On both sides of the therapy table: Navigating dual identities of being a clinician with lived experience in eating disorders

I have had a lived experience of Anorexia and Bulimia, which for me, started around the age of 12 and continued up until my early adulthood. I have been a consumer of several services across the public and private system, and have had a spectrum of experiences.

My experiences have led me to becoming a lived experience advocate, speaker, and researcher in the area of eating disorders and youth mental health. For the last 5 years, my advocacy journey has filled me with joy. I’ve enjoyed speaking on local and national platforms, educating others through workshops. These experiences have served as a tool of reflection on my progress in recovery, and have been key motivators in staying well.

First and foremost, I identify as a lived experience advocate. Like any advocate, I bear dreams of reforming our healthcare system, and enacting positive change within the eating disorder sector. Standing up for what I believe in, smashing stigma. Being a voice for those who are not afforded the same privileges as I have had, encouraging incorporation of lived experience voice into service delivery.

However these very things I feel so passionate about, that have given me direction and purpose, I recently felt as though I have had to take a step back from.

Now I can also tell you that I am a clinical psychologist registrar, currently working in the private and public sector in the area of eating disorders.

It is a strange transition, from being client to clinician.

I have worked, and currently work alongside, other clinicians who were once on my treating team as an inpatient, day patient, and outpatient. They have evolved from being therapists, to colleagues, mentors, and supervisors. I have been very fortunate that most have been supportive and accepting.

During my final year of clinical psychology training, I completed a placement at an outpatient service that I was once a consumer at years ago. I remember heading to clinical supervision after one of my final client sessions and being teary; teary not because difficult emotions had come up. Rather, they were happy tears of joy.

It was an incredibly special moment to absorb and revel in—it felt unreal to have been able to provide support to clients at the very service that once supported me, and to have treated my very first eating disorder clients. In that moment, I was reminded of why I chose recovery over and over again until it became my reality.

I have noticed a shift in how much, and how, I am able to go about advocating from a lived experience perspective as I move from being a client, to clinical psychologist trainee, to now clinical psychologist registrar. As a client or advocate, others were always supportive of my aspirations in becoming a clinical psychologist, and my efforts in consumer advocacy.

As a clinical psychologist trainee, I continued to advocate, however started to feel stifled under the unspoken, silent stigmas of the system and societal expectations.

Expectations and stigma that mental health professionals themselves cannot have mental health lived experience, since they are meant to be “professionals”, perfect; never sad, anxious, nor angry. I started to feel that my advocacy efforts were frowned upon; because now that I was moving into a “clinical professional” space, these things were “not allowed” anymore.

Interestingly, in a novel study by University College London researchers, their two UK-wide anonymous surveys found that among 678 clinical psychologists and 348 clinical psychology trainees, 2/3 had a mental health lived experience (Grice et al., 2018; Tay et al., 2018). This statistic is higher than the 1 in 5 Australians who will be affected by a mental illness each year. Additionally, a study by Bachner-Melman and colleagues (2021) found that among clinicians working in eating disorders, 39.7% had a lifetime eating disorder diagnosis. Yet, the mental health among clinicians remains a taboo topic.

During my clinical training I joined a committee with other fellow clinical psychologists and trainees, as a means of starting difficult conversations on the mental health of clinicians. There were many questions voiced, that perhaps had not been voiced elsewhere due to shame and fears of being “caught out”: “What about clinical psychology trainees with lived experience who need support?”, “Well, I can’t go to THAT clinic for therapy since I want to do my placement there!”, “Well, I can’t do placement at THAT clinic since I’m already a client there”, or, “I can’t go to THAT clinic because a clinical psychology student in my cohort is already doing their placement there!”

Something I have observed as I have transitioned from being a client to clinician, is the very paradoxical nature of the mental health profession. While we advocate tirelessly for eradicating mental health stigma in the community, we do not tackle stigma within our profession with the same vigour and tenacity. Similarly, while we are great at supporting our clients, we do not always treat ourselves with the same empathy and self-care; nor do we always practice what we preach.

I will say that so far, I have been extremely fortunate. I have had incredible clinical and research supervisors, mentors, and employers who have welcomed and embraced me as a whole; for being a clinician with lived experience, not just one or the other. I have always kept my lived experience at the forefront of all clinical supervision discussions, through my clinical training and now as a practitioner.

I believe that everyone has their own unique lived experiences, which can consciously or unconsciously impact on their therapeutic practice with clients. And as such, it is imperative to have an awareness of how my lived experience can be used to best support my clients.

For me, my lived experience of my eating disorder has allowed me to feel a greater empathy with my clients, and a confidence in delicately balancing this with firmness. I feel better able to hold patience with my clients when being met with resistance, and separating my client’s eating disorder from their personal identity.

When my clients cry with a sadness so raw and painful they cannot stop, I know that they are actively fighting hard against their eating disorder, not sitting comfortably and letting the eating disorder win; it is simultaneously a sign of strength, and one of loss and grief that they are letting the eating disorder identity go. When my clients oscillate back and forth between wanting to recover and not, I know the ambivalence stems from the tug-of-war, the escalating-arms-race in their minds between the pro-recovery and eating disorder voice.

The “lived experience clinician” concept is not new.

Carolyn Costin, Rufus May, Marsha Linehan, Eleanor Longden are just a few examples of clinicians with lived experience. The “Honest Open Proud Mental Health Professionals” (HOP-MHP) project run by University College London, and ‘in2gr8mentalhealth’, are other examples of recently established organisations dedicated to valuing, supporting, and destigmatising lived experience among mental health professionals. Albeit slowly, conversations are emerging.

Many often ask me if working in an area of personal resonance is “triggering” or “confronting”. If I am honest, it is not. Rather, the most difficult part for me is looking clients and families in the eyes; eyes that hold so much agony, despair, and hopelessness.

Eyes begging for answers, wondering out loud, “is recovery possible?”, “when does it get better?”, “how do you know?”. I know that look, because it was once mine, my family’s. Yet, I stand there, with the power to hold out that hope—that I am living , breathing, proof recovery is possible; but I withhold it. I am bound by boundaries and professional obligations. I have to fight hard against the urge to hold out that hope; the same hope I wished I received earlier on, that was so pivotal in my recovery.

I grapple with an identity crisis. I am not here, nor am I there; I inhabit a liminal space. It will feel clunky for a while, because my co-existence as both a professional and consumer is uncomfortable for the system. The system is not yet ready for the change of embracing the “in-between” because it is scary, uncertain, foreign territory. To ask me to choose between clinical or lived experience work feels wrong; for embracing purely a clinical role denies my lived experience and authenticity, the very vessel that allowed me to arrive at the present.

For now, I will continue sitting with discomfort, co-existing in between, waiting patiently for the system to arrive. Because, first and foremost, I am a lived experience advocate, and I stand up for what I believe in.

Written by Pheobe Ho

References and further reading

• Bachner-Melman, R., de Vos, J. A., Zohar, A. H., Shalom, M., Mcgilley, B., Oberlin, K., … & Dooley-Hash, S. (2021). Attitudes towards eating disorders clinicians with personal experience of an eating disorder. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 26(6), 1881-1891.
• Grice, T., Alcock, K., & Scior, K. (2018). Mental health disclosure amongst clinical psychologists in training: Perfectionism and pragmatism. Clinical psychology & psychotherapy, 25(5), 721-729.
• Hobaica, S., Szkody, E., Owens, S. A., Boland, J. K., Washburn, J. J., & Bell, D. J. (2021). Mental health concerns and barriers to care among future clinical psychologists. Journal of Clinical Psychology, 77(11), 2473-2490.
• King, A. J., Brophy, L. M., Fortune, T. L., & Byrne, L. (2020). Factors affecting mental health professionals’ sharing of their lived experience in the workplace: a scoping review. Psychiatric Services, 71(10), 1047-1064.
• Tay, S., Alcock, K., & Scior, K. (2018). Mental health problems among clinical psychologists: Stigma and its impact on disclosure and help‐seeking. Journal of Clinical Psychology, 74(9), 1545-1555.
• University College London Unit for Stigma Research, Honest Open Proud for Mental Health Professionals (HOP-MHP)
• British Psychological Society: Guidelines for supporting and valuing lived experience in psychologists:
• In2gr8mentalhealth:  For “in conversation series” featuring professionals with lived experience, see: https://www.in2gr8mentalhealth.com/series
• Looking after your mental health as a mental health professional