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generalists and specialists

Posted Apr 16 2011 11:56pm

Laura R. I'm glad things seem a little less aggravating today. The issues you ran into this week may come up again, so it's worth saying a couple of things.

Therapists are trained first to become generalists- to possess a broad and in-depth knowledge of the entire field. Some therapists remain generalists, which is totally cool. These therapists often work with a wide range of clients, and they can work in a wide variety of settings.

Some therapists elect to pursue further training in an area of specialization. It's like with medical doctors: they are all trained to be generalists first, and then they can choose to specialize (in psychiatry, podiatry, oncology, dermatology...) after they've completed their general training.

Generalists can handle many, many things. Again, think of a medical doctor. You can go to your primary care doc for a wide variety of issues, right? That doc can treat an enormous array of illnesses and injuries. He or she can also treat some things that a specialist would treat.

But, there is a limit to what a primary care doc feels comfortable treating. He or she will refer you to a specialist for more in depth assessment, diagnosis and/or treatment. This is no slight on the primary care doc- it's only a reflection of how many, many medical issues there are in the world and how one doctor couldn't possibly know everything about every single one of them.

It's the same with therapy. Generalist therapists are great. The vast majority of people do just fine with someone who's well trained, competent, experienced, generalist. In some cases, a specialist is a more appropriate choice.

It's easy to see this when we think of medicine: if you had a serious problem with a bone in your left foot, and your primary care doctor wasn't sure what was up, you'd go see a podiatrist. And it wouldn't occur to you to go meet with a dermatologist, right? You'd go to the foot guy.

If you have an eating disorder, you wouldn't meet with a therapist who really knows sleep problems. Your best bet is to work with someone who knows eating disorders in depth.

Now, having said that, there are some cases where either someone can't or doesn't want to see an ED specialist. Sometimes there isn't a therapist in the area who's a specialist. Or sometimes someone is already well situated with a therapist before the ED begins, and he/she doesn't want to change to a new therapist.

Sometimes this is worth a try, and sometimes it does work out well.(and, just so you guys know, I'm talking about relatively mild eating disorders here. my vote in general, and certainly for moderate, serious or severe EDs is for the sufferer to work with a team where everyone is a specialist- these illnesses are simply too dangerous and too complicated to not have specialists on board)

There are a few options for the therapist and the client in the situation where the therapist isn't specializing in EDs. One is, as Wendy pointed out, for the clinician to get consultation and training in eating disorders. Another is for the client and/or the client and therapist together to consult periodically with a specialist who can help them make sure nothing is falling through the cracks.

Laura R, it's going to be important to keep talking to your therapist about this issue. Not every minute, or even every session maybe... but to keep track of how this is going. He may be an awesome therapist; he just doesn't happen to know about eating disorders. Over time, you and he will want to make sure things are going in the right direction. One of the tricky things with these eating disorders is that clinicians and client often don't even realize what may be falling through the cracks if they don't know what to be looking for. And, then, so many things may have fallen through the cracks that the client gets into medical and/or psychological trouble.

Like with the rest of your treatment, take this slow, ask questions (don't be afraid to keep talking to your therapist about this- he shouldn't be afraid to talk about the issue, and you aren't insulting him or criticizing him by bringing it up). And keep talking to the rest of your treatment team also. This is a team effort- so make sure you include and utilize everyone you have!

One last facebook thing for today: you guys are really sweet how you're trying to help each other friend or like my page, and you're really sweet that you want to be on my page. We're still in the middle of this transition with it- me, and you guys. Just want to remind you there's no way to make a mistake with it. You can't possibly screw it up. Just play around with it and get used to it existing and see how it goes... that's my strategy :) 


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