Tag Archives: therapy

Board Certification Chaos: How Disunity and Private Equity Diluted the Community

Few areas of mental health care illustrate dysfunction as clearly as the eating disorder board certification industry.

What began decades ago as a grassroots movement of passionate clinicians, dietitians, and advocates has metastasized into a labyrinth of overlapping credentials, proprietary “certifications,” and glossy corporate training programs.

Today, the United States alone boasts well over one hundred distinct eating disorder related certifications. This is more than that which exist for all other major psychiatric conditions … combined. For schizophrenia, there are fewer than a dozen. For depression, arguably the world’s most common mental illness, maybe two dozen. For autism, a total of ten programs. For eating disorders?

This is a table listing eating disorder related certifications:

The eating-disorder field, serving a far smaller patient population, is drowning in certificates, credentials, and branded “specialist” designations. And more are seemingly arriving every month.

This glut is not a sign of progress. To the contrary. It is the predictable outcome of a profession with no unified standards, no central accrediting authority, no ethical oversight, and an increasingly privatized treatment economy driven less by patient outcomes than by returns on investment and profiteering perpetrated by individuals and their egos.

The Great Credential Free-for-All

Unlike psychiatry or psychology fields with centralized boards and accreditation bodies, the eating disorder community has no single regulatory anchor. Instead, numerous competing organizations (IAEDP, AED, NEDA, ANAD, APT, and others) define “competence” differently and seldom recognize each other’s credentials.

The result is a credential arms race. Clinicians seeking legitimacy often accumulate multiple certifications, not because each adds new expertise, but because no one can agree which ones actually matter. Every theoretical school, CBT-E, DBT, FBT, ACT, somatic, trauma-informed, HAES®, intuitive eating, and more has spawned its own “certifying institute.”

With no governing framework, anyone can create a credential. And many have. Do you want to include social justice and political issues? Blame White Supremacy Culture? Blame the white man for all mental health issues? Create a certification program which does not include any information on ethics, or state-of-the-art medical and biological treatment? No involvement of diverse persons in creating a certification program? Extensively utilize information that is well known and has been in the community for many years? Sure! Why not? Who is going to say you cannot?

When Certification Becomes a Branding Exercise

This fragmentation might have remained a benign inconvenience if not for a second, more corrosive force: monetizing eating disorder certification through the rise of private equity.

Over the last decade, investment firms have used their monopoly power to control the narrative and then, consolidated the treatment landscape. In doing so, they squeezed the very life out of the field one dollar at a time. Large PE-backed treatment centers now own a majority of residential and intensive outpatient programs in the United States. And yet, at least one CEO of private equity owned treatment center testified in a sworn affidavit that the private equity owners prioritized profit over patient care. And patient care was compromised.

Private equity’s influence reshaped everything, from staffing ratios to program philosophy, but nowhere is the shift more visible than in education and credentialing. Under investor ownership, training is no longer an act of professional stewardship; it’s a marketing opportunity. Corporate chains launch internal “training academies” that sell branded certifications to staff and outside clinicians. Certification has become the new advertising … a low-cost, high-margin product that projects authority and generates revenue.

The loans to the investors are not simply going to pay themselves. Additional streams of revenue must be found to meet the financial demands.

Disunity as a Business Model

Eating Disorder organizations have failed to coordinate standards because fragmentation serves their financial interests. Each group has its own alleged proprietary curriculum, fees, and renewal dues. Collaboration would mean shared intelligence, information, revenue and control. Research and data would be collaboratively shared. For the first time the term, “evidence-based” would have substantive merit instead of simply being a vacuous catch phrase without any real meaning, without definition and without regulation.

Private equity masterfully exploits this vacuum. Without a single regulating body to enforce quality benchmarks, PE-backed centers can market themselves as the “gold standard” simply by aligning with whichever certification best fits their brand narrative. Or better yet, simply create your own standard of demonstrating expertise. No matter how many patients are abused, groped, or treated as if they were mere grist ground down by the mill of greed and incompetence, any treatment center can claim they are the “gold standard.”

Since they are privately owned, they can operate in the shadow of secrecy with information, which at best may be shared with their fellow PE owned overlords at quarterly meetings. Meetings which are conducted clandestinely, never to be disclosed to the families which need the highest level of care.

The Human Cost of Credential Inflation

For patients and families, the consequences are not academic, they’re life-altering. A parent searching for specialized care for a child with anorexia may encounter a clinician advertising six or more “certifications,” yet none of those credentials guarantee the provider has completed supervised ED training, worked within a multidisciplinary team, or met any validated competency benchmarks.

This blurring of standards enables underqualified practitioners to enter the field under the guise of expertise. Genuine experts are forced to buy legitimacy through redundant credentials simply to remain competitive in a marketplace driven by SEO and optics rather than outcomes.

The Wellness Economy and the Collapse of Accountability

The eating disorder arena overlaps with the $5 trillion wellness industry, which thrives on micro-credentialing. Nonclinical players, nutrition coaches, yoga instructors, and social media influencers alike obtain “eating disorder informed” certifications online, sometimes in less than a weekend.

Education has been replaced by branding. Evidence based care is replaced by radical social justice brain washing. If a person is offended by society, they need only slap an inflammatory label on the issue and not worry about its nuances. Congratulations! You have just become certified as an “Inclusive” board certified expert. The result is a field saturated with worthless credentials but starved for accountability.

Questions which should be asked are not being asked. For example, what new information does your certification program provide that was not already public knowledge in the community? Did, and does, your certification program include research professionals, medical doctors, dietitians, mental health experts, or even any men on its advisory board? Did you collaborate with any organizations or treatment centers when you were creating your program? What specialized knowledge does your organization have which other organizations do not possess? Do you have any agendas outside of providing necessary care for families suffering from eating disorders? How is your certification program going to lower the appalling mortality rate of eating disorders? Objectively speaking, how and why is your certification program an improvement over that which is already in the public domain?

Without substantive answers to these questions, professionals are left with a meaningless diploma … and simply more innocuous initials to put after your preferred pronouns.

A Perfect Storm of Profit and Disunity

Disunity and privatization feed each other. Lack of collaboration creates a vacuum; private equity monetizes it. The proliferation of proprietary programs generates revenue and brand differentiation but erodes professional credibility. Without regulation, there is no penalty for low standards, only rewards for market dominance.

The tragedy is that eating-disorder professionals entered this field to help patients including those most often marginalized by healthcare systems and diet culture. Yet through disunity and commodification, the field has allowed itself to become a marketplace rather than a discipline. Every new certification minted without oversight or accountability is another crack in the foundation of public trust.

Until collaboration replaces competition, and professionalism and the priority of patients triumph over profit, the eating disorder treatment industry will remain a cautionary tale: proof that when market logic outruns moral logic, vapid expertise becomes just another product for sale.

Inflammatory Labeling = No Progress

The mental health system in the United States is inundated with inequities and is hindered by limited access to care. Universal complaints about mental health include gross underfunding of services, provider shortages, fragmented care between mental and physical health, inadequate insurance coverage and widespread stigma that creates policy and opportunity barriers for people with mental illness. No one disputes that reality.

When significant cultural issues confront us and change is demanded, generally there are two types of people.

There are those people who lead, who are people of vision. They recognize and identify the problems and then commit to explore workable, rational, obtainable, collaborative solutions. These people who will negotiate with Satan himself if it leads to more people receiving the help they so desperately need.

Then there are “the ROYS.” In Texas, that acronym stands for “Rest of Y’alls.” This constitutes the vast majority of people. Those who are content with only complaining about the problems without being willing to invest in finding a rational, reasoned, collaborative solutions. When facing those issues, they immerse themselves deeper in their tribes safely ensconced in the comfort of their echo chamber. They are satisfied with whining and applying inflammatory labels to the issues. Their egos and fears drive their lack of vision. They refuse to interact with anyone who does not agree with them.

With that backdrop, how may we presume the eating disorder advocacy/therapist community responds to the daunting issues confronting mental health in general, and eating disorders specifically?

In the past few years, I have spoken with research professionals, medical doctors, therapists and advocates about the state of the eating disorder community. All seem to be unanimous in their view that things have never been worse in the eating disorder industry and communities.

As such, it should come as no surprise that the community seems largely content to address daunting, societal mental health issues by fostering divisiveness through utilizing inflammatory labels on their websites, publications and even a purported certification program. In general, inflammatory labels are cavalierly directed toward other people in the community, but only from a person’s keyboard.

So, what is inflammatory labeling? Inflammatory labeling is just as it sounds. It is when we assign highly negative or even cruel labels to people or organizations.

Focusing on inflammatory labels instead of solutions in social justice movements, or for that matter in any context, hinders progress by reducing complex issues to oversimplified caricatures. This practice intensifies social divides, alienates potential allies, and prioritizes outrage over tangible reforms. While rhetoric is central to advocacy, the way it is framed can either drive constructive dialogue or deteriorate into unproductive polarization.

Studies on social movements have found that extreme or inflammatory rhetoric, including labeling, tends to decrease public support for a cause. This is because such tactics reduce the average person’s sense of identification with the movement, making it difficult to find common ground. Inflammatory labels simplify people into negative stereotypes, making it harder to recognize their full humanity.

This reflects the sociological concept of “labeling theory,” which posits that assigning a negative label can lead to a self-fulfilling prophecy and further entrench deviance. Labeling opponents with charged terms can create a binary “us vs. them” mentality, making it difficult to challenge ideas through reasoned debate. Instead of addressing the complexities of an issue, discourse devolves into a culture war of labels, name calling, and finger pointing all of which obscures real policy solutions.

By way of example, radical eating disorder activists casually throw out inflammatory labels like:

There are so many others: White Privilege, Whitestream Research, toxic masculinity. These inflammatory terms of derision are directed at anyone who does not agree with their viewpoints as well as the mainstream medical and mental health communities. In addition, the term “invasive species” is even being used to define or refer to the same White Supremacy Culture and people and organizations which fall under that umbrella. And that is supposed to be productive?

As for any proposed practical, realistic collaborative solutions to address the inequities in mental health care? They propose none.

A few years ago, a small group of people published a letter directed at eating disorder organizations and treatment centers. Amongst the demands made in the letter included: providing reparations to Black People, Indigenous people and People of Color, (“BIPOC”) especially queer and transgender BIPOC; hiring a transgender consultant to revise your marketing material; establishing sliding fee scales for BIPOC, transgender and gender diverse clients; redistributing wealth from the for-profit ED treatment world; providing access to Hormone Replacement Therapy.

Other radical activists equate mental health research and treatment as a zero sum game. That BiPOC, LGBTQ+, fat therapists and professionals must be centered and that there is no space for white, straight and thin people to jump in. Or that white, liberal female therapists should focus more of their attention on social justice issues and political reform in all they do.

Of course, in the unlikely event the latter ever happened, those therapists would then be labeled as White Saviors and would be publicly eviscerated in the town square ala Lindo Bacon.

There must be a way. Other than inflammatory labeling, whining and complaining, what possible solutions exist which could be explored to address some of the inequities in mental health care systems?

Inequities which include far too few medical doctors, therapists, counselors and other medical and mental health professionals who are BIPOC. Minority and BIPOC communities are far underserved. Medical school training largely ignores eating disorders and BIPOC issues. Far too few BIPOC persons receive mental health care. Access to meaningful mental health care is severely limited for BIPOC persons. Research has not included significant BIPOC participation. Mental health care can be prohibitively expensive.

These complex, daunting issues require collaborative wisdom. And when progress is made on these issues, as they surely must be, this necessarily will result in a more enlightened society. So, the question must be asked again … how are name calling, tribal mentality and inflammatory labeling going to be remotely effective in addressing these serious issues? Answer … they aren’t.

A roadmap does exist for systemic mental health reform in the U.S., prioritizing enforceable, high-impact interventions first while building toward longer-term initiatives. The roadmap assumes some federal and state collaboration, leveraging funding, licensing, audits, and measurable metrics. But it is possible. It will not be easy. It will require participation, wisdom and sacrifice from society as a whole. It will require us looking past our human frailties and being bold and forward thinking. But it is possible.

And so, we will address that roadmap next.

When Social Justice Therapists Go Too Far …

Since prolific anti-semitism directed toward Jewish therapists by non-Jewish therapists is an appalling reality, it was predictable that the assassination of Charlie Kirk would reveal the worst in humanity … including of course, eating disorder therapists and family liaisons. More’s the pity.

When a loved one has an eating disorder, families are already living in a war zone. Every meal feels like a battlefield. Every doctor’s appointment feels like judgment day. And when parents turn to therapy, they are not looking for ideology, slogans, or someone’s Twitter feed come to life. They are looking for life saving help.

Eating disorders don’t care about politics. They don’t care about hashtags. Eating disorders only care about shutting down organs, hijacking minds, and killing people. But too many therapists, treatment centers, and professional organizations are importing America’s divisiveness into treatment. The result? Families are left paralyzed, distracted, and betrayed.

More and more therapists and family liaisons are peddling something else: politics disguised as treatment. Some wave the flag of “Free Palestine” with militant zeal. And yet, most could not even remotely explain the complex nuances of Middle East politics going back thousands of years. When the phrase, “From the River to the Sea,” is spewed forth with all the hatred and horror which exists within the soul, many therapists and activists cannot even identify which river or which sea is being referred to, let alone identify the dark significance of that phrase.

These militant therapists and family liaisons sneer that the death of Charlie Kirk, a conservative commentator was deserved, and in their ignorance and room temperature IQs, slap “ism” labels on him and then rejoice that his life was tragically cut short. These providers and activists are intentionally obliterating the line between activism and care. Families should take this as the clearest possible warning sign: walk away. As fast as you possibly can. Do not trust those people or their organizations.

It is bad enough that families seeking help often find therapy rooms that sound more like activist seminars than clinical spaces. Instead of guidance on food and recovery, they get:

  • “Diet culture is colonialism.”
  • “Anorexia is a symptom of white supremacy.”
  • “Thin privilege is the real disease.”

These are not treatment strategies. They are slogans, ripped from Twitter and recycled in therapy sessions. When families should be hearing about family-based treatment (FBT), CBT-E, or medical stabilization, they’re handed culture-war scripts that do nothing but fracture trust.

Eating disorders thrive on chaos and division. They feed on families who are fractured, therapists who are distracted, and organizations that are broken. Every minute spent arguing over slogans is a minute not spent on saving a life. Every resource squandered on activism is a resource stolen from recovery.

Therapy is supposed to be a sanctuary from the chaos of the outside world. It is supposed to be a space where pain is met with compassion, not political litmus tests. Injecting social justice battles into that space doesn’t just distract — it actively harms.

Here’s how:

  1. It replaces healing with indoctrination. Patients and families arrive desperate for answers about food, weight, fear, and survival. Instead, they may be handed lectures about geopolitics, race, or privilege. The family’s suffering becomes a prop for the therapist’s personal crusade. That is gross exploitation, not care.
  • It breeds division when unity is essential. Eating disorders tear families apart. Recovery depends on pulling together. A therapist who filters everything through activism risks turning family members against each other based on political or cultural identity. That kind of manufactured division is gasoline on the fire.
  • It signals contempt for dissent. A therapist who proudly mocks the death of someone they dislike politically is broadcasting one thing: if you disagree with me, I do not respect you. How could any family trust such a provider to respect their child, their family bond, or their values? Trust collapses before therapy even begins.
  • It encourages rigidity instead of curiosity. The most effective therapists know they don’t have all the answers. They ask, they listen, they adapt. But the activist-therapist thrives on certainty: oppressors vs. oppressed, good vs. evil, us vs. them. That rigidity suffocates the flexibility patients desperately need for recovery.
  • It undermines professional ethics. The ethical codes of every counseling profession warn against imposing personal beliefs on clients. Therapists who cannot resist bringing their political militancy into the room have already failed the most basic test of professionalism.

Let’s be clear: cultural awareness and respect for diversity are good things. But respect is not the same as ideology. Sensitivity is not the same as indoctrination. Families need therapists who can meet them where they are, not therapists who drag them into battles they never signed up to fight.

Eating disorders are the second most lethal mental health illness, outpaced only by opioid addiction. This is life-or-death work. Families should demand nothing less than evidence-based treatment, humility, and compassion. When a therapist instead advertises their political rage as part of their practice, they are showing you what matters most to them — and it isn’t your child’s recovery.

The therapy room should be sacrosanct and must never be allowed to become another front line in America’s political battles. Families: if your loved one’s treatment starts to look like activism instead of medicine, get out. Your child’s survival depends on science, unity, and clarity — not the noise of a broken country bleeding into a broken field.

Hannibal Lecter, Frazier Crane, Dr. Blane … and You!

Therapists are on the front lines of mental health. They are in the trenches. They are the professionals upon whom we rely to reach down into our darkness of despair and lift us into the sunlight. To show us a bold new future filled with hope and joy. To have the strength and resiliency to not just help us fight our own internal struggle toward mental wellness, but who are able to maintain their own sanity. They must be intelligent, courageous, self-aware and in order to meet the broadest range of patients possible, they must possess an open mind regarding culture, society, life and yes … even politics.

[I understand at this point the 4 remaining therapists who may still read my missives may be pressing the block/ignore button. That’s ok.  After all, we can’t have a man (or person who identifies as a man or a person who is not in our tribe) be allowed to have any type of voice which may disrupt their echo chamber!] … But as usual I digress.

Seriously, what an incredibly difficult job. As patients, we spew forth our anger, our guilt, our sorrow, the rawest of our emotions and we trust that our therapist can help guide us to the genesis of enlightenment, a path of wisdom … Or at least give us a break on their hourly fees after we have been seeing them for one year. Whichever … Whatever!

And yet, Hollywood and the television and movie industries trend toward casting doubt upon that premise. Those bastards!

So, let’s look at a few series in which therapists were prominently featured as we attempt to understand Hollywood’s seemingly negative portrayal of therapists.

First, the series “Hannibal” featured everyone’s favorite cannibal psychiatrist, Hannibal Lecter. If he wasn’t helping his patients resolve their issues, he was dining upon them… with some fava beans and good chianti.

Ok… so that may be a bad example.

There was everyone’s favorite radio psychiatrist, “Frasier” who when he wasn’t doling out McTherapy on his daily radio show, he was struggling with his own many personal issues involving family and friends. And he went through a legion of failed relationships ad infinitum.

The “Shrink New Door.” This limited series is a dark comedy starring Paul Rudd as Dr. Isaac Herschkopf – a charismatic yet manipulative therapist who exploits his relationship with patient Marty Markowitz (played by Will Ferrell). This show delves into themes of power dynamics, boundaries, and ethical dilemmas within the context of therapy while providing audiences with a unique cautionary tale about misplaced trust.

“Gypsy” was a brief series starring Naomi Watts as therapist Jean Holloway. It delved into themes surrounding boundaries, ethics, and personal relationships within the profession. Jean becomes increasingly entangled in her patients’ lives outside her office – blurring lines between professional responsibility and personal desire.

Then there is Loudermilk. A comedy about a recovering alcoholic, Sam Loudermilk, who works as a substance abuse counselor. Despite sometimes helping the people he works with, Sam’s defining characteristics are being uncaring, sarcastic, and self-centered.

A recent series, Shrinking just completed its second season on Apple TV with a third season to come. Shrinking is a comedy bundling the elements of friendship, love, kindness and dysfunctionality with an underlying theme of grief. The characters are bound together by their support and love for each other. And yet, their own struggles and dysfunctions define each character, their very existence. And give an alarming glimpse into the reality of countertransference.

Finally, there is YouTube sensation, “Dr. Blane.” Dr. Blane should best be watched instead of described:

What do those series, and numerous other series not cited have in common? They all depict counselors, therapists, those people upon whom we rely to help us, as being inherently flawed, emotionally needy and dysfunctional. A person who should be receiving therapy instead of doling it out.

Now, I did not write nor produce these series. And yet, they all portray therapists/counselors in less than a flattering light.  Aren’t we justified in wondering why that is? Keep in mind this is Hollywood.  The place from where the messaging seems to be, “we invented extreme, radical leftism, we hate everyone who does not agree with us, we are looney toons.” So, other than a belief that comedic dysfunctionality sells, why would the very left of the leftists portray therapists/counselors in an unflattering way?

Unless … there is a shred of truth in it.

Which brings us to the aforementioned countertransference. Therapists know that countertransference occurs when a therapist lets their own feelings shape the way they interact with or react to their client. In a therapy session, a client might remind the therapist of someone or something from their present or their past. As a result, the clinician might unconsciously treat the client in an emotionally charged or biased way.

Therapists trying to heal themselves through their patients. While inflicting their own views of cultural and societal liberalism upon those whom they are tasked to help and thereby bastardizing the therapy process.

Those therapists are fairly easy to spot.  Most have social media posts replete with cut and paste posts on how all Republicans and/or President Trump are evil. He is the Anti-Christ! The world is coming to an end!

These therapists/counselors drag this pablum into the therapy room. In fact, there are counselors who openly admit they do exactly that! And to those counselors, I ask, do you honestly believe that there is space in the therapy room for your own mania? Is it ever appropriate to bring your own biased political views into a therapy session and attempt to infuse them into your patient? Especially with eating disorders where other mental health concerns are more often than not, inextricably intertwined?

Especially since there are so many complexities with eating disorders. Isn’t a counselor’s time better spent studying how and why the malnourished brain does not operate? Learning what parts of the brain are impacted? Looking at the genetic components of eating disorders? Or what you know about RTMS? Or ketamine regiments? Or Ai interactions? Or brain implants?

Your patients … our loved ones deserve the very best from you. This is not your special opportunity to heal yourself.

Now, make no mistake, there are many incredibly intuitive, intelligent, and insightful therapists.  Those who make a difference.  This is not a case of Diogenes the Cynic holding a lantern wandering the Greek countryside looking for one honest man.

But … it may be in the same zip code.