Written by: Lee Thomas

Time to read: 10 minutes

Note: This blog post contains descriptions of disordered eating behaviours. A content warning is listed prior to that section.

When it comes to eating disorders, there is no shortage of fighting imagery. Beat it, conquer it, destroy it, defeat it. And before you read another word here, I first want to say: if those approaches work for you, or your loved one, or your client? Then keep doing them. I’m not trying to take this from you. 

But for a lot of people, this approach isn’t working.

We know that many people never get treatment. And for those who do, they often don’t complete treatment. And even for those who do, there is a high rate of “relapse.” There’s no universally agreed-upon definition of recovery or relapse, so articles vary wildly in the numbers they quote, but everyone seems to agree that eating disorders are often a long-term struggle.

So, clearly, something isn’t working here. But why?

Maybe it’s because the eating disorder isn’t actually evil.

Enter IFS, stage left. Internal Family Systems therapy, or IFS, is based on the concept of multiplicity — that your mind isn’t all one thing, even though that’s what you’ve probably been taught most of your life. Instead, your mind is made up of a bunch of different subpersonalities, or “parts.” Sort of like the movie Inside Out, but for real. In IFS we divide these parts into 3 categories:

Exiles are generally young parts of us that hold a lot of big emotions, especially pain. This might be the part of us that says “I feel worthless”. 

Managers are the proactive parts of us that try to prevent this exiled pain from overwhelming us. This might be the part of us that says “I have to do everything perfectly, otherwise I’ll feel worthless.”

Firefighters are the reactive parts of us that leap into action when the exiled pain is overwhelming us. This might be the part of us that says “I can’t handle feeling this way! I have to make it stop!” And will do whatever it takes to rescue us in that moment.

[Content warning: disordered behaviours. Skip this italicized section if you’d like to avoid]

In real life, this might look something like this: I might have an exile that believes that my body is bad and wrong, and feels a ton of shame whenever anything body-related comes up. In order to prevent this shame from flooding me, I might have a manager that says “if you just lose weight, then you won’t need to feel that shame.” And maybe it works, for a moment…

…But then, maybe I am rejected by a potential romantic partner, and I assume (rightly or wrongly) that it’s because of my body. The exile comes screaming out and starts to flood me with feelings of shame. It’s like an emotional fire that’s burning me up inside. It feels intolerable. So then a firefighter comes in to rescue me from this fire, and I scramble to the cupboard to eat anything I can get my hands on, whatever it takes to numb this horrible feeling. And maybe it works, for a moment…

…But then the manager voice comes back online and is horrified and critical: “I can’t believe you ate all of that! You’re disgusting! You’re a failure! No wonder nobody likes you!” This makes my exile start to feel shame again, and a firefighter comes back in to put out this new fire: get rid of the food. And maybe it works, for a moment…

…But then the manager criticizes me for throwing up and pledges that tomorrow we won’t let ourselves eat so much, because that’ll make up for today being such a disaster. And on, and on, and on.

So as you can see, the parts are trying desperately to help keep things stable in their own way — even though the ways in which they’re trying to help aren’t, in fact, helpful. Like many elements of disordered eating, it’s like being stranded in the middle of the ocean on a raft and drinking salt water to try to quench your thirst, even though it ultimately makes you more dehydrated. It’s an act of desperation that, despite being unhelpful in the long term, is entirely understandable given the circumstances. And, despite being entirely understandable given the circumstances, is also not helpful long term. Just because it hurts doesn’t mean it’s malicious, and just because it’s not malicious doesn’t mean it doesn’t hurt. 

There’s another element at play as well, something that’s not exactly a part — your Self. One of the things that I like about IFS is also one of the things that I have struggled with the most about it, which is that it is unabashedly spiritual. IFS believes that everyone has a Self, which is sort of like a soul, or a core You.

This Self is like a compassionate, curious, loving parent figure. It knows that your parts are trying so hard to help you, that they actually kind of hate the job that they’re doing right now, and that they’re only doing it because they feel like they have to. We say there are No Bad Parts because the parts aren’t evil or malicious. They’re just extremely misguided. They are so good in their hearts, they are trying so hard to help, but they have very hard, and sometimes very harmful, jobs.

In our italicized example above, the exile part is holding onto so much pain related to shaming experiences around my body. The manager part wants to help prevent this pain, so they criticize me harshly before anyone else gets a chance to, even though they know it’s hurtful. The firefighter part doesn’t want to see me incapacitated by pain, so they try to help using the only tools available to them, even though this job earns them nothing but criticism from all the other parts (not to mention everyone else in my life). These parts are so profoundly dedicated to helping me, even at the expense of their own wellbeing. So then when outsiders like therapists and family members label these parts as “monsters” and “enemies,” no wonder they push back. 

So if we’re not fighting them, what do we do instead?

It’s not easy, but it is simple. We love them. 

If you rolled your eyes here, I feel you. There’s a part of me that genuinely can’t believe the type of therapist I am now. I can hear my younger self saying incredulously, “A key component to healing from an eating disorder is love? Grow up.” But unfortunately, it is true. I sometimes joke that I became an IFS therapist because at my heart I’m actually an ACT therapist — it’s all about workability for me, and this loving approach works.**

At its heart, IFS is about building community. Imagine if you felt like you belonged, and were safe, and unconditionally cared for. Imagine the sort of healing you could do if you felt like you were deeply loved no matter what. Imagine if someone saw the good in you even when you yourself can’t see it. That’s the power of community. IFS helps you to create that world internally, which can help you create it externally, too.

So what does that look like in real life?***

I might have an exile that feels a huge amount of shame about my body. I might work with this exile in therapy to help it to release the beliefs that burden it. I might help it get un-stuck from the past. I might let this exile know that I’m delighted by it, and that not only am I able to take care of them, but in fact I would be thrilled to take care of them.

I might have a manager that says “if you just lose weight, then you won’t need to feel that shame.” And I might sit with that manager and say “It makes so much sense to me that you feel that way. Thank you so much for trying to protect me.” I might help that manager to understand that I’m not a little kid any more, that they don’t need to take care of me. I might let this manager see that I care about my future and that they don’t need to be harsh in order for us all to be safe.

If my exile gets triggered and my firefighter comes in to rescue me, I might say “Wow. You are working so hard. Thank you so much. I’ve got it from here. I love that exile part, and its distress isn’t too much for me to handle.” I might let the firefighter see that I’m still engaging in pleasurable activities even when things aren’t on fire. I might tell them how much I appreciate all the things they’ve done to try to protect me over the years.

I do want to reiterate that being compassionate doesn’t mean that we’re enabling these parts. Loving a child doesn’t mean that we let them drive the car. But it does mean that we respond to them with compassion and kindness rather than with cruelty and punishment. We’re not fighting them because they’re not our enemy. We appreciate how hard they’re trying to help, and we recognize that they’ve been trying to help us for a long, long time. As Sam Dylan Finch wrote in this excellent blog post, “To relate to my ED as something I have to ‘fight’ or ‘beat’ is a betrayal of all the younger versions of me that conspired to protect my life and my future. I wouldn’t be here without them.”

Our parts love us deeply, and it’s about time we love them back.

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If you’re interested in working with an IFS therapist, I recommend using the IFS directory or searching out someone who has received a minimum of Level 1 training from the IFS Institute. As of the time of writing this article I am not currently accepting new clients for individual therapy, but you’re always welcome to check my availability here to see if that’s changed. I do have spots available for clinical consultation. 

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* For the record, I think that the blog post on externalization that I pulled this quote from was very thoughtful and well-done, so I don’t mean for this to be perceived as a criticism of the blog post itself

** IFS is not a new therapy, but it is having a very hot moment right now, so lots of people are hearing about it. In some ways, I love this — I think IFS is great, and I have personally and professionally experienced how powerful it can be. But I feel like it’d be remiss not to note that so many therapies have had this same arc. Therapeutic modalities can be trendy just like anything else. So do I think IFS is amazing and a therapeutic modality well worth considering? 100%. But do I think it’s a perfect panacea and the only possible route to healing? Absolutely not.

*** If these examples sound trite or corny, I get that. Taking this stuff out of the individual therapeutic context has that effect, but I felt like I should include some examples anyway. Please trust me when I say that if you do this work with your own parts, the compassionate statements you come up with will not feel corny at all.

Author: Raquel, adapted from TransCare+

Last year, Raquel and Lee contributed to the “Queerly” project in collaboration with TransCare+. We wanted to share this very cool resource with you and summarize our specific contributions:

Queerly Volume 1 is an anthology exploring the intersections of queer identity, community, and ecology through the themes of “Grow,” “Eat,” and “Live.” Developed by queer and gender-diverse voices across Canada, the book combines storytelling, art, activities, and poetry to celebrate the resilience and creativity of 2SLGBTQIA+ communities. With contributions ranging from tattoo art and gardening guides to reflections on communal care and food as resistance, the collection fosters a sense of belonging and encourages readers to engage with nature and their surroundings in radical, affirming ways.

(if you’re having difficulty accessing the resource, email us thealeocollective@gmail.com and we’ll email you a PDF version!)

“Eat”, the section that begins on page 55, is the section Raquel and Lee contributed to:

Page 60: “Queering food and eating” audio recorded conversation
This conversation between Lee Thomas and Raquel Griffin explores the intersections of queerness, food, and eating practices, focusing on how queering food systems can foster inclusivity, and challenge societal norms. The dialogue emphasizes the cultural, political, and personal dimensions of food as a site of resistance and identity. 

Page 61: Visual ecosystem map (by Lee Thomas)
Walks you through creating your own visual ecosystem map of your relationship with food/eating

Page 64: What do you really want to eat? (By Raquel)
Using Intuitive Eating principles, Raquel walks you through a mindful eating experience, exploring the sensory aspects of food to assist you in exploring the question “What do you really want to eat”? Available through multiple mediums: a guided audio practice, transcript from the audio practice, or through provided journal prompts.

Written by: Lee Thomas

Time to read: 8 minutes

Note: Many Aleo blog posts are meant to be read by clients who are struggling with disordered eating or body image concerns. This one, though, is specifically for clinicians. (But of course anyone is welcome to read it!)

In my therapy practice, many people I work with have sought me out specifically because of my eating disorder specialization, which is probably not super surprising. Want therapy for an eating disorder, see an eating disorder therapist.

But a lot of clients I’ve worked with over the years didn’t come in initially for eating disorder therapy. They came in for other concerns — alcohol use, relationship problems, childhood trauma, work stress, ADHD management, you name it — and then in our work together we discovered that they have a disordered relationship with food. My secret strategy for uncovering this? I ask.

“What is your relationship with food?” is a pretty standard question for me to ask within the first session or two. If the client answers in a way that suggests a disordered relationship with food, usually my followup question is “have you ever talked about this with a therapist before?” What I’ve found surprising is that the answer is almost always no… even when it’s a client who had already been in therapy for many years.

Now, to be clear, this isn’t meant to be a shaming “gotcha!” to you or any other clinician. Clinicians are fallible, myself included. We all bring our own lenses into this work — and we don’t tend to find what we’re not looking for.

“I don’t work with eating disorders” is a common thing for me to hear therapists say. But this creates a vicious cycle where clinicians believe they don’t work with clients with eating disorders, and so don’t ask their clients questions about eating disorders, and so they don’t hear about their clients’ eating disorders, and so they continue to believe that they don’t work with clients with eating disorders.

And obviously nobody is required to change their practice in any way just because I wrote a blog post. But what I’m hoping to do here is to help clinicians recognize that 1) yes, you can work with clients with eating disorders, and 2) you don’t have to do it alone. 

To start with, let’s name some concerns that you, as a clinician, might have about working with clients with eating disorders.

“I need to work through my own food stuff first!”

You might have your own disordered relationship with eating and not feel like you’re in a place where they can effectively work with others around this topic. Even though you’re a clinician, you are a person first, and it’s absolutely okay to be selective about your work in order to keep yourself well. That being said, I don’t think your own disordered relationship with food inherently precludes you from being a good therapist to others. My own early work in the mental health field was as a “person with lived experience” (as we called it back then), and there’s lots of good work by Dr. Jennie Wang-Hall on this topic as well. Having support through something like a clinical consultation group can help you to explore things like countertransference to help ensure you’re taking care of both yourself and your clients.

“Clients with eating disorders don’t want to change.”

There’s still, unfortunately, a lot of stigma around people with eating disorders. Clients with eating disorders are still sometimes portrayed as manipulative, untrustworthy, unmotivated, and resistant. Can they be those things? Sure. They are human beings. We are all capable of being those things, sometimes. But a lot of this stigma is based on carceral beliefs about mental health care provision, and it’s not true. 

In defence of most clinicians, in my experience the percentage of clinicians who don’t work with clients with eating disorders because of overt stigma is actually pretty low. (Or maybe that’s the circles I run in, because the research definitely reflects that stigma is still very much present.)  But none of us are infallible, and it can be easy to slip into stigmatizing beliefs if you’re not surrounded by a community of clinicians who can support you when you’re feeling discouraged, and lovingly hold you accountable when you start to veer off course.

“There’s too many liability concerns.”

I’ve been in a lot of clinician consultation groups, and a common thread that I hear is that we as clinicians are terrified of getting in trouble, whether that’s with our college or with the legal system. In a lot of ways this can be a good thing — we have a lot of power in the therapeutic relationship, and having the college as an institution to protect the public helps to ensure that health care professionals are behaving ethically. However, I do think that sometimes the fear of getting in trouble becomes a sort of boogeyman that causes clinicians to be more risk averse than is necessary, even when it’s to the client’s detriment. We’re so afraid of doing the wrong thing so we end up doing nothing! And eating disorders can exacerbate this risk aversion because of the physical health concerns involved. Part of the benefit of a consultation group is that you can explore your concerns with other professionals, who can help you to figure out which risks feel worthwhile.

“It’s outside of my scope.”

I think there’s a both/and to be had here. On the one hand, it’s really important to practice within our scope and training. Like, I don’t have any EMDR training, so it would be wildly unethical if I were to just start doing EMDR (especially if my only motivation was that some random person wrote a blog post telling me that I should). But on the other hand, I think it’s also important to acknowledge that part of how we expand our scope is by pushing into new areas where we are not yet an expert.

I think this is especially true for clients where you already have an established relationship. Research consistently shows that the biggest predictor of positive therapeutic outcomes is the relationship between the client and the clinician. You might not be an eating disorder expert, but you might be a Therapeutic Alliance With This Specific Client expert, and that’s a really, really important element to consider.  If you’re considering expanding your scope in order to support an existing client, consultation (whether individual or group) is definitely something you’ll want to pursue to help you increase your clinical skills and steer clear of potential pitfalls.

“I only work with trauma (or anxiety, or substance use, or…)”

This is a variation of the “scope” concern, I think. And, again, if you really want to stay in your specific wheelhouse, nobody is stopping you. But there’s a ton of comorbidity with eating disorders and other conditions. If you’re working with trauma, or anxiety, or substance use, or almost any other area, you are almost certainly also working with clients with eating disorders. And that’s even before we consider the subthreshold eating disorders, aka disordered eating. Food is one of the basic building blocks of the human experience — it’s going to influence, and be influenced by, other conditions in a client’s life. If someone has experienced trauma we aren’t shocked when it impacts their relationship with romantic partners, friends, work, or many other elements of their life. We should expect that it would impact their relationship with food, too.

So all of this to say: the reality is that you’re already working with clients with eating disorders. The choice you have now is what you want to do with this information.

If you’re open to suggestions, I think the Confident and Competent Clinician Consultation Group could be a good place to start.

As a clinician in a private practice, I’ve made a point of investing in consultation throughout my career, and I truly can’t overstate the impact that it’s had on my practice. A consultation group is a soft place to land when you’re feeling discouraged, and it’s a reality check when you’re way off track. It’s a place to learn strategies and phrases that your colleagues find helpful with their clients. It’s a source of reassurance and guidance. And, as a bonus, it’s often counted as continuing education credits. 

Courtenay Vickers is a registered dietitian and member of the Aleo Collective. She and I decided to start this group because we’ve both found consultation to be unbelievably valuable to ourselves, our practices, and our clients — and we want to share it with you!

Registration for our group closes January 31, 2025. We would love for you to join us!