consent are covered in the initial session, and throughout therapy as needed. 11. Safety is always a priority: physical health implications. Eating disorders have serious physical health implications, so it is essential that all clients have an open and active relationship with their general practitioner (GP)18. Therapists are not medically trained and do not have the authority to monitor physical symptoms. Workers should refer to the client’s GP if they have concerns about the physical health of a client. This should only be undertaken in consultation with the client, unless there are mitigating factors that may reduce the safety of the client. in the initial session, and throughout therapy as needed. 12. The lived experience of the client is always valued. This is a core principle of feminist practice – that the therapeutic relationship is based on the notion that the client is the expert over their lives regardless of their experiences and backgrounds19. Sessions should be tailored to fit with the knowledge and experience of the client. This means that a flexible approach is essential. If the worker approaches each session in a directive way that does not allow client agency and empowerment, the session will most likely meet the needs of the worker, but not the client. This is a crucial issue given that over 75% of people who identify as having an eating disorder do not seek help20. It appears there are many reasons for this including the shame and stigma that come from having an eating disorder21. By valuing and affirming the client’s lived experience we can encourage and support them towards recovery. We value the lived experiences of those who have had eating disorders by incorporating these diverse voices in all levels of the organisation.
Herman, J.L. (1994) Trauma and Recovery: From domestic abuse to political terror, Pandora, pp. 159-160. Surgenor, L.J. & Maguire, S. (2013) ‘Assessment of Anorexia Nervosa: An overview of universal issues and contextual challenges’. Journal of Eating Disorders, 1:29. Hay, P. et al. (2014) ‘Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for the Treatment of Eating Disorders,’ Australian and New Zealand Journal of Psychiatry, 48:11, 1-62. 19 Brown, L.S. (2018) Feminist Therapy, 2nd edition, APA: Washington. 20 Hart, L.M. et al. (2011) ‘Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases’, Clinical Psychology Review, 31, 727-735. 21 Ali, K. et al. (2017) ‘Perceived barriers and facilitators towards help seeking for eating disorders: A systematic review’, International Journal of Eating Disorders, 50:1, 9-21. 16
17 18
Eating Disorders Queensland
17
