IT IS MY GREAT HONOR TO INTRODUCE TO YOU MY DISTINGUISHED TEACHER AND MENTOR, CAROLYN COSTIN. CAROLYN IS CONSIDERED A PIONEER AND EXPERT IN THE eating disorder field. WITH DECADES OF CLINICAL PRACTICE AS A  PSYCHOTHERAPIST, SHE IS AN INTERNATIONALLY KNOWN AND HIGHLY SOUGHT-AFTER SPEAKER. UTILIZING HER OWN PERSONAL EXPERIENCE WITH ANOREXIA, SHE BOLDLY PUT FORTH THE NOTION OF FULL RECOVERY, LITERALLY CREATING THE DEFINITION DURING A TIME WHEN OTHERS OFFERED ONLY SYMPTOM MANAGEMENT.

Carolyn was the first to open a residential eating disorder treatment center. The famed Monte Nido residential centers were designed as homes to provide an optimal setting for successful treatment and true healing where psychological needs were combined with yoga and meditation. After recognizing notable improvements in patient outcomes where providers also had lived experience with eating disorders, Carolyn established the Carolyn Costin Institute. The Institute is a rigorous training program that provides supervision, and certification for becoming an eating disorder recovery coach. She has authored several books for clinicians and clients, along with contributing to nearly every major eating disorder organization in the world. Carolyn’s contributions to the eating disorder field are unmatched. She changed the course of my life as my role model and I am truly blessed to call her my friend. With Carolyn’s help, I was able to launch my own eating disorder recovery coaching private practice, Merrit Elizabeth Recovery. 

CAROLYN, CAN YOU TALK A LITTLE BIT ABOUT HOW YOU STARTED THE CAROLYN COSTIN INSTITUTE? CAN YOU ALSO EXPLAIN WHAT THE CAROLYN COSTIN INSTITUTE IS?

I had thought about it a lot when I was running Monte Nido. And before even Monte Nido, when I was running hospital programs, I would bring in people who were recovered that I knew that were graduate students to help me with people during meals or when they got out of the hospital, but I never called them coaches at the time. I just said they were recovery support people. I didn’t even think about the term “coaches.” But I’ve always known that there’s been this gap in the field where there are sober coaches, life coaches, business coaches, and leadership coaches, and no eating disorder coaches. I was too busy running Monte Nido to do it, but I thought somebody really ought to do this because there is a service here in the gap between sessions– the in-moment experience where people need assistance and they need people who not only have been there, although that’s part of it, but people who are trained to how best use their lived experience. So after I sold Monte Nido, I was kind of depressed for about a year. And, I started thinking about it, and my first director of operations for the Carolyn Costin Institute (CCI), Jeanette Shumway, contacted me and said, “Hi. I’d like to start some eating disorder services.” Anyway, we started talking and I realized, oh, this is somebody that I could do it with. She had a lot of skills and helped me to open this institute. We didn’t know what it was going to be. I wanted to train people who had recovered themselves, and I was open to training other people. I wanted it to be rigorous. I wanted people to really learn how to stay in their own lane, and not get in the way of the job of a therapist or a dietitian. But how do you support someone when they have the goals from the therapist? Or they have the goals from the dietitian, but they can’t just go out and do it just because they have that goal. They can’t get to the restaurant and order that food or keep it down after eating pizza or pasta for the first time in a long time, or setting up their kitchen. So there were a lot of reasons for the Institute to come into existence, but I had no idea it was going to be as big as it’s getting.

I opened a little six-bed residential, and I thought I would be running it for the rest of my life, and now residential treatment is ubiquitous all over the country. And even when I sold Monte Nido, I think there were fourteen programs I was running when I sold it. And this is kind of the same. When there’s a gap in the field, honestly, it doesn’t feel brave until you look back. I didn’t feel like I was brave opening Monte Nido. I felt like, oh my god. We need residential for eating disorders. It really makes no sense that people have to be in outpatient therapy or all the way to hospital. And I was feeling the same way about this coaching thing. It doesn’t make any sense that we’re not training eating disorder coaches.

HOW MANY COACHES HAS THE CAROLYN COSTIN INSTITUTE TRAINED, AND HOW MANY COUNTRIES HAVE CCI-CERTIFIED COACHES?

Right now, we’re at about–and this is rough because I lose a little bit of track– but I’m not going to be far off in saying we have about a hundred and fifteen practicing coaches in about sixteen countries. And actually, where we have those coaches is really fascinating. I’ll just give you a few that were really surprising to me. I have a coach right now training from Ethiopia. I mean, that was like, really? And Peru, Columbia, Belgium, Czechoslovakia, Czech Republic, Ukraine, and Dubai.

It’s just really blown my mind at how people have found it. And I think how people have found it is because there is always someone who’s recovered who is trying to figure out, “How can I give back, I want to give back & I know that I need some training, and I don’t necessarily want to be a therapist and go to school to be a therapist. I just want to help support somebody like I wanted to be supported.” And in all of those countries, there’s not a whole lot of infrastructure for eating disorders anyway. They don’t have a ton of eating disorder dietitians. They don’t have day treatment programs. They don’t have IOPs or residentials for that matter. They are having an interesting time in their countries, being a coach and finding a therapist or a doctor or a dietitian to work with, who is helpful in all these different ways, but sometimes they know more about specifics with how to work with someone with an eating disorder. 

HOW WOULD YOU DESCRIBE EATING DISORDER RECOVERY COACHING TO SOMEONE WHO MAY BE COMPLETELY NEW TO THE IDEA?

First, I would ask them if they’ve heard the terms like sober coach. That’s the closest, I think. You know, someone who really steps up and has become sober and helps somebody else who’s trying to get sober or is newly sober– goes to their house and pours out all their alcohol, just like some of our coaches go to somebody’s home when they’re getting out of treatment and gets rid of their diet pills or their laxatives or goes shopping with them. The main part of the job isn’t necessarily having a session. It’s doing things with you. Whether it’s virtual or whether it’s in person, it’s helping you fulfill all the things that your team and you have decided are necessary for you to get better. So that will involve texting, and it could be texting at different hours of the day and night, reaching out for help in the moment where we all know, problems don’t necessarily happen in the office space. They happen when you have someone with anorexia who commits to doing this meal plan, but sits down at breakfast in the morning and looks at it and goes, “I can’t do that.“

You can have a coach who’s with you every morning on Zoom, having breakfast with you. Or with you at a restaurant having breakfast, or just texting back and forth, getting you through that meal. Those are things that therapists and dietitians don’t have the time to do. There are a few dietitians that are more involved like that in terms of helping people with meals, but for the most part, coaches are helping with that in-the-moment support, figuring out ways to make it happen, and being role models. Because when you’re recovered, it is something to be around people who are still struggling and be able to say, “Yeah, I felt that too. Yeah, I did that too. Yeah, I understand. Yeah, I thought I would never get better. Yeah, I thought I would never accept my body.” All those things. And then getting to the point where look where I am today. Yeah, and I believe in it so much, I’m willing to help other people get there. I think that’s a huge factor.

WHY IS A CERTIFIED COACH HELPFUL TO OTHER PROVIDERS ON AN EATING DISORDER RECOVERY CLIENT’S TREATMENT TEAM?

Well, I can tell you what they’re telling me. I have providers now saying, I don’t even want to work without a coach, which is really amazing. That’s come a long way. Some are still afraid, I think some are still worried about the training. How do I know this person knows what they’re doing? How do I know that they’re really recovered? But you could say that about any field. You and I probably both know people in the field, dietitians, or therapists who have an eating disorder, it happens. It happens in all realms of eating disorder treatment and other kinds of treatment. And my position is, look, I just straight up ask. And as you know, if you’re going to be a CCI coach, you can go through one track, which is a normal track, and you can go through the other track, which is the recovered track. And for those in the recovered track, I make sure in the training that I am weaving in questions like, “How are you using your personal experience?” But the other thing I would say is that it’s like a track coach or a swim coach or whatever. And this is where with coaches, it’s about staying in the lane. And what I tell coaches to say is, look, if I was a track coach and you came with a broken leg, or you came saying, “I don’t wanna run. I’m not gonna run.” I would say maybe you need something else, like a sports psychologist or a sports physician or whatever, but I’m a coach. That’s what I do. So it’s okay that this isn’t the best match, but it isn’t the best match. And I’m out of my league trying to help you when you come to me as a running coach and you have a broken leg. So there are ways that you explain to someone that a coach really does help the person who has some level of motivation and goals of behavior change that they want to make.

Some practitioners get a little bit threatened by coaches. But I think a lot of them welcome it because they have a job to do. Everybody has a job to do. And the lanes can be a little bit wobbly, you could pass into a lane and back. It’s not like you’re never going to talk about someone’s underlying issues. We would be fools if we just ignored that, but you know how to get back on track. You know how to steer it back. You know how to say, “Report back to the therapist about that.” And you know how to bring it back to “Yes. So what are the goals that we’re working on.”

And that’s why the training is so important because for some people, that’s a bit second nature. And for other people, it isn’t. They can go through the whole training. They can answer all the questions when you have to write them down, but they get with a client, and sometimes people get afraid. They don’t want to upset the person. They have so much empathy, and this is the biggest problem-that they’re too kind. I’m all about being empathic, but you also have to challenge people to get out of their comfort zone or they’re not going to get better.

WHY ARE EATING DISORDER COACHES NECESSARY IN MODERN-DAY EATING DISORDER RECOVERY TEAMS?

Well, I always think they would have been useful. If I go back in time, I would have liked to have one too. I think they always would have had value. It just took a while for that someone to step up and do it. But I also think now there’s so much happening so fast. Like, you can go in your session with your dietitian, and then you can come out and look at some celebrity posting “what I eat in a day” videos on their TikTok or Instagram and be completely thrown off in two seconds and think, “Really? That’s all she eats in a day. Wow. Look what she looks like.” And so being there in real time where you can get a text where they can reach out to the coach and say, “I’m struggling with breakfast after watching this thing.” I also think that with residential treatment, it’s expensive. Not everybody has the coverage for it. People are getting concerned about what’s happening in the residential treatment industry.

Weirdly, although I didn’t predict this, I see coaching being a game changer in terms of helping people not have to go to residential because it’s really hard to keep someone from residential when you just have a therapy appointment with them once a week and maybe a dietitian appointment once a week. Even if you have two times a week with a therapist, one with a dietitian. Let’s say you have three times a week. That’s three hours a week. Whereas when you go into residential, it’s 24/7. Or you go to IOP or day treatment. So coaches can come in and do these blocks of time, like spend two weeks with the client just getting them on track, getting them into a routine, being with them while they do it. And that’s turned out to be a fascinating thing that I didn’t really originally have in mind or plan for. And that can go all the way to live-ins that go up to three to six months, which we’ve had a few coaches do. I think there’s a place in heaven for them, because that is super hard work. But you have families saying, “Coaches turned so and so around or turned me around. And now I don’t have to go to residential.” And that’s pretty astonishing.

WHAT DO YOU SEE FOR THE FUTURE OF THE CAROLYN COSTIN INSTITUTE? WHAT DO YOU SEE OR THE FUTURE OF EATING DISORDER RECOVERY COACHES?

Well, I didn’t necessarily know this in the beginning, but I think now that it’s going to grow and that it’s going to be as normal to have coaches around and people with lived experience giving back, as it is to have therapists and dietitians. I think that’s going to happen. But I think what’s also going to happen is what happened with residential, that places will open up. And you know me, because of the course, I’m very dedicated to do something right and to do it in a way that is not cutting corners, and so when I opened residential we had a high staff-to-client ratio. Everybody had three therapy appointments a week at least, one with the dietitian, one with the psychiatrist, and one with doctor. There were a lot of services. We had a fitness trainer and yoga and meditation, so many things that we took evidence-based and combined it with different modalities. I offered all that. I trained staff and everything. I see places starting to offer a coaching certificate or say they have coaches, and then I ask what the training is, and I don’t get much back. And that worries me because right now it’s not regulated and anyone can hang up a shingle and say that they’re a coach, and I worry. But there is a way to make this very rigorous and credentialed. Make sure you have supervision and an internship and eating disorder clinician, someone at least that has training and is overseeing the internship. And I don’t see that happening, so that worries me. But I do think that coaching is going to continue to grow, and I think it’s going to continue to have increased acceptance, especially since the acceptance of the place for lived experience in the eating disorder community has grown along with the acceptance for peer support in other arenas of mental health. There has been a lot of research on the efficacy of peer support. And that has not happened with eating disorder coaching, but that’s the next step is for it to happen. And one of the CCI coaches is working on that right now.

Coaches are trained to assist clients in everyday situations with treatment goals by organizing appropriate challenges and providing ongoing support throughout the course of a client’s recovery journey. Coaches can assist in real life situations like grocery shopping, clothes shopping, meal outings, and more. Coaches will help clients find and strengthen their healthy self, while identifying behavior changes that need to be made in order to achieve full recovery. Carolyn discusses more on how coaches can be helpful on her social media–her Instagram page is linked here. If you want to learn more about The Carolyn Costin Institute or the rigorous certification program to become a coach, check out Carolyn’s website here.

If you’re ready to take the next step in your recovery journey, let’s talk about how eating disorder recovery coaching may be a game changer for you. I offer a free 25-minute consultation call, let’s get it scheduled here!

Merrit Elizabeth

Merrit Elizabeth is an Eating Disorder Recovery Coach certified by The Carolyn Costin Institute. She holds a master’s degree in Health Promotion Management and has years of experience working with women with eating disorders.