Opposites attract: Therapy and nursing as complementary forces in eating disorder treatment

Presented by Emma Riebi, LPC, LMHC, and Christine Stokert, RN

Collaboration between the disciplines of eating disorder treatment can have a significant effect on patient outcomes. Nurses and therapists are often seen as operating in opposite treatment disciplines, but at their presentation at the 2023 Within Health Summit, Therapist Emma Riebi and Nurse Christine Stokert discuss the ways their fields can collaborate to benefit eating disorder treatment. 

The multidisciplinary approach

A multidisciplinary approach is the gold standard of care for eating disorder treatment; as we know, eating disorders are biopsychosocial disorders, i.e., they affect a person physically, mentally, socially, psychologically, and spiritually.

For eating disorder treatment, a multidisciplinary team consists of medical, psychiatric, psychological, and nutritional expertise:1

  • The multidisciplinary approach is recommended across all levels of eating disorder care.
  • It’s particularly important in higher levels of care.

Qualitative studies have shown the importance of high levels of collaboration between multidisciplinary members. It is:2

  • Crucial for seeing the “big picture” of clients’ treatment
  • Invaluable in the clinical decision-making process
  • Helpful in determining which discipline takes priority/preference and at which time

The role of therapists and nurses in eating disorder treatment


Many people still hold onto the perception of the stereotypical therapist who sits on a couch and talks to people about their feelings, which ultimately “fixes” them. This very idealistic view doesn’t accurately represent how therapists are trained and work. 

Therapists are trained to take a client-led approach, i.e., instead of “fixing” the client, a therapist helps the client come to their own solutions, as well as tap into their own sources of healing and the support systems in their lives. In eating disorder treatment, therapists do the following:

  • Meet with individual clients, couples, families, and groups.
  • Guide clients in finding their own solutions. Therapists empower clients by diving into the process of what’s happening to them (in their bodies and minds) in the present moment
  • Provide education on eating disorders to clients and families.
  • Impart coping skills. This is particularly important in the early stages of eating disorder treatment when there is a high level of distress in clients.
  • Explore the “roots” of the eating disorder, including any traumas.
  • Create a safety plan with clients, looking at suicidal ideation, self-harm, substance use, and anything else that could affect a client’s safety.  This information is used to develop a plan that empowers clients to take their safety into their own hands.
  • Coordinate with outpatient providers, schools, and other entities, as clinically indicated. 

Overlap between therapists and nurses

Overlap between therapists and nurses

There are several elements of eating disorder care where there is a significant overlap between nurses and therapists, as the above Venn diagram shows. Nurses and therapists can step outside their “lanes” to come together to help clients move forward in their treatment.

Capitalizing on collaboration

Medically-compromised clients

Inpatient and outpatient eating disorder clients are often medically fragile. When medically-compromised clients enter eating disorder treatment, collaboration between disciplines is important.

When a client has a high level of medical complexities, these concerns can often “hijack” therapy sessions. This is where nurses can become key allies to clients, addressing medical concerns and allowing a therapist to focus on the root cause(s) of eating disorders, such as trauma.

Additionally, nurses and therapists can come together in a session to converse with clients from both therapeutic perspectives. Furthermore, collaboration between therapists and nurses provides an excellent opportunity to learn from one another. Being informed about the goings-on with a client in other disciplines enables all-around support of a client's treatment for the best possible outcomes. 

Collaboration between therapists and nurses requires:

  • A high level of communication
  • Firm, in-session boundaries with clients
  • “Back up” from each other

Psychiatrically complex cases

It’s well known that many eating disorder clients have one or more co-occurring psychiatric disorders. There is usually a typically complex interplay between these co-morbidities, which requires treatment of the person as a whole, i.e., treat all co-occurring disorders at once. This is where it becomes key for nurses and therapists to work together, particularly when it comes to medications.

Neither nurses nor therapists prescribe medications and, therefore, can provide more objective information on recommended medications and address any concerns a client may have from different, yet complementary, standpoints. For example, a nurse can inform a client about the biomechanics of how a certain medication may work, potential side effects, and how to take it. At the same time, a therapist can discuss a client’s beliefs about and barriers to taking medication.

Collaboration between nurses and therapists can improve:

  • Client willingness to consider medications, e.g., in clients who are afraid to take medications for fear of negative side effects or weight gain
  • Client medication compliance
  • Client follow-through with psychiatric/medical recommendations
  • Potential for client splitting, e.g., in particularly complex cases where a client is offering different narratives

The “opposite” approaches of therapy and nurses can tackle different client barriers. For example, nurses can offer fantastic support in helping clients attain and refill their prescriptions, as well as put a routine in place for taking their medications at the right time.

Family and team sessions

Often, nurses are not considered part of family settings. However, nurses can and should be utilized to provide complementary skills and approaches to therapists.

  • Nurses and therapists respectively: “Let’s get things done” vs. “Let’s talk about that.”
  • Nurses, therapists, and the other disciplines all have a unified goal: “Get this person well.”
  • Coaching family members vs. family therapy, e.g., through coaching nurses, can provide families with practical skills and psychoeducation to support loved ones with an eating disorder.

Case presentation: Client A

The case of Client A provides an excellent example of how collaboration between nurses and therapists looks in reality and leads to positive patient outcomes.

About Client A:

  • Presented with atypical anorexia, co-occurring recurrent manic depressive disorder, and moderate PTSD.
  • 8 months in treatment at Within Health.
  • Severely undernourished at admission.
  • Medical symptoms included dizziness upon standing, chronic pain, multiple food allergies/intolerance, sleep apnea, and migraines.
  • Over 10 previous treatment stays for suicide attempts, suicide ideation, self-harm, trauma, and eating disorders.
  • Disordered eating behaviors included restriction and chewing/spitting.
  • Developed difficulty swallowing.
  • Had a difficult time taking medications.

The treatment plan for Client A focused on decreasing eating disorder behaviors while not engaging in self-harm behaviors or engaging in disordered earring behaviors to soothe anxiety. Treatment also included following up on Client A’s medical appointments. 

The treatment modalities used included dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT), internal family systems therapy (IFS), and solution-focused therapy. Nurses and other members of the multidisciplinary team also worked with Client A in utilizing the skills learned in DBT and other therapies, contributing to positive treatment outcomes:

  • Nutrition intake increased in quantity and variety.
  • The client utilized DBT skills to manage self-harm urges.
  • At discharge, self-rated self-harm urges were at 0 out of 10 (with 10 being the highest).
  • Able to fully weight restore and maintain a biologically appropriate weight for around 4 months before discharge.

At the time of admission, Client A had had clinically significant elevated scores across the board. By the time of discharge, Client A was at or below the clinical threshold, experiencing a reduction in eating disorder symptoms, an improvement in quality of life, and a significant reduction in depression and anxiety.

Outcomes after treatment

The outcomes of Client A are a testament to how well therapy and nursing work together.  A prime example of nurse and therapist collaboration was with the client’s trouble with their sleep apnea machine. 

Face coverings were very triggering for Client A. The therapist worked on addressing the client's trauma while the nurse worked on getting them to understand how important the sleep apnea mask was for their health, as well as reinforcing the work of the therapist.  This resulted in Client A using their sleep apnea mask for the first time in years.

Practical tips and application

Tips for nurses

  • Refer clients to therapists when necessary, but also reinforce therapeutic goals, including client utilization of skills.
  • Use appointment time to support clients in meeting relevant therapeutic goals, e.g., diaphragmatic breathing.
  • Help clients connect the dots between medical and therapeutic goals, i.e., how medical stability supports therapeutic progress.

Tips for therapists

  • Refer clients to nursing when needed, but also reinforce medical goals with clients.
  • Use session time to help clients meet medical goals, if helpful and necessary, e.g., hydrating together if a client finds it difficult to drink fluids.
  • Don't be afraid to provide psycho-education to reinforce nursing and medical recommendations.

Tips for both nurses and therapists

  • Come together as a team for case conceptualization and treatment trajectory.
  • Structure team meetings to support all disciplines having an equal voice.
  • Any team member, including nurses, can call a team meeting.


  1. Joy, E. A., Wilson, C., & Varechok, S. (2003). The multidisciplinary team approach to the outpatient treatment of disordered eating. Current sports medicine reports, 2(6), 331-336.
  2. Davidson, A. R., Braham, S., Dasey, L., & Reidlinger, D. P. (2019). Physicians’ perspectives on the treatment of patients with eating disorders in the acute setting. Journal of Eating Disorders, 7, 1-9.