Medical Definition of body image: a subjective picture of one’s own physical appearance established both by self-observation and by noting the reactions of others (“Body Image.” Merriam-Webster.com. Merriam-Webster, n.d. Web. 19 Jan. 2017).
What if you are unknowingly colluding with your patient’s body shaming behaviors? In the definition, above, as therapists, the reactions we show our patients may add to, rather than relieve, body shame. This conundrum is what we face. All the helpful things we might suggest or encourage are usually reflexive. The question that needs careful consideration is: `Is the timing of the intervention helpful?’
Body image worries come out in all sorts of ways. From vague statements about getting healthy, taking better care of oneself, eating better, to obvious declarations about calorie limits, gym plans, , are all opportunities for identifying the pain that drives the statements.
For many clients without body shame, many of these statements are commitments, freely made and can be accepted as positive changes for improved health. But, when depression, anxiety, feelings of worthlessness are also present, further assessment is needed.
Supporting positive health behaviors is a big part of therapy and the evidence that eating in a well-balanced way, along with physical activity, has positive effects on anxiety and depression, but sometimes what is needed is other than what it seems.
How we support our clients who struggle with body image, emotional eating, eating disorders and chronic dieters needs a rethink.
It is so incredibly common in our culture to buy into the cultural norm of dieting and dissatisfaction with appearance that acknowledging the effects of this mindset on your client’s relationship with him or herself is often overlooked. Many therapists participate in diet talk, even when they know diets don’t work.
Dysfunction is often masked with good intentions.
If you engage in conversation, strategizing or goal setting around any of these three areas you might be participating in the illusion of helping. (Don’t worry I’ll give you some ideas about what to do instead).
Here are a few ways body shame is disguised as “getting healthy:”
1. Suggestions About Diets
Therapists, especially if you’re not actively practicing in the areas of eating disorders, emotional eating, body dissatisfaction, etc. may not realize that talking about what is the best diet is fueling the problem. This method communicates to clients that the problem is what they are doing with food. (While what they’re doing with food may need to change, it’s only after addressing the underlying emotional motivations in therapy that we can address behavioral change with staying power).
They haven’t found the right way to eat. There’s a subtle communication that they’re the problem and/or it is their lack of willpower that is keeping them stuck and unhappy. This stance can be construed as a “blame the victim” mentality. Ultimately, it’s very disempowering.
2. Asking About What, When, How Your Client Eats
While this information is good to have for assessment and treatment planning around strategies for habit change, if the goal of the conversation is to set a goal about the food, you’re missing the point. This approach shifts the focus on the food again rather than the feelings that lead to the problematic food behaviors. They want help with the pain from the feelings even if they do not know what drives their body shame, yet.
3. Talking About Exercise
Encouraging a health-focused active lifestyle is great. The problem is when people feel badly about their bodies, they talk about exercise solely for changing their physical appearance. The foundations are based on dysregulation and are usually anxiety or depression driven. When the exercise goal is missed or does not produce the desired result, it will usually lead to a rebound of more harmful self-loathing.
So, what are you to do?
The patient wants to connect with you in this way: I have feelings I don’t know how to identify, make sense of and manage, so instead I translate a general feeling of discomfort into a socially acceptable form of discomfort. I am ashamed of my body. I’m going to soothe myself with food – over or under eating or over or under exercising or in other ways, like pursuing cosmetic surgeries/bariatric surgery, etc., because changing my appearance might help me feel better.
What they want and need from you are these four things.
1.Listening to the pain they experience that doesn’t have anything to do with their body but is filtered through a lens of body shame, depression and anxiety. Body shame is their way of getting the pain outside of themselves to make it tangible. You can help them identify the feelings body shame is communicating.
2. After they have identified the feelings they’re experiencing, work together on what strategies they will use to process the feelings and manage them.
3. Motivate them to separate out their feelings from the body shame. It is easy to fall back into denying there is something more to disliking their bodies. Yet, the relief that comes with translating the physical focus of the pain into both a felt sense and language so they can conceptualize their experiences is where transformation takes place – bit by bit – one feeling at a time.
4. Lastly, support their goals regarding nutrition, physical activity and body contentment. There will be many opportunities to do this once the feeling identification and processing strategies are in place. The biggest challenge is to hold back and allow your clients to make their own decisions.
When they are in the driver’s seat, making the decisions about which way to go, they are more likely to integrate what works for them with curiosity about possibilities and with your help, they may just take the risk and work toward their goals with congruence.
Autonomy is one of the most valuable aspects of working with body shame. For clients suffering with body shame, it’s the place where they need to go to gain a more complete sense of self.