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Interview with: Dr. Thomas Britton, DrPH, LPC, LCAS, CCS, ACS of Structure House
What drew you to the field of eating disorder treatment? Why?
I entered the field of mental health in the early 90’s as a therapist in public outpatient treatment. I had the wonderful opportunity to work with incredible clinicians who helped to shape me into the clinician and leader I am today. I like many, were drawn into the field with the desire to give back and help others in finding their own path to recovery.
I was very fortunate that my own journey to recovery didn’t include the pain and isolation of an eating disorder, but the patterns and pain experienced in my early years shared many parallels and gave me great empathy for those with eating disorders. Back then, there was only one treatment center in my area that provided hospital based care and no outpatient therapists existed that were trained in ED.
As the years went by, I developed a specialization in working with addictions and remember seeing many of my patients stabilize their drug and alcohol use only to find an eating disorder begin to take over their lives. I have the hindsight today that I didn’t receive the training and support to develop the competency necessary to identify and treat eating disorders. It is hard for me today to consider how I may have underserved those patients of mine who carried both burdens.
It is this empathy and insight that drove me to shift my attention and support to the eating disorder treatment community.
I now know the statistics regarding the relationship between eating disorder patients with addictions and addicted patients with eating disorders. As a Division President of the largest provider of substance abuse services in the country, I have the unique opportunity to strengthen the quality of care we provide to our patients with co-occurring disorders whether or not they present to our substance abuse or eating disorder programs.
We are in the process of finalizing a best practice truly integrated care model to support clients on both sides of the fence to deal with their secondary issue whether it is an eating disorder for a substance abuse patient or substance abuse disorder for an eating disorder patient. I’m very grateful to be a part of an incredible team that helps people to recover every day.
What keep you in this work, day after day?
There is no question that working as a helping professional is an extremely demanding and emotional job. I remember reading in graduate school that 50% of master’s level clinicians leave the field within two years of completing their degree.
Over the years I have developed a practice that not only makes me want to come to work but helps me see the miracle of our efforts. I consistently seek out the stories of successes big and small that come as a result of the work we do. It is those stories and the inspiration they bring that makes me keep on keeping on.
What is your philosophy on eating disorder treatment?
I believe that all behavior is goal oriented action to achieve one’s needs. Many individuals, especially those with trauma, develop ways to live and cope in the world that work initially but end up destructive and often deadly. As a result, my philosophy is that we as clinicians need to provide the skills necessary to develop new coping skills that create a life worth living.
My experience and philosophy depends strongly on the belief that insight oriented work needs to happen to perpetuate the changes made in treatment. We use skill based approaches including DBT, CBT, Motivational Interviewing, education and psycho-education.
We complement our skill based work with holistic mindfulness centered individual and group therapy to work through traumas, addictions and mental illness. Family therapy, aftercare planning and medical management are the final pieces necessary to solidify the recovery.
What tools would you like your participants to gain while working with you?
We seek to provide our participants with the ability to maintain an awareness of their mind, body and spirit to empower them to grow and maintain their recovery. We teach participants among other things how to manage the destructive impulses to self-harm, restrict, purge and use substances. We provide participants with the skills to function in the real world post-treatment.
What do you envision the future of eating disorder treatment to be like?
My hope for our future first and foremost is an increased competency in all disciplines to identify and refer patients with eating disorders to eating disorder specialists. My related hope is that the body of clinicians trained to competently treat individuals with eating disorders to recover grows.
The fact that so few ever receive treatment and even fewer receive treatment from one trained in ED is disheartening. My hope is also that ED is recognized more clearly by managed care as the critical issue it is, providing funding for appropriate levels of care. Finally, I want to see the competency of eating disorder specialists’ increase dramatically in their ability to treat co-occurring substance use disorders.