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Description
The author surveyed counselor education programs accredited by the Council for Accreditation of Counseling and Related Educational Programs regarding the importance placed on eating disorders in counselor preparation and how they may be addressed. Most respondents valued the topic, and most did include or would consider including eating disorders in their training programs. Recommendations for infusion into curricula are discussed.
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Recent data indicate that up to 6% of persons in the United States have some form of an eating disorder, and as many as 58% to 70% of women experience body dissatisfaction (Alexander, 1998; Brumberg, 1997; Mazzeo, 1999). Among specific populations such as athletes, college students, and adolescent girls, the ratios are even higher. Although primarily conceived as a problem among women, research shows that men represent 10% of all cases of eating disorders (Alexander, 1998). It is perhaps the growing prevalence across age, gender, ethnicity, and other cultural variables that suggests that eating disorders, in some form, are likely to be encountered by counselors at some point in their practice.
Unlike other disorders, eating disorders tend to appear across populations, ages, cultures, and settings. There are specific life-threatening aspects to undetected and untreated eating disorders, and because of these aspects, counselors must be exposed to the etiology, manifestation, and treatment of eating disorders within multiple contexts. There must be an understanding that it is not only individuals with clinical eating disorders who suffer from esteem and related emotional difficulties but also those with manifestations of disordered eating and body image concerns that are less clinical. Prevention and treatment of all forms of eating disturbances at all places along a continuum should address weight and body-related issues as well as emotional concerns (Scarano & Kalodner-Martin, 1994; Tylka & Subich, 1999). It is often the groups at less extreme points on the continuum who are overlooked in prevention and treatment. Interventions at these less extreme points may be an essential prevention effort, because these persons are at risk for moving farther along the continuum toward clinical eating disorders.
Counselors must be prepared to properly address eating disorders and related eating-and-body-image concerns, whether directly in individual or group counseling or in outreach and prevention efforts. Counselors who are informed about eating disorders can be instrumental in the team approach to care for such clients. Few primary care providers, integral members to team treatment, have the necessary training to diagnose eating disorders in the early stages (Gurney & Halmi, 2001). Without training in detection and treatment, care providers may not recognize that a client has been exhibiting eating-disordered behaviors and attitudes until serious medical consequences occur (Gurney & Halmi, 2001). By this time, many clients may be resistant to treatment. Furthermore, the broader demographic profile of persons affected by this issue indicates that counselors must be prepared to work with clients with eating disorders and related concerns.
The reality of the nature and prevalence of eating disorders and related issues begs the question of the preparedness of counselors to work with clients presenting with these concerns. The American Counseling Association's (ACA; 2005) ACA Code of Ethics indicates that counselors must have knowledge of the content with which their clients present. The Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2001) states that the counseling profession anticipates and responds to social changes in the United States and world cultures. It is likely that counselors who are working with and from a developmental perspective will be exposed to eating disorders issues at some point in their careers. Counselors must therefore consider their reactions and preparedness to work with persons with eating disorders.
There are implications beyond the ethical services counselors offer to specific populations that warrant exposure to eating disorders in counselor preparation programs. Countertransference issues for counselors are particularly great with the presentation of body image and eating disorders. Issues such as overidentification with the client, control, secrecy, helplessness, and avoidance of affect may be manifestations of the counselor's own perception of body image and personal experiences with eating disorders (DeLucia-Waack, 1999). The very sensitive, prevalent, and personal nature of eating disorders increases the likelihood that counselors will have their own issues triggered through working with clients who have eating disorders. A related survey of healthcare providers indicated that 28% of providers working with persons with eating disorders reported being moderately to greatly affected by their work with this population (Shisslak, Gray, & Crago, 1989). It seems that counselor preparation must address eating disorders, given the deleterious nature of the disorders, the fact that some forms of eating disorders are not at the clinical level, the potential for transference, and the developmental nature of both eating disorders and the counseling profession.... |
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