Over the years, I have noticed something in the eating disorder field that I have become increasingly curious about. I am not sure whether it exists to the same extent in other areas of mental health, but I sometimes notice that we can begin to think primarily in terms of treatment interventions.

For example, if Family-Based Treatment (FBT) has not led to the desired outcome, we might think, “Perhaps we should move to CBT-E.” Or for an adolescent, we might feel that we should only be using FBT. If CBT-E does not seem like the right fit, perhaps SSCM is the answer.

Please don’t get me wrong, I am a strong advocate for evidence-based treatments. Treatment models provide invaluable guidance, and I often encourage clinicians to develop real depth in one or two approaches rather than collecting lots of techniques. The question is not whether we should use evidence-based interventions. The question is how we decide which intervention to use, and for whom.

At the same time, I wonder whether we can sometimes become so focused on finding the “right” intervention that we lose sight of the bigger picture and the person sitting in front of us.

Treatment models are designed to guide our work, not define the person. This is where formulation becomes so valuable. It helps us understand not only what someone is struggling with, but why, what is keeping it going, and where change might best begin.

Instead of asking, “That treatment didn’t work, which one should we try now?” perhaps we could also ask:

  • What wasn’t helpful about the previous approach?
  • What does this person need at this point in their recovery?
  • How might our formulation guide where we go next?

I also wonder whether our focus on interventions reflects something very human in us as clinicians. Most of us know the feeling of hoping that the next training, the next modality or the next technique will be the missing piece. I have certainly had those moments.

But over time, I have come to think that just as we encourage our clients to develop a different relationship with difficult emotions, perhaps we as clinicians also need to develop a different relationship with uncertainty. Therapy can be messy. Progress is not linear. We w will not always have the answers, and that does not mean we are doing it wrong.

At the end of the day, no treatment model creates change on its own. Change comes through the courageous work our clients do, supported by a therapeutic relationship that feels safe enough to explore, challenge, practise and grow. Our interventions matter enormously, but so does how well they are matched to the individual, their current needs, and the therapeutic relationship in which they are delivered.

If this resonates with you, I hope it offers a little reassurance. Rather than feeling pressure to find the perfect intervention, perhaps we can give ourselves permission to zoom out, return to our formulation, and reconnect with the whole person in front of us.

Perhaps the work is not about finding the missing piece at all. Perhaps it is about learning to see the whole picture, bringing together evidence-based interventions, thoughtful formulation, and genuine curiosity about the person sitting in front of us.