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Symposium Speaker Series: Having Difficult Treatment Conversations with Patients and their Support Systems

The 9th Annual Veritas Collaborative Virtual Symposium on Eating Disorders creates space for our community of experts to come together and advance our understanding of what it means to provide best-practice eating disorder care. Our Symposium Speaker Series offers an advance look at our keynote speakers and the topics they will cover.

Leah Graves, RDN, LDN, CEDRD-S, FAED, is Vice President of Nutrition and Culinary Services at Veritas Collaborative and has been treating patients with eating disorders for more than 30 years. A founding member of the Academy for Eating Disorders, Graves is widely recognized for her expertise in medical nutrition therapy, nutrition counseling, clinical supervision, and research.


Rollyn Ornstein, MD, is a board-certified Adolescent Medicine specialist and Medical Director at Veritas Collaborative’s Child & Adolescent Hospital in Durham, NC. Dr. Ornstein has more than 20 years of experience treating patients within eating disorders and has been widely published within the field. She has presented her research at both the International Conference on Eating Disorders and the Society for Adolescent Health and Medicine.


Elisha Contner Wilkins, MS, LMFT, CEDS-S, is a licensed therapist and serves as Executive Director at Veritas Collaborative’s Child, Adolescent & Adult Center in Richmond, VA. Wilkins has more than 20 years of experience treating eating disorders both in private practices and at higher levels of care. She has also used her expertise in the space to support the development of several eating disorder treatment programs.


Jonathan Levy, MD, CEDS, is a fellow of the American Psychiatric Association and Medical Director at Veritas Collaborative’s Child, Adolescent & Young Adult Hospital in Atlanta, GA. He is currently an adjunct assistant professor of psychiatry and behavioral sciences in the Department of Psychiatry at Emory University School of Medicine.


We recently sat down with Leah Graves, Dr. Ornstein, Dr. Levy, and Elisha Contner Wilkins, to learn more about tough conversations with patients and families, what clinicians can do to confidently approach conversations about a need for a higher level of care, and their upcoming symposium presentation Tough Talk: Having Difficult Treatment Conversations with Patients and Their Supporters. 

Veritas Collaborative: What are the most common conversations had with patients and supporters about eating disorder treatment?

Leah: In my experience, the conversations are highly individualized. Yet, two common themes come up frequently. One common theme is resistance to a recommendation to enter a higher level of care. Many want to try outpatient care first, even if the severity of the eating disorder warrants a 24-hour care setting. Another common theme is questioning treatment targets, especially those related to weight. Our culture is so focused on weight and marginalizing of those in larger bodies that even in the face of a life-threatening eating disorder patients and their families fear any recommendation that does not conform to our culture’s thin ideal.

Dr. Ornstein: The most common conversations I have had with patients and their families about eating disorder treatment have usually surrounded the appropriate level of care for the patient’s medical and/or psychiatric presentation, at the time. As a medical provider, I have also had in-depth conversations about the medical complications of eating disorders and the long term, irreversible impact of these complications. I have also had to have conversations with families about the genetic predisposition for eating disorders while also allaying the guilt and the blame they may be putting on themselves.

Veritas Collaborative: What are some best practices that providers across disciplines can lean on when discussing treatment with patients and supporters?

Dr. Levy: It is important that everyone is on the same page and presents a united front. The eating disorder will find any crack and try to broaden it as much as possible so that the focus is shifted off of the eating disorder and onto “inconsistencies.” I try to balance the autonomy of the patient with my knowledge about the need for treatment and try to hit the sweet spot between pushing too hard and not hard enough.

Veritas Collaborative: What can providers do to enhance the lines of communication with patients and supporters during treatment?

Leah: I believe that setting up regular meetings is important. Use this time to support them in their contribution to the treatment process and to work through any fears and concerns together, while also making time to celebrate the triumphs. There is tremendous power in accompanying someone through such a difficult time.

Veritas Collaborative: Can you share an experience you’ve had navigating these kinds of conversations with patients and supporters? Maybe a time where communication had an impact on patient outcomes?

Dr. Ornstein: I have had many families that waited a month or two to finally take the plunge and enter a higher level of care tell me that they wished they had listened to my advice initially, as they felt those early months were lost time.

Elisha: When patients have thought about leaving programming prematurely to return to work or school, it is important to discuss the implications of that choice and potential relapse. Though challenging, this conversation often helps patients reset their expectations and remain on the recommended course of treatment.

Veritas Collaborative: What is the one thing you hope attendees learn from this workshop?

Elisha: While there is not a one size fits all approach to having these difficult conversations, I hope that attendees can learn some different strategies, so they feel confident in having these conversations which are crucial to the work that we do.  I also hope to offer some new strategies they have not tried or thought of before.

Dr. Levy: That eating disorders are grueling—and as a result, they can be challenging to treat. Treatment is filled with difficult conversations but is what makes the work we do so rewarding. It is difficult, but absolutely not futile, and patients do get better.

Register today for Veritas Collaborative’s 9th Annual Virtual Symposium on Eating Disorders to tap into the collective knowledge of our community of experts and leaders in the field. You can connect with colleagues, advance your understanding of best practices, and earn up to 26.0 continuing education credits in the process.