Case Study


Case Study

It’s Not about the Diet: Building a healthy relationship with food

September/October 2015


Most therapists have been taught that if we can help clients understand the emotional triggers of their overeating, they’ll be able to control their behavior and lose weight. Some of us, when working with clients on the continuum from occasional overeating to binge-eating disorder, build strategies around nutrition, portion control, and exercise habits. But more often than not, weight loss—should it occur—is fleeting. In fact, the pursuit of weight loss typically triggers and sustains overeating.

My focus with clients who have overeating and weight concerns is to help them learn how to have a healthy relationship with food. Typically, these clients have internalized the cultural message that their bodies are “wrong,” and that shame is reinforced when the dieting solution they’ve pursued, which usually works initially, almost always fails. We therapists need to recognize that when we reinforce the notion of weight loss as a marker of success, we set our clients up to leave therapy with even more shame about one more failure.

When Joelle called me to set up an appointment, I could hear the cycle of shame in her voice. “I’ve got to get my eating under control,” she told me. “I’m a middle-school librarian, and in the summers, when I’m not working, I’m really good at sticking to my diet. But as soon as I go back to school in September, everything falls apart.”

A few days later, Joelle walked into my office. She had long hair and was dressed casually, in a…

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