Should a therapist reveal they’ve experienced an eating disorder?

Beth: Hello and welcome to Let’s Talk, a Butterfly Foundation podcast about all things body image and eating disorders. I’m your host, psychologist Beth Shelton, and the title of today’s episode is Should a Therapist Reveal They’ve Experienced an Eating Disorder? Between a quarter and a half of all eating disorder clinicians have their own lived experience of an eating disorder.

Beth: I’m going to repeat that because I think this will probably come as a surprise to many. Between a quarter and a half of all eating disorder clinicians have their own lived experience of an eating disorder. Yet the question of how those clinicians navigate that experience in practice, for example, whether to disclose, to whom, and what the risks and benefits are for them and for their clients, is a new area of interest and expertise.

Beth: Pheobe Ho is a clinical psychologist, researcher, and lived experience advocate who’s been thinking and writing about this intersection for years. She has a personal history of an eating disorder, and has trained and worked alongside former members of her own treatment team, including working at a service where she was once a consumer. Pheobe brings research skills and personal insight to this conversation.

Beth: It’s lovely to have you here, Pheobe. Thank you so much for coming and being part of Let’s Talk.

Pheobe: Hi, Beth. Thanks so much for having me on here today.

Beth: This episode is for clinicians navigating this terrain and for clients who may be wondering what it means for their recovery when their therapist has been there too.

Beth: Pheobe, if it’s okay, we’ll start with the personal. You’ve written about these issues from a very personal place. Can you tell us a little about yourself and what drew you to this topic?

Pheobe: Thanks, Beth, and thank you for the introduction. I am a clinical psychologist based in Perth, Western Australia. I’ve been working in the eating disorder field for probably about 10 years now.

Pheobe: I haven’t always worked as a clinical psychologist though. When I first started working in the eating disorder field, I actually started out as a lived experience advocate. I did lots of lived experience speaking, advocacy and peer work across local and national levels. It’s really given me such a great understanding of the sector from that consumer lens at so many different levels.

Pheobe: I think that passion from seeing and meeting a range of other like-minded consumers and lived experience advocates really cemented for me my passion to continue working in this space, which then led me to starting and completing my clinical training as a clinical psychologist. So that’s been my journey, and very recently I’ve started my PhD research on this very area of supporting eating disorder clinicians with lived experience. This is really something that I’ve picked up over the years, and observations that I’ve made in this sector have driven me to conduct my research today.

Beth: That is amazing, Pheobe. That is a really long-term follow-up of those sets of interests. I remember meeting you when you were doing the clinical advocacy more specifically and being struck by how clear and on it you were with everything. To know that you followed it all the way through to now your PhD research is really exciting, and I really look forward to where this is going to go.

Beth: That’s because, from my point of view, knowing lots of clinicians who are in this situation, I supervise a lot of clinicians, and I feel their uncertainties, and I share their uncertainties as a supervisor as well. So I’m really looking forward to how we can move this forward.

Pheobe: Thanks, Beth. I completely agree with you. Since becoming a supervisor as well, and supervising not just clinical psychologists and trainee students but also allied health and peer work, it’s really given me quite a different lens on the different intricacies that happen, and maybe the questions that we keep asking but don’t necessarily have guidance on how to answer. That’s exactly how this research was born. It was born out of the dozens of people who had contacted me asking all these questions. Over the years, Beth, I started compiling these different questions in a Word document. It started out that way.

Pheobe: But then over the years, I noticed and observed that there were the same patterns and trends that kept recurring and the same questions that were being asked. I got so frustrated with going, “Why are there no answers? How can we better support clinicians with and without lived experience to better understand some of these questions and navigate some of these scenarios?” So this is really how my PhD came about.

Beth: Give us some examples. What sort of questions are these that people have been asking for years?

Pheobe: The biggest number one thing that people ask me is how do you navigate being a clinician and practising as one, as well as reconciling that with your own lived experience? Or how do you go about deciding whether or not you disclose to people in the workplace?

Pheobe: That might be managers, line managers or clinical supervisors. Do you or do you not disclose to clients? What happens if you need to seek professional help, so psychological help? That becomes a challenge because you might have worked in that same workplace. I’ve had people in university clinical training who’ve said to me, “Well, I really want to do my placement at that workplace, but I’m really afraid to because I was once a client there.”

Pheobe: Or potentially, “I want to work there, but what if I do need treatment and to seek help, and that’s the only service around me?” So I think there are a whole range of multilayered ethical complexities that come with this terrain. There are also other more clinical processes, such as how does that impact you as a clinician? How do you go about navigating what might come up for you? How do you best support your clients and be present for your clients? I could say a whole list, Beth, but these are just a nutshell summary of some of the things that have been raised.

Beth: Yeah. Look, it’s a great way of getting our brains working on what some of the things are.

Beth: Another way I’m going to ask you. I know that you yourself have worked at a service where you were once treated. What was that like, and what does it reveal about the sorts of complexities that we need to face as we sort out some of these issues?

Pheobe: With that question, about working at a service that I had once accessed, I will also say that extends to things such as working alongside previous treating clinicians.

Pheobe: As I’ve mentioned, what I’ve found over the years, Beth, is that this experience is not something that is uncommon or unique to me, because I have heard from lots of clinicians across Australia that that has been the case. On a personal level, for me, it was quite special to have come full circle. When you look at the research and when you hear about others with lived experience, it can be such a long journey.

Pheobe: We know that the mean illness duration for eating disorders, for example, is five to seven years. So when you’ve gone through that journey, or you’re in the midst of it, you can sometimes lose hope that recovery is possible. To have gone through that whole journey and almost come out the other end is quite special.

Pheobe: For me, on a personal level, it was a reminder of the challenges I had previously overcome and worked so hard to overcome in recovery, and it signified a really huge personal milestone. For myself, and I know from speaking to lots of other clinicians across Australia, it can sometimes be that reminder of why we do what we do, to give back, that idea of coming full circle. Some of the other things I experienced were a great level of empathy for the clinicians who worked in that service alongside me at that point in time, but also this really great empathy for the clients that I provided support to with eating disorders.

Pheobe: I had that felt experience of going through the ups and downs of recovery. While I personally never disclosed to clients, and that’s a personal choice that I made, I know that my experiences in some ways still gave me that insight and understanding, particularly when working with clients in that service, and clients with eating disorders more broadly.

Pheobe: So that was one of the things that came to mind when I started working there alongside these previous treating clinicians. I will also say, though, Beth, that it’s definitely been a very interesting terrain navigating some of those relationships that I raised earlier in terms of ethical complexities.

Pheobe: What I found was previous treating clinicians then evolving to be mentors or colleagues, or people who provided me with expert clinical supervision on an ad hoc basis. That was really interesting because it was acknowledging that there had been a previous therapeutic relationship, and now this is a different context.

Pheobe: That was a past chapter and this is a new one, so how do we actually work together to navigate that? That was interesting because there aren’t really any guidelines out there that can guide how you navigate these multiple relationships. So I think that was a big challenge that I definitely faced.

Pheobe: What I reflected on particularly early on, Beth, when I first started my clinical training and went through university clinical training, was that when I was working with clients with eating disorders, I sometimes noticed this really strong urge to disclose to my clients. It was coming from a place of, I care so much and I’m so passionate about this. But then I sought really fantastic clinical supervision around, hang on, I need to pause.

Pheobe: What’s driving my urge and my desire to connect with these clients? Can I do it in a different way? Does it involve disclosure, or am I doing this for myself or for my clients? So quite early on in my clinical career and through my clinical training, I have been extremely lucky and privileged to have had some really fantastic clinical supervision that walked me through all these different ethical scenarios, going through ethical decision-making frameworks to understand how I would use my lived experience, whether or not it was in a formal way, so disclosing in supervision, or deciding do I want to disclose to clients. Understanding how I use that informally or formally was really helpful when I first started.

Pheobe: So how I show up for my clients, how my lived experience has shaped my own clinical practice, as well as understanding the kinds of biases I’ve had from my own recovery experiences, which may or may not influence how I train in particular evidence-based practices and treatments, and how I deliver them as well.

Pheobe: Through that whole journey, I’ve been able to seek really great supervision, engage in really great reflective practice with the guidance of mentors and supervisors, and try to mentalise what it would be like not just in my shoes as a therapist, but what would it be like for my clients if they did or didn’t know I had lived experience?

Pheobe: I know that was quite a long-winded way of answering your question, Beth, but as you know, I’ve got many different thoughts and perspectives to explore on this particular topic that I hold so close to home.

Beth: I can see that. I’m asking you about a big thing, when you made that amazing shift between getting through the recovery journey and then being able to say, “I can help. I can use what I’ve learnt, and I’ve used what I’ve understood.”

Beth: And then what is it really like, and what came up as a result of that? One thing I want to ask you a little bit more about is, have you changed? You said that initially you got advice to be really careful around disclosing and what it meant for you and what it meant in the process. What’s your current thinking about the pros and cons of disclosing to clients?

Pheobe: That’s a great question, Beth. Do you know, I will often have this question asked of me from clinicians across Australia: “Do you think I should disclose or not?” My response to them is always that this is so nuanced and not a one-size-fits-all right or wrong answer. It’s something that is so personal to individuals, clinicians, and people who aren’t clinicians who have lived experience. It’s really up to them to decide whether or not they disclose, to whom, and how much.

Pheobe: For me, what helped me decide whether or not to disclose in different situations has involved weighing up the pros and cons. What is the impact going to be like on myself? What is it going to be like on my client? I engage in lots of reflective practice, with lots of guidance from mentors and supervisors, to ask myself reflective questions such as, “Can I still deliver the same evidence-based treatments without disclosing?”

Pheobe: “How will disclosing impact my clients in a helpful way or a harmful way? How do I show up to meet my client where they’re at and meet their best interests? And am I doing this because it’s a benefit for myself rather than my client?” So at the end of the day, when it comes to disclosing to clients, it’s always putting the clients first and making sure that I’m doing no harm. That is how I have often operated.

Pheobe: Sometimes I have definitely felt more of a pull to disclose to clients, and I’ve really had to check in with myself and ask myself why. Other times I haven’t. In those moments I feel that pull, I ask myself, “Okay, how is this so different to the other client that I’ve worked with? Why am I feeling this pull a bit more here compared to the other client?”

Pheobe: So there are those pros and cons of weighing things up. The principle I often had to work from is, when I make a disclosure, am I comfortable with my client potentially sharing that with another service user? Am I okay with that particular disclosure not being able to be retracted?

Pheobe: How am I going to sit with that? How would I manage or navigate that if other people found out? It might be other consumers, it might be family members, it might be colleagues in the service if you had not disclosed to them previously. So I think it’s about the wider impact. Yes, in that particular therapeutic relationship, how is that impacted, but also the broader impacts as well.

Pheobe: On a personal level, Beth, through going through that process of weighing up the pros and cons, I personally don’t disclose to clients. However, the exception to that is that sometimes I have had clients ask me if I have had a lived experience, or if I’ve lived through it. I always try to go in with a really curious and non-judgemental stance and mind of, “Oh, I’m really curious about where that question’s come from.”

Pheobe: I really want to try and understand their motivations and reasons for asking that question. A lot of the time, what I have found is that clients are just curious and really want someone to know that they’ve got it, that they understand it, because eating disorders can be such an isolating experience. To know that someone else gets it is huge.

Pheobe: So I try to ask and be curious from that lens, and sometimes that leads to a disclosure, sometimes it doesn’t. I haven’t actually disclosed a lot to clients. Having said that, there have also been times where clients have from the outset mentioned they know that I have lived experience because of the prior advocacy and quite public-facing lived experience work that I have done.

Pheobe: If that comes about, again, I still take that really curious stance of, “I’m really curious, how do you think this impacts our relationship moving forward?” So again, taking that really curious stance and always holding in mind what are the client’s best interests.

Beth: Yeah, absolutely. In my own clinical experience, one of the places that I’ve seen the absolute power of clinical process being infused with lived experience is with multifamily therapy for anorexia. Just the power of having lived experience people come, and the transformation that creates in families who are perhaps struggling with anorexia and all that happens in a family, especially in relation to hope and expectancy. Seeing perhaps young people who have recovered, and also having clinicians who can give information who have been carers, that kind of infusion.

Beth: Do you think that hope and expectancy is a big part of what can happen too?

Pheobe: Absolutely. If we look at the peer support and the designated lived experience space, we notice how beneficial the power of lived experience really is. Having worked in those more designated lived experience spaces prior to my clinical training, I have received firsthand how powerful that has been, listening to someone who had been through it when I was a consumer, which really helped on my recovery journey. And at the same time, now working in a clinical role, I am so in awe of the passion of so many lived experience and peer workers that I’ve met over the years. Hearing about their stories, the energy that they bring, and how they use their lived experience to support clients and families and people with eating disorders more broadly, I think that’s been really powerful.

Pheobe: So yes, absolutely, that hope and letting them know that recovery is actually possible. As I mentioned earlier, when you’re stuck in the midst of an eating disorder, it can be so hard to see the light at the end of the tunnel.

Beth: Mm.

Pheobe: So to hear and listen to someone that has been through it can speak miles.

Beth: Absolutely. So I guess what I hear you saying, particularly about clinicians now rather than the peer work space, clinicians who have lived experience, is that it’s complex. It depends. It requires careful discernment around implications, balancing with positive aspects that might occur.

Pheobe: I would say so, absolutely.

Beth: We’ve talked about disclosure to clients, and then there’s the other issue of disclosure, isn’t there? Disclosure to your colleagues, to managers, to supervisors, those kinds of things. Maybe we should dive in there as well now we’re on this topic. What do you think about those considerations, Pheobe?

Pheobe: I think when it comes to disclosures to colleagues, so this might be other clinicians in your workplace, a clinical supervisor, a line manager or a manager, the same weighing up of pros and cons really applies as with disclosures to clients. Again, it’s thinking about the broader impacts of that disclosure. Something I have heard from different clinicians over the years, prior to my work and research now, is what will happen to my registration if I’m trained clinically?

Pheobe: That is a really big fear on many clinicians’ minds, how they might be viewed or perceived by colleagues. Particularly for early career clinicians, or clinicians who might be students in training, there is that fear around evaluation and being assessed as not being competent, for example, if they have a supervisor that is assessing their performance and signing them off.

Pheobe: I’ve certainly had different clinicians at different stages of their career asking me, “Is this something I should do?” My role is not to say to them whether or not they should or shouldn’t, but really to ask them the questions to help them engage in that reflective practice to come to their own decisions. What is your workplace culture like?

Pheobe: Is your workplace culture one that feels psychologically safe, that is able to support you in harnessing that lived experience as an asset, rather than viewing it as something that shouldn’t be talked about, that should be swept under the carpet? Over the years, I’ve certainly had clinicians tell me of both actual and perceived fears of discrimination. Sometimes they want to disclose to colleagues or managers to gain things like flexibility or workplace accommodations, so they can fulfil the tasks and responsibilities of their clinical role.

Pheobe: Sometimes what they’re afraid of is that discrimination, that stigma, that judgement. Will I get marked down, quote unquote? And sometimes they’re actually afraid of a lack of action as well. Sometimes people can think that if a clinician makes a disclosure in a workplace and something isn’t done, that that’s okay.

Pheobe: But let’s take a step back and question that. What is that lack of action actually signalling and indicating? I’ve had the really great experience of working across a multitude of different eating disorder workplaces over the years, and I’ve had largely pretty positive experiences, I would say.

Pheobe: Because I was previously a lived experience advocate and peer worker, it’s been really interesting to navigate disclosures in the workplace, because that has always been a given prior to coming into the workplace. When I interview for jobs, it will be on my CV that I have previously worked as a lived experience advocate and a peer worker.

Pheobe: Because I take that lens, I’ve been very lucky that most workplaces have been very welcoming of that lived experience and viewed it as an asset. So in some ways, when it comes to weighing up the pros and cons of disclosing in the workplace, I didn’t have a choice, because that was something I did before coming into clinical training.

Pheobe: There are lots of benefits, like we’ve talked about, in terms of that increased understanding and empathy. But it can also come with this really uncertain terrain of, will I be judged? Will I be discriminated against? If I’m seeking accommodations and flexibility in the workplace, will managers and supervisors around me act to provide me with the support?

Pheobe: Whether it’s things like adapted workloads or flexible work arrangements, if you need to go to appointments in the morning or at particular times of day, can that flexibility be folded into your job plan, for example? Something I also hear, and I nearly forgot, Beth, is that sometimes people who have disclosed and maybe haven’t received that supportive response might find others in the workplace misattributing any underperformance to their lived experience.

Pheobe: What I mean by that is if someone is, say, late for work one day or needs to take some leave, colleagues or managers might inaccurately assume that that’s because they are unwell with their lived or living experience of an eating disorder. Other risks I’ve heard about include colleagues wrongly assuming that everyday choices are a sign that someone is still unwell, when actually they’re well into recovery.

Pheobe: So there’s definitely that fear of any performance or people’s actions being misattributed or wrongly assumed to be coming from a place of not being well.

Beth: Mm.

Pheobe: So I would say those are the kinds of ethical complexities and risks that can be helpful for clinicians to weigh up when deciding whether or not to disclose in a workplace.

Pheobe: And Beth, I will preface this by saying that whatever I’m saying on this podcast today, there are actually no guidelines out there. There’s not really much guidance on how you navigate these ethical issues.

Beth: And that’s true for everyone who’s in that workplace, right? And the organisations beyond that workplace, within the sector and beyond it in the health sector as well.

Beth: Everybody’s operating a little bit on uncertainty and a kind of awkwardness. Whereas if we were able to have some guidelines around what was expected when working with colleagues with lived experience, and for the colleagues themselves to be able to make demands and say, “This is how it needs to be,” we’d just be in a much stronger position, I think.

Beth: Pheobe, can I just ask you something? You’ve talked there about the risks of disclosing. Are there risks of not disclosing? What about people who are trying to keep this entirely private to themselves over years and years?

Pheobe: When we think about disclosure, that can happen at many different levels.

Pheobe: When you look at disclosure in the workplace, some clinicians will choose never to disclose in their workplace, and that is their personal choice. I would say, though, sometimes it can be really helpful to have other personal supports outside the workplace. It might be external therapy or supervision, or just having supports where you can process some of the feelings that might be coming up for you.

Pheobe: The things that I’ve heard over the years from many clinicians across Australia is that they carry with them the distress that comes with concealment. I’ve had people say things along the lines of, “I feel like I’m a bit of a fraud,” or, “I feel like I’m a bit of a hypocrite, because I myself have lived experience, and I’m working in this area, and I come from a place of wanting to care and help.”

Pheobe: But having to continue to conceal it can be really challenging and really distressing. Being worried about the potential fears and repercussions that might come up if I disclose might mean that I don’t feel safe, for example, raising it with a clinical supervisor. In the land of therapy, there’s something called countertransference and transference, which refers to what might come up for you when you might be seeing a client whose experiences might be similar to your own.

Pheobe: Having a clinical supervisor that you can trust or confide in, if you are experiencing things like really strong countertransference or transference when working in this area of personal resonance, can be really quite helpful. For example, it might be that your own personal treatment experiences have led you to think, “Maybe I should use this particular therapy strategy more than another,” and then bringing that to supervision and going, “Okay, where is this coming from?”

Pheobe: “Is this coming from my own lived experience that’s shaping my clinical practice, or do I actually think it is clinically indicated because of my clinical judgement?” Having a space to process and talk about that can be really helpful if that’s something a clinician is being impacted by, and not having that space can also add to that distress, from what I’ve heard across different clinicians. Sometimes working in this field, if you have a lived or maybe even living experience of an eating disorder, might activate or trigger some things within you that maybe you hadn’t thought about or hadn’t processed.

Pheobe: So again, having that space to talk about those things, about what is lived experience versus what is my clinical judgement, and to seek flexibility and accommodations in the workplace, can be really helpful. The risks of not disclosing can be quite multilayered as well. It’s not just that it’s risky or it’s not. It requires clinicians to really think through the pros and cons at different levels, and the impacts on themselves, their supervisors and their clients.

Beth: Mm. But the work you’re describing, of understanding what you bring as a therapist and how that can impact your relationship and the process with your client, is work that everyone has to do. It’s not a special amount of work, it’s just in a particular area, I guess. What I’ve felt from people with lived experience who are clinicians is that they have two wells of knowledge and knowing, and one is their own lived experience.

Beth: Usually people who become clinicians have had an experience of an eating disorder that’s really mattered to them, where they learnt a lot and they went deep. They come out of that, and then wonderfully they want to find a way to help others with that. So there’s a strong desire to help, and it’s really beautiful.

Beth: And then they go and do the thing that you did, which is learn all about the research and all about the clinical strategies, holding a different kind of well of wisdom. And then they have to hold both of them together, which is amazing, I think, and requires an enormous flexibility and reflective capacity.

Beth: But it’s not so different from what everybody has to do. Do you think?

Pheobe: That’s a great point you make, Beth. I’m just thinking about supervisors I’ve had over the years. Sometimes I do go in and disclose from the outset, but sometimes I’ve actually waited a bit, for whatever reason.

Pheobe: Even in those moments, those supervisors have still been really helpful in helping me understand what’s coming up for me as a clinician, because clinicians are humans. We all have stuff that comes up for us.

Beth: Exactly, yeah.

Pheobe: And it’s trying to understand how that stuff helps shape our clinical practice, or how we can be aware of that and still ensure that we’re showing up for our clients in the best way.

Beth: Let’s move on to what needs to change, or really, how could things look better? The field has made real progress, I think, in understanding the importance and power of lived experience, and learning how to let it into the field through designated roles and peer workers, and lived experience influence across lots of areas of organisations.

Beth: Why hasn’t that translated into clearer support for clinicians with lived experience? How come that’s still a bit shrouded in all the things we’re talking about, all those risks? Is that what it is?

Pheobe: I think so. I think it’s the things I mentioned before around stigma and shame, this being quite a taboo topic, fears of being reported to health regulatory bodies such as AHPRA, and losing your registration or your job.

Pheobe: With that also comes the impact of losing your livelihood. If this is something that has brought you passion and purpose and meaning in your life, and maybe something that might have kept you well, that can be a really hard thought to come to terms with, and what the impacts of that can be.

Pheobe: I think it’s fear of judgement. Sometimes we can think of things in a really black-and-white way, such as I’m either a clinician or I’m someone with lived experience, and there’s that us versus them divide. We know from the literature increasingly that that is rarely the case.

Pheobe: Many people wear different hats, and there are actually many intersections. You can be someone who has lived experience and conduct research, or be a clinician, or work in policy, and vice versa. There are so many of these intersections. Maybe as a sector, what we need to do is broaden our horizons and think of things a bit more holistically. We are all human, and we have different intersections that might come together in many different ways with different people.

Pheobe: As a sector, it’d be really helpful if we did have clear guidance on how organisations, managers, supervisors, and clinicians both with and without lived experience can come together to support the non-designated clinical workforce. I do really think, Beth, that this is a whole of sector effort.

Pheobe: It is not just the job of clinicians with lived experience. It’s about how we come together as a sector to create psychologically safe, mentally healthy and resilient workplaces, so that clinicians with lived or living experiences can feel supported, not stigmatised, not shamed, and can feel okay to seek professional help, or disclose in the workplace if they want to seek accommodations or supports.

Pheobe: I do think this will have really positive impacts and benefits for the clients and consumers that we provide our care to. If you think back to that oxygen mask analogy, the ones you see in the flyers when you hop on a plane, as treatment providers we really need to take care of ourselves, be in a good head space, and take care of our mental health and wellbeing before we’re providing that to others, so that we can ensure we are providing the best possible level of care.

Pheobe: Those are the kinds of things that I would really like to see shift in the sector, and also clarity of the scope of role between the designated and non-designated lived experience workforce.

Beth: Mm.

Pheobe: In the broader mental health literature, there is still quite a lot of grey area, or actually limited research, on how you map out those roles and responsibilities between designated and non-designated roles.

Pheobe: I probably don’t have an answer for you, Beth, but it’s something that we do need to talk about, so that lived experience is valued in both of those different roles.

Beth: Absolutely. And that we can use lived experience, that great well of knowledge and understanding, along with the clinical research, and let them actually work together in order to do the very best for clients. That’s what we need in the big picture, isn’t it?

Beth: It’s how do we get the guidance, and I’m really glad, Pheobe, we’ve got you leading some of that new development. If I understood you rightly, you’re going to be working on some guidance in the next little while. Is that right?

Pheobe: That’s right, Beth. We’re very lucky to have won a seed grant from the Australian Eating Disorder Research and Translation Centre, or the Centre for short.

Pheobe: In the coming months, we’re really hoping to conduct a co-design research piece looking at the topic that we’ve been discussing on this podcast today. Because there is no guidance, what does guidance even look like? What different lenses and angles do we need to consider from the points of view of managers and supervisors, clinicians with and without lived experience, as well as the impact on clients?

Pheobe: For consumers with lived or living experiences, what is it going to be like for them to know that their clinician has lived experience or doesn’t have lived experience? There are, as I mentioned, so many multilayered ethical complexities that need to be considered. And I don’t have all the answers.

Pheobe: But I’m just really glad that as a sector we are starting to have these conversations. It’s not just for the wellbeing of clinicians, but also for clients, and for the sustainability of the workforce. We know that in eating disorders, and mental health more broadly, there can be burnout and stress and anxiety among the clinical workforce.

Pheobe: So when you pair that with working in an area of personal resonance, and the really nuanced complexities that are unique to that, how can we actually better support this cohort as a sector?

Beth: Wonderful questions. Fantastic that you’ve got a framework to ask those questions in and to move things forward.

Beth: My hope and prediction is that five to 10 years down the track we’ve really made some change in this area, and things are a lot less uncertain. There’s less fear and stigma, and there’s more creative and useful utilisation of lived experience across the whole clinical sphere. That would be my hope.

Beth: As you go forward in thinking about guidance and frameworks that might help the eating disorder sector with this, are there frameworks in other areas that we can look to for help?

Pheobe: That’s a great question, Beth. You’re right in saying there are currently no eating disorder specific frameworks that guide clinician disclosure to clients or colleagues. But what we can do is look elsewhere in the broader mental health field, and there has been an increasing amount of research done in supporting disclosure decisions among mental health professionals over the years.

Pheobe: A really great resource that I recommend clinicians look into is the Honest, Open, Proud Mental Health Professionals Program. It is run out of a fantastic unit at University College London, or UCL. I believe that unit was started back in 2018, and they’ve designed a whole program to guide clinicians in understanding safe disclosures.

Pheobe: It borrows a lot from safe storytelling principles from the designated lived experience sector, and it goes a step further to understand, what are my obligations as a clinician professionally, legally and ethically, and how do I fold that in if I am deciding to disclose to clients and/or others, such as colleagues?

Pheobe: Disclosure is so nuanced, and there are so many different levels, and it’s always up to the person to decide how much to share.

Pheobe: Disclosing something like, “I have a lived experience,” is very different from saying, “I’ve had a lived experience,” and then delving into your history. It’s really tricky because we don’t necessarily have that guidance at the moment with eating disorder specific frameworks for disclosure, and there are a couple of unique perspectives that need to be considered in eating disorders as well.

Pheobe: We know that an eating disorder is a mental illness that can impact your cognition and your judgement, for example. We know that things like comparisons and appearance can feature as part of it.

Pheobe: I’ve definitely worked with clients who have said to me, “I trust you,” or, “I don’t trust you,” based on their perceptions of my body.

Pheobe: Those kinds of eating disorder specific nuances need to be considered in our eating disorder specific frameworks, which is why I think broader mental health frameworks on disclosure can be really helpful to inform the eating disorder sector. And at the same time, we need to consider the nuances specific to the eating disorder field.

Beth: Absolutely. How would people be able to access the UK resource that you noted?

Pheobe: That’s a great point. If you Google Honest, Open, Proud Mental Health Professional, or HOPMHP, it should be on the University College London website.

Beth: Absolutely. Thank you so much, Pheobe.

Pheobe: No worries. Thanks for having me on.

Beth: If you are listening and thinking you may like to seek help for yourself or someone you care about, please reach out to the Butterfly National Helpline on 1800 334 673, that’s 1800 ED HOPE, for a free confidential conversation with a specialist counsellor.

Beth: Or you can chat online by visiting butterfly.org.au and following the prompts at the top of the page. To find out more about today’s episode, check out the links in the show notes and on the Butterfly website. Just head to butterfly.org.au/podcast and click through to this episode. Let’s Talk is produced for the Butterfly Foundation by Beth Shelton and Sam Blacker from the Podcast Butler, with the support of Waratah Education Foundation.

Beth: Our executive producer is Camilla Becket, with support from Melissa Wilton. Thank you for listening. Go gently, go well, and see you next month.