Great post. And maybe I'm alone here, but I have found that "nice" therapists are ultimately... boring. I mean, really, you're PAYING for someone to just sit there and do nothing... unless they ***** you off and are willing to go where your friends and family are not. I actually had one therapist tell me, "I trust you. You're smart. You don't have to eat right now if it makes you feel better. I'm sure you'll eat again when you're ready." Wow!!! I was thrilled to get the go ahead, and from a professional! How nice was that! So I took my paid for permission, and left him, happy with the results of my 4 month "therapy." My current therapist and I have been working together for about 6 years... and although she is very caring, she also isn't one bit scared to ***** me off, to tell me she doesn't trust me w/food, to set boundaries and insist on progress if I want to keep working with her. I've gained a significant amount of weight, have moved up a couple clothing sizes, and am told that this is not as far as it's going to go. I hate it. We fight about it. And I'm motivated to stay... b/c I'm getting what I'm paying for. It's uncomfortable most of the time, but it certainly isn't boring.

GREAT post Carrie. I can very much relate. I hadn't thought about "People don't change when they see the light, they change when they feel the heat." but it is so true. My therapist is very nice, but she has said from the get go that she I won't like her all the time, and I won't always like what she says. Those ground rules laid out the path for a great therapeutic relationship. I know that she pushes me out of kindness and a desire to see me get better. Best thing about her as my therapist is that she SEES my ability to get better when I don't. That's what I need.

And yes, I do have a puppy too, who is the best snuggler in the world, and the best listener too, but he doesn't know how to push me :)

OMG my family therapist said the same thing to me! Talking about how I feel that I dont want to eat is all well and good but it doesnt lead to behavior change. I have to change my behaviors to get better whether I feel like it or not!

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I agree, great post Carrie, as 'a therapist in training' it is interesting to hear your perspective and it is something I have learned along the way from my supervisor - who is one of the nicest people I've met, but she can be tough when needs be and she taught me to empathic but firm. And it is important to be clear from the start that there is work to do to recover.

This rhymes with what I tell my daughter over and over...

"Acknowledging during a therapy session that you need to be in your weight range doesn't keep you in your weight range. Eating does."

I have a nice therapist, and she has helped me get further in recovery than any other therapist - previous therapists ranged from fairly "blank slate" to very, very direct.

I understand that some people really need to be pushed, and I imagine that's especially the case when one is not feeling particularly motivated to recover. (When I started with this therapist, I was motivated, but had been told - and had come to believe - that long-term recovery wasn't a possibility for me.) I also know that my therapist pushes more and is more direct with other clients who's temperaments respond well to that.

I've actually come to determine that I NEED a nice therapist in order for therapy to be successful for me. Feeling pushed results in me feeling threatened and shutting down. I'm also very emotionally sensitive, so if a therapist is really direct, it's very easy for me to internalize that and feel badly about myself, which does not help me to feel deserving of recovery. However, if a therapist is supportive and nice to me, and gives me time to think about the next step (even if it's just a few minutes to process things in session) I'm MUCH more willing and able to try new things.

I feel like this blog entry is confusing a "nice" therapist with a push over therapist. My therapist is one of the nicest people that I've ever met AND she has firm boundaries and non-negotiables that enforce the behavioral aspects of recovery as well. I have maintained my weight for over three years. I have stopped purging all together. I meet my full meal plan everyday and am working on flexibility. I exercise moderately. My nice therapist has helped me to do all of this and she lets me know that these things are non-negotiables. She just does it nicely.

@Say:
I hear you on everyone needing different things from a therapist! I was actually thinking over my previous comment (above) after I posted it and wondered if saying I've been working w/my current therapist for 6 years would actually make it sound as if she is not pushing me hard enough/fast enough. But the fact is, I had severe traumas, attachment, and trust issues that had to be addressed first and fully before I was ABLE to be pushed- so I get what you are saying. Establishing the therapeutic "secure base" for some people is an absolute prerequisite for more intensive/provoking therapy- and for some people it takes significantly longer than others. Boundaries are a must- but how they are presented has to be tailored to the client, their past experiences, their temperament.

**Here's the thing: talking only gets you so far. As someone said at this year's NEDA conference, "Insight doesn't lead to behavior change. Behavior change leads to behavior change."** I wrote this on a post it when I heard it at NEDA and taped it to my fridge when I got home (and now I don't even remember which presentation it was in!) . Love it.

As for the "nice therapist" conundrum...ugh, I had to dump a nice therapist last year before I started with my current team. I was heartbroken, mostly because I felt like an ass for firing her, not because I particularly liked her. But I was making NO progress. And I was pretty sick at that point, but even I was getting tired of telling HER what I needed to be doing, having her say, "sounds good" and then not doing it because no one was backing me up/giving me support.

My therapist now happens to be very nice but she is also a royal pain in my (eating disorder's) ass. The staff at my last treatment center(s) were the same and it was the first time anyone really challenged the disorder. I went through hella rounds of treatment, many therapists etc and they were always willing to negotiate...not always clearly put up with BS, but definitely meet me in the middle when it shouldn't have been that way.

My new general rule of thumb is when I leave a session feeling 100% great and not at all uncomfortable or pissed, there's something wrong. Fortunately, this doesn't ever happen. I usually end up feeling irritated, confused and thankful.

Say, you're right. There is a big difference between "nice" and "pushover." I think lots of people settle for nice because it means they don't have to make rather scary changes. I don't think that nice is necessarily bad BUT it is often easy to fall into a rhythm of. If nice brings about positive change, then by all means, go with nice!

I'm glad you found a therapist that works for you.

@Say, "I understand that some people really need to be pushed, and I imagine that's especially the case when one is not feeling particularly motivated to recover."

I think you're more on target with tailoring therapy to ones temperament. I really wanted to get better and had the motivation to get well, but I needed someone to push me to do the hard stuff.

"Nice" and "firm" are not mutually exclusive, but not wanting to find a new therapist because your current one is "nice" (although you're not making progress) is not a great reason to stay-- and that is where this post started. I happened to find someone who is generally a nice person, but the reason I continue working with her is because she is challenging, not just because she is nice. Challenging may look different depending on where you are in treatment, and for me, different on different days, but if I ever felt like there was no push in therapy, I'd probably leave (and a good therapist, in my opinion, would not keep seeing someone who was not making some forward movement. I've been fired from therapists for that reason).

@Carrie, sorry for hijacking this post...apparently I have serious opinions on finding effective treatment, haha.

This is what I love about CBT--it requires behavior change. For my daughter to lose her fear of eating bread she had to ... (drumroll, please) ... EAT BREAD. To lose her fear of drinking water she had to drink water. To ditch the fear of speaking up in class, she had to speak up in class. To stop the compulsive exercise, she had to STOP DOING IT.

This may sound impossible to someone who hasn't been there. But the therapist helped her (she's just 7) make a chart of fears that were Big, medium, and small, and tackle them one by one, starting with medium and small ones, one or two at a time. Tremendous results!

If a therapist isn't giving measurable results after 4 sessions? DITCH THE THERAPIST. That is, unless the goal isn't to get well ...

OMG you have been reading my mind. I've been having probs describing our therapist for 2 years without appearing to be too critical... It was because she was TOO NICE. So very very NICE. But ED loves nice kind therapists who feel that a tougher line (ie getting them to eat) "isn't helpful to the patient" as it might push them in the wrong direction and result in a refusal to have treatment etc etc.

A good therapist has to be flexible, take no BS, and hold hope when you can't even understand what hope is, let alone have it. They also have to be honest. I once had a therapist who blatantly lied to me (told me she'd repeatedly called my mobile to make an appointment when she hadn't - my mobile chronicles every missed call), and then still wanted to continue to work with me...i terminated that relationship. If a relationship really doesn't mix - i had another therapist who kept telling me i needed to get in touch with my Catholic roots - having never been brought up Catholic, and actually Jewish by birth, but not practice. She also week after week confused the names of my wonderful husband with the names of my abusers, which was really painful. i've recently worked with a trainee psychologist who was amazingly skilled, and we did some amazing work together. He only once stepped over a line - but had the guts to phone me up after the session, and apologise wholeheartedly. Thus showing he wasn't caught up in his own self-importance. Another good sign of a skilled therapist.

Hm, I recently hired a "nice" therapist and I'm not sure it was a good move. I've been recovered from my ED for many years but recently have been struggling a bit with anxiety and some OCD issues, which are my ED's siblings. Mostly I'm just having occasional panic attacks, checking/repeating/counting a bit more, etc...but I will admit maybe I've also slipped into mild ED behaviors and fantasized about indulging them further. Small stuff but I feel guilty about it.

So I found a therapist, but it's my first time hiring one since I was a minor when I was in recovery and I'm an adult now. She's very nice but so far not very firm, she hasn't pushed me to do any exposures yet (but it's only been 5 sessions?). I've been honest with her about everything but the ED. I know, I know...and she actually hasn't even pressed me for a full history, because "it will take awhile to get to know each other and you can tell me things at your own pace." Every week I think I will confess and then I don't, because maybe this week I will fix my eating on my own and not need her help with it.

Maybe I should find someone else? Or the problem is me?

@Anon: Are you asking my opinion, or saying "hmmmm" like you're thinking things over? If so, I will give it, but it is just an opinion and I hope others will weigh in as well... If not, and you're just musing, I guess I'm offering my opinion anyhow! :D

You need to get help now, while it is still your choice to do so. Eds take on a life of their own if left untended. If you feel a connection w/this therapist (you feel safe, curious, motivated) then 'fess up at your next session. To make it easier if you go blank during sessions, write/type it out while you're still at home, and mail it to her so you can't chicken out- or take it in and hand it to her first thing to read.

But it kind of sounds like you're unsure about whether you even like this therapist- you sound hesitant- like you don't exactly know what she's doing or if she's even interested in you. If that is the case, find a new therapist asap, and take your pre-written issues in if that will help. I would think that 5 weeks (over a month) is long enough to spend time just getting to know each other- it sounds like she is taking her sweet time, while you are struggling invisibly. But I'm not there- so maybe what's really happening is that she's questioning and you're freezing up and not answering? Only you know that. Either way, it's not about you being a "problem" or doing something "wrong"- not at ALL- it's about you figuring out how to get what you need. That's not always a smooth process!

You're a leg up on how I started- I was in complete denial about my ed when I went to see my current therapist and she had to convince me I even had one! I think it's great that you know what you are struggling with- now you just need to get those struggles out in the open with someone who can help you.

I needed a nice therapist who pushes me. And I have one. :)

(I'm the Anon 2:54pm)

Thinking things over. But I appreciate opinions.

"so maybe what's really happening is that she's questioning and you're freezing up and not answering?"--yes. I like her and I trust her but she doesn't push so I keep chickening out. And then I rationalize that I am not really doing anything so bad, and if I tell her she will say I have no problem (I can't be sick if I'm still maintaining, it's only a few meals a week, whatever) so I might as well not.

Also, she is nice, so I am not scared of her. I wonder if other people who were involuntarily treated are frightened of mental health providers? I was 11 when I was most sick and 16 at my first relapse, and my parents committed me both times, and I'm so terrified of therapists I didn't seek help when I relapsed at 23, and I'm 29 now...ugh. So much for insight.

Hi again, Anon:

I am sorry that you experienced medical/forceful trauma when you were younger, and that it has made you afraid. I was never forcefully committed, but I did experience repeated abuse from my pediatrician when I was little. I am terrified of medical practitioners and of being alone in an office with one. In the past, I "used" therapists to dump off information crowding my head or to get a prescription for anxiety and then dumped them without ever opening up to them. I am in my 30's and this is the first therapist I've actually worked with!

You are in control of this situation- you can stay or leave, and she really has no say in the matter. You can choose to tell her or not tell her your symptoms. You can choose to work with her or not, based on her reaction to what you say. Sounds like you have a lot of insight, actually- sounds like you know you feel scared, and you know it's because of "old" stuff. Tell yourself you are safe. Remind yourself that you want to take care of you. :)

Dr. Mark Warren of the Cleveland Center for EDs, stated recently that some progress should be evident after 4 weeks of therapy.

Do you need info on eating disorder treatment? It can really make a difference in your recovery.

Just to clarify--a different anonymous commenter....

So, for what it's worth, as I crawl my way out of a relapse...nice doesn't always help your recovery. In fact, nice sometimes ends up colluding with your illness. For those of us who are "nice, good girls" with a very real problem, we tend to fool a lot of people. I struggled with a therapist for nearly 6 months who was "nice," but in the end watched me continue to deteriorate. My current therapist is incredible. Do we always get along perfectly? No. Do I push and she pushes back? Absolutely. Is she incredibly hard on me, challenge me, enforce a strict set of rules? Yep. But without her, I would probably be headed further into the looking glass. Sometimes tough love is exactly what we need. This illness would never leave many of us if there wasn't a voice stronger than the ED. Again, just my personal opinion, but I'd take my non-negotiable, but gentle! therapist over a "nice" one any day.

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