How Therapists Promote Diet Culture: An interview with Rachel Coleman

How Therapists Promote Diet Culture: An interview with Rachel Coleman Curt and Katie speak with Rachel Coleman, LMFT, CEDS about what therapists should consider in working with clients who have eating disorders, the impact of society on body image, and how clinicians can increase their competency in an area many feel they are lacking. Why do so many clinicians feel under trained in treating eating disorders? How do societal views impact our client’s body image and what is the impact of diet culture? Does a lack of graduate education in eating disorders ethically impact our ability to treat eat disorders in a non-specialized practice? What’s missing from our understanding of eating disorders? All of this and more in the episode. Interview with Rachel Coleman, LMFT, CEDS

What do clinicians do when therapeutic interventions might trigger eating disorder behavior?

• Many interventions call for physical activity that might trigger eating disorder behavior or feelings in clients.
• If a client wants to participate in a physical activity intervention, consider their motivation.
• Ensure that a client has multiple tools in their anxiety toolbox.
• Be mindful if the modalities and treatment recommendations are based in fat phobia or weight stigma.

How can clinicians assess their clients for an eating disorder?

• Eating disorders can present meeting full DSM-V criteria or, in many cases, seem at the “subclinical” or mildly clinical level.
• Evaluate how your client feels about societal messaging and the impact it might have on them.
• In assessing clients, look to determine the impact of behaviors and patterns on daily functioning. If client’s are sacrificing other values to focus on weight or body, it should be discussed.

How can clinicians increase their education in treating eating disorders?

• Clinicians need to do their own work surrounding their bodies and internalized messaging.
• Therapists should focus on learning about the complexities of eating disorders and the social justice movements that surround weight stigma and fat phobia.
• Familiarize yourself with the ideas of body trust, body neutrality, and health at every size.
• Many treatment centers offer free webinars to educate clinicians in eating disorder treatment.

What are the ethical and legal considerations in treating eating disorders in a non-specialized private practice?

• Always get consultation.
• Some clients might present with “subclinical” or mildly clinical levels of an eating disorder.
• There is a difference between asking questions and treating the answers.
• Clinicians should encourage clients to see a medical doctor when necessary.
• Working with dieticians and medical doctors to create a holistic team, best serves the client.
• Clinicians should be aware when to refer to a higher level of care.
• Therapists should limit self-disclosures

How does Diet Culture impact our clients?

• Diet culture is a mindset and system of theories we all exist in, that credits a person’s shape and size as the primary indicators of health and moral superiority.
• When bodies don’t meet these “standards” of beauty as societally defined, they are often oppressed.
• Messaging about dieting and our bodies is inescapable in our society, so it’s easy for subconscious beliefs about food and bodies to infiltrate sessions.
• Therapists’ self-disclosures should be limited and focus on affirming client’s experience.