Joe Sciarretta, LCSW, Shares His Experience Treating Eating Disorders
Joe Sciarretta, LCSW is a professionally trained and experienced New Jersey based therapist who specializes in helping people struggling with Eating Disorders, OCD, Anxiety, and Depression. He’s been working in the field for over 10 years in a variety of positions that range from direct care staff all the way to his present role as a full-time independently practicing therapist. His time working in some of the most notable eating disorder treatment centers in the area have equipped him to be a skillful and hopeful therapist to his clients.
Jenny: What made you want to work with eating disorders?
Joe: I like to tell people that I found my passion for eating disorder work by accident, but stayed with it on purpose. I took an internship as an undergraduate at an ED hospital. I was really inspired by the client’s stories, their willingness to change (even though it was difficult), and the staff that helped them. I thought that this is something I could be good at.
Jenny: Prior to that, had you known anyone with an eating disorder?
Joe: Like most people in the world, I did know someone with an eating disorder, but I didn’t know that I knew. I had friends of friends in school who would ‘disappear’ for a few months and then come back healthier, but I never knew what was going on with them until many years later. Other than that, it wasn’t something that was as commonly discussed as it was today.
Jenny: What do you like about working with eating disorders?
Joe: I really like that my clients are smarter than me, so I always get to learn something. Don’t get me wrong, I know that I am a smart person too, but my clients truly have sharp minds that I look up to. I also think there is so much potential for this population to change, and even though they doubt their ability to heal, it makes it all the more enjoyable when they surprise themselves by how much they can accomplish.
Jenny: Which therapeutic approaches do you use?
Joe: I avidly use the 8 Keys to Recovery from an Eating Disorder by Carolyn Costin and Gwenn Grabb. I think the most important concept for a person with an eating disorder to understand is the idea of the eating disorder self and the healthy self: the two warring voices that pull someone with an eating disorder in opposite directions at the same time. This idea is focused on a lot in the 8 Keys book. I also use a lot of CBT and Exposure Therapy with clients. What CBT teaches us is that the best teacher for anyone is experience, even if it is a lesson you learn from breaking patterns in tiny ways. It's hard for someone to argue with, “I tried something different and I feel better”.
Jenny: How do you involve loved ones in therapy?
Joe: I want to involve loved ones in whatever ways my clients are open to - I am game for anything. Obviously, the client has to be on board and there has to be some willingness coming from them. I think I am such a fan of family work because of my training: I ran a multi-family group at Monte Nido for 4.5 years and my mentors always emphasized the importance of family support. My family sessions can look like: a question-and-answer session, teaching/education about eating disorders, or airing out family issues in a safe, supported environment. I think that clients who involve loved ones are really wise to do so. Whenever appropriate, they absolutely should.
Jenny: What would you suggest to someone who has treatment fatigue?
Joe: As long as someone isn’t in life-threatening danger, it can be ok to take a break from treatment. Sometimes the best therapy is living your life and noticing, without someone trying to show you, that you are limited by your remaining symptoms. This frustration with being unable to do things without a lot of difficulty can be the best motivator for people, especially people with perfectionistic tendencies, or people who don’t like being told what they can/can’t do. On the other hand, with that being said, ultimately clients have a responsibility to take care of themselves whether they are in treatment or not (just like we all do). Personally, I will work with this kind of client on harm reduction for a period of time or even focus on other areas that are affecting their life: obsessionality, flexibility, anxiety, perfectionism, etc. Sometimes seeing improvement in other non-ED areas can help someone take a step in their ED recovery.
Jenny: What would you say to someone who is hesitant to work with a provider who has never had an ED?
Joe: More than personal lived experience, I think the most important thing that makes a good ED therapist is a willingness to understand your experience. The only way to really do this is to listen to you and your story. In my opinion, a non-recovered therapist who does this will be more effective than a recovered therapist who does not. As someone who has never struggled with an eating disorder, I’ve listened to those around me who have, in order to learn and gain understanding. In the beginning especially, this was a very humbling experience, because there was so much I didn’t know at the time. As a bonus, even though I can’t speak about this personally, I can channel my recovered examples and teach from what others have taught me.
Jenny: Do you think it's important for therapists to have ED specific training?
Joe: This is a tough question because there are a lot of famously recovered people (like Carolyn Costin) who have gotten better with non specialists. However, standards today are different than they were back then. There wasn’t the option to see a specialist because they really didn’t exist. So the fact that some people got better without specialty care proves that it is not 100% necessary. However, I think that anyone with an eating disorder would be best served by a specialist. It just makes the process easier for the person seeking care. So if you have the option to work with a specialist it is an added benefit for sure.
I believe the most important piece in working with a provider is connection and the second most important piece is someone who understands eating disorders. If you have a therapist you love and isn’t a specialist and you can make progress, great; however, after a few months, if no progress is being made, consider seeking out a specialist.
Jenny: Are there any demographics you prefer working with?
Joe: In the realm of eating disorders, I often see clients with a myriad of other co-occurring diagnoses including: OCD, anxiety, depression, relationship issues, etc. And even without a co-occuring diagnosis, everyone with an eating disorder has other issues going on in their lives and I enjoy addressing all of those, too.
Jenny: What is your philosophy about recovered vs always recovering?
Joe: I subscribe to the philosophy that one can be fully recovered. That being said, I don’t think every client will decide to set that goal for themselves, especially at the start of treatment when even small changes can seem overwhelming, so I believe in incremental steps to change. Every part of an eating disorder that people let go of is going to result in an improvement to their life, even if the transition period is difficult.
I think one thing that really stands out to me about recovered people is that they tend to be really thorough about letting everything go that was a part of their ED. They are deeply committed to change, but again that almost never happens on day one. They develop that conviction over time as they see that their prior change is adding up to a better and better life.
Jenny: Have you ever shared a mutual client with a recovery coach?
Joe: I’ve worked with recovery coaches before and I really enjoy it. It makes my role as a therapist even more effective. The coach helps facilitate behavioral changes while I can focus on the underlying issues and developing insight. One of the most common mistakes I see clients make is splitting recovery into two halves: changing eating habits but refusing to talk about hard issues, or vice versa, and talking about anything but refusing to change eating habits. The only people who really get better are those who do both at the same time, and I think recovery coaches help facilitate that shift so well.
Jenny: Any favorite moments as an eating disorders therapist?
Joe: I love when I can make someone laugh, even if it happens at my expense! Getting someone to see the absurdity in something they have taken very seriously can be a breath of fresh air and a powerful experience. Humor, when used properly, can be a great way to start helping someone address a previously held sacred belief that was, in reality, holding them back. Laughter is definitely good medicine!
If you want to learn more about Joe’s services, check out the links below:
Bio: https://dovetailcounsel.com/about
Services: https://dovetailcounsel.com/services
Blog: https://dovetailcounsel.com/blog