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Hope Is Essential When Working With People Who Have “Chronic” Eating Disorders

by John Levitt, PhD

I never use the word “chronic” or “difficult” when describing a person who has been struggling with an eating disorder for a long time and who has required medical stabilization numerous times. These people may have been in and out of eating disorder treatment, and they may require more or different care from others, but they always have hope. I believe that if we lose sight of the hope for a person, we damage their chance of recovery.

After more than 40 years of working with people who have eating disorders, I have learned that the vast majority of them can be treated and a significant portion do actually recover. Most people who have eating disorders are not stuck intractably, destined to continue their disordered behaviors for life.

What I have found, however, is that personal therapy that is specifically designed to support these people through their recovery is critical. While we may need to rely on hospitals and treatment centers to medically stabilize these people, they often only fully recover when under long-term care from a trained psychotherapist.

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I understand how scared and exhausted parents can be by their child’s eating disorder. It’s not easy to parent a child who has an eating disorder, and repeated trips to the hospital and/or treatment center(s) can be emotionally and financially draining. I understand why some parents may lose hope that recovery for their child will ever be possible; but at that point, I’d like those parents to seek their own therapy so that they can bring hope and strength to the parent-child relationship.

In fact, if parents are feeling really run-down by the care required to support a child who has an eating disorder, I encourage them to not only seek therapy, but also to go on vacation, spend time building other relationships and hobbies, and expand their lives even as their child pursues recovery from an eating disorder. It may sound strange to tell a parent who has a child who has an eating disorder to go on vacation, but sometimes that’s exactly what is needed for the parent to have the strength and resilience to continue providing the care and acceptance needed for healing.

There is no magic bullet in eating disorder recovery, but if there were, it would be in the form of ongoing supportive and fully accepting relationships. A therapist can be one of the people who can provide this unwavering acceptance of the person who has an eating disorder, and that is a big part of how healing takes place. The therapeutic relationship is key to providing a safe space for the person to find his or her own motivation to recover.


It’s important to know that there is no single definition of recovery, and it’s also important that we find ways to enable the person who has an eating disorder to define what recovery will look like for them personally. We don’t make much progress when we push our own ideas of what recovery is, because each person has their own thoughts, opinions and internal motivation. We don’t succeed in long-term recovery by forcing our own ideas of what the person needs to do, but we can make great progress by helping the person tap into their own vision of recovery.

Someone who has an eating disorder really benefits from having people who believe that they will recover. Parents, therapists, and others can provide this belief, hope and acceptance. What we work towards is helping the person accept some of that hope into his or her own mentality, and to begin to feel true hope in their own future after an eating disorder. Remember that having an eating disorder is not a crime. It cannot be punished away, and instead needs to be treated with respect of the person’s own perspective.

When a person who has an eating disorder begins to have self-determination and thoughts of a future without an eating disorder, then we see tremendous change in both behavior and mental condition. This takes time. I can’t put a definite timeline on it, but most of my clients come to see me once per week, sometimes for a year or even more. This is the long-term investment that people must make in full recovery from a challenging mental disorder like an eating disorder. The good news is that when the investment is made, people can and do recover from eating disorders – even the most “chronic” or “difficult” cases.

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John L Levitt, PhD, CEDS, FAED, FIAEDP, is the coeditor of the book, Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment , and was on the Editorial Board of Eating Disorders: The Journal of Treatment and Prevention Email: Phone: (847) 370-1995

See Our Eating Disorder Treatment Guide For Parents

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