Being Judgmental Never Belongs in any Eating Disorder Therapeutic Relationship

In successful eating disorder treatment, a non-judgmental approach is the foundation of therapy. The person seeking help needs to see from the start that the relationship is based on mutual respect, building trust and an immediate sense of being on equal footing.

If the there is even a hint of judgment at the beginning of treatment, then it behooves the person to look elsewhere.

People with eating disorders feel very alone, seek solace primarily, if not solely, from their eating disorder and have come to believe that other people need their help and support but that they need to figure life out themselves.

If there is even an inkling that the therapist will be needy in the relationship, that is also an immediate red flag.

Therapists can show they aren’t judgmental not just through words but through action.

The food journal is an incredibly personal and exposing step for anyone with an eating disorder to take, in all likelihood more vulnerable than any other step in therapy. If the therapist approaches the journal as a collaborative exercise to help learn about both the person and their eating disorder without judgment, the journal becomes not only informative but also a step towards trust.

Therapists also need to take in new and important details of the person’s life and eating disorder with care, concern and compassion. People seeking help are used to clinicians overreacting. Therapists often jump to a safety contract or need for higher level of care when the they feel overwhelmed or scared. It’s a big step towards trust for a therapist to attempt to work together rather than react immediately out of fear.

Third, respect for the person’s autonomy, individuality and judgment builds bridges to trust. Clinicians too often conflate an eating disorder with a lack of reason and functionality as an adult. Much to the contrary, people with eating disorders often have a very astute understanding of the people around them and an acute ability to perceive nonverbal communication. The eating disorder serves as protection from people but not a sign of poor decision making.

Establishing a relationship without judgment leaves room in therapy to explore one underlying experience in most people with eating disorders: shame. Judgment reinforces shame and also hides it from view. No one will allow this painful feeling to emerge in a relationship devoid of trust.

Shame represents the deeper repudiation of oneself and the ultimate fear of being true and real in any relationship. Shame confirms the feeling of not being good enough, not having value, not being lovable. The deepest shame can be hidden under an eating disorder but still erodes any sense of hope and a future.

If judgment pervades a therapeutic relationship from the start, shame forms the bedrock of that relationship and practically eliminates any chance at getting better.

For anyone seeking help for an eating disorder, the first and most important experience to avoid in therapy is feeling judged. I beseech people seeking therapy to pay attention to feeling judged and instead feel able to look for a new therapist who can create an environment moving towards recovery.