Reflections on working online with Eating Disorders

by | 13 Oct 2021 | Eating Disorders, Mental Health (all), Updates / Personal | 0 comments

Today’s post is a little more personal. I know some readers have expressed an interest in me writing about my own experiences and thoughts more. So, here I am….

At the outset of the pandemic, I was a little reluctant to move my entire therapy practice online.  I’m sure many Therapists felt the same, and I saw the scramble for some to educate themselves on  working online as a relatively new concept for them.  However, I’ve been working online for YEARS; my very first role in the arena of mental health was actually supporting people who self-harm via an online chat system.  I’ve also worked for organisations supporting young people online and have always offered the option of online therapy for as long as I’ve been in private practice.  My general attitude to this has been that it’s the client’s choice.  There are many reasons why accessing services online might better suit someone, and, as long as I am practicing ethically and safely and am taking in account the differences in doing so (and making the client aware of this too), I see it as a viable option.  So, it sort of came as a surprise to me that I felt so against it.

Like many when the first lockdown began, I thought I’d just take a few weeks off. I contacted all of my face-to-face clients and offered online sessions, or a pause till face-to-face could resume. Most wanted to wait. I’m sure I probably said something along the lines of “things will go back to ‘normal’ soon”. With hindsight we can all cringe at that statement now. Honestly, at the time, I was glad that most wanted to wait – because I did too!

As you know though, a few weeks of lockdown quickly became a few months, and slowly people started to enquire about having therapy online. As the numbers in my diary grew, I felt a bit anxious about the perceived risk of working entirely online with those affected by Eating Disorders. Eating Disorders have the highest mortality of all mental health conditions and I had always absorbed the message (although from where I don’t know?) that working with this higher level of risk clients “should” be supported face-to-face. However, all of a sudden the choice was to access support online, or access no support at all. So, I chose the former and filled up my diary. The entire time I was thinking about the day that I’d be back to sitting with clients in my therapy room.

For me that day has never come, and right now the clinic from which I’ve worked for almost a decade is being prepared for sale. That sounds like a sad statement, a statement to be followed up with how the pandemic took something from me, professionally or personally….. But it didn’t.

The more I worked online the more I came to feel that – at least for me – it didn’t make much difference to how connected I feel to clients, or what happens in a therapy session. Both my own observations and actual research have shown online therapy to be effective. It slowly became apparent that some of the benefits of working online were very valuable to clients – especially factors such as time saved due to not having to travel. If it takes an hour to get to an appointment, an hour in an appointment, and an hour home again that becomes a significantly bigger commitment of time to fit in around say education, work or family. No travel makes therapy more accessible for many.

The biggest positive I personally felt though was that working online gives a client far more choice as to which therapist they work with. No longer limited by proximity, or reasonable travel time, clients can choose a therapist who actually best suits them as an individual. They can make this choice from a huge pool of professionals and are not limited by geography.

As a result I have found myself working with clients from all over the country and the more I’ve worked the more I’ve warmed to the idea of working online, and found a new home in doing so. I understand that it isn’t for everyone – but nor am I the right Therapist for everyone. It just doesn’t make sense for me right now to return to face-to-face work. I’m definitely not saying this is forever, but it’s certainly where I am at right now.

In fact, I have been reflecting on something that I think is an important lesson – why did I think working face-to-face was “safer” for those with Eating Disorders? The answer to this question is actually one of weight bias! Weight bias in Eating Disorder care is the topic I’ve researched, the topic I speak about, one of the major issues I see in many Eating Disorder Services. By telling myself it is SAFER to work face-to-face I was, without even realising it, inadvertently working on the assumption that I would SEE physical deterioration in someone far more easily in person….that this would lead me to action and to keeping someone safe. But Eating Disorders are mental health challenges and risk is present irrespective of the way a person looks…. Risk is always present in my work and the processes I have for managing this work just the same online as they do in the clinic.

I wanted to share this realisation because I think it is important to show that we are all learning and growing all of the time. If you feel comfortable to share your views in the comments I would love to hear how you’ve managed as a professional in the pandemic?


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Kel O'Neill

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