Contrary to what many people think, eating disorders are not really about the food.
As clinicians, when we treat people with eating disorders, we often fixate on the food. Those who aren’t eating enough are coached to eat more. Those who overeat are coached to eat less. And those who fit neither category are similarly led to correct the problematic behavior.
But does that alone really help?
I’ve struggled personally with an eating disorder and now professionally serve clients dealing with a wide range of struggles. These experiences have shown me that while there’s an impulse to go directly at eliminating the behavior, it just doesn’t work.
Eating disorders, like many other types of behavioral issues, are not the problem. They are a response to a deeper problem.
My personal experience in treatment has shaped my work as a therapist. It informs how I think about problems, clients, and healing. I understand how stubborn problems can be because I have experienced this battle myself.
Here are some lessons I’ve learned about therapy through my personal and professional work:
1. Getting help doesn’t mean you have to go all-in right away.
When I made the decision to go into treatment, it was not a big, dramatic moment. I didn’t hit rock bottom or get rushed to a hospital. Instead, I had graduated from college and got laid off from my job. My family had been encouraging me for a while to get help, with their worry and sense of helplessness rising every day. I didn’t necessarily want to get rid of my eating disorder, but I knew I wasn’t happy. Now that I had less distractions, my family and I decided that the time was right.
I wasn’t exactly jumping for joy. I was terrified by the prospect of gaining weight and making change. And in my experience, most people dealing with an eating disorder, addiction, or other mental health issue find themselves in a similar position. They might be ready for some kind of change, but they don’t exactly show up 100% enthusiastic for recovery, eager to do absolutely whatever it takes. For this reason, as a therapist, I know that it’s a journey and am willing to meet people where they are.
2. It’s important to treat people with trust, dignity, and respect.
Once in treatment, my dietitian instructed me to make huge changes to my diet and my body. And honestly, it felt overwhelming - it was like torture. It was a level of discomfort that I was not ready for. And I didn’t feel it was necessary, either. When I brought this up, to my surprise, my team listened. They worked with me to lower my caloric requirements, while still sticking to a long term goal. It made me feel heard and helped me trust my team.
Therapists often perceive clients who want to slow down as manipulative. Traditional treatment of eating disorders and addiction is calibrated around a presumption of mistrust. Many therapists tend towards being skeptical of the apprehensive feelings of their clients, assuming things like, “Maybe they are trying to trick me.”
However, the key to telling the truth is trust. When people feel like their clinical team is not listening to them, they may feel inclined to be evasive or lie.
This is why deep respect and collaboration with clients is incredibly important. In my work, my goal is to cut through fear with transparency and treat my clients with the trust and dignity that they deserve. I work hard to respect clients’ ideas and knowledge about the steps they want to take. I want to work side by side with them to get them where they want to be.
3. You can’t just take the problem out of the person.
It’s easy to view an eating disorder as something that takes over a person and forces them to act against their better judgement. But it’s not quite that simple.
Eating disorders are very good at co-opting the things we care about the most.
In my case, I am the kind of person who likes to keep things neat, tidy, and organized. I like control in my life. Anorexia co-opted my desire for control. It gave me a clear way to take control over my own body and gave me a result that I wanted.
My eating disorder even co-opted my desire to be different and convinced me that anorexia was the best way to do it.
No matter how much you made me eat, how much weight you made me gain, you weren’t going to remove that value from me that made me deal with food this way in the first place. Without addressing this entanglement, it’s likely that anorexia - or any other problematic behaviors - would pop up again.
In my treatment, my dietician focused on making sure that my body was becoming healthier. My therapist worked with me to become more aware of what was influencing my thoughts and behaviors. They helped shine a light on how to make choices that would allow me to be more intentional about what I was living for.
I’m not going to lie—it was tough. I had to give up things that I was pretty attached to. Giving up anorexia did mean that I had to give up the safety it offered. But I had a lot to gain as well. It also meant that I was inviting new and forgotten things into my life that mattered to me.
4. Getting help is risky. Treatment should take similar risks.
Going into treatment is taking a huge a risk. You are acknowledging that you have a problem. You are stepping down the path to major change and putting your trust in someone else, likely a stranger.
For this reason, clinicians must also be willing to experiment, take risks, and work out of the box in this same magnitude.
Therapists often worry that if they take their clients’ preferences into account, they will collude with the problem. This is no small risk.
However, with great risk comes great reward. If you operate on a strong foundation of mutual trust, the client will be far more likely to own up to their mistakes and, most importantly, own their recovery. A recovery on a client’s own terms is much more likely to last. Together, we learn and move forward.
As a clinician, I don’t see it as my role to fix people. I’m not just here to diagnose a problem and apply a blanket solution for that problem. I’m not interested in prescribing simple solutions or one version of recovery.
Instead, I want to listen and work with my clients to find out what exactly it is they want in life and help them get there. I see myself as a guide, as someone who helps people build a life that they want to live.
Gali Barak is Clinical Director at Evo Health and Wellness, a mental health program in Venice, California, that respects where you are and where you want to go. Among its services, Evo serves clients dealing with problematic relationships to food. Find out more about Evo’s program.