Treating Body Image Concerns

Ahhh, body image! The concept that was completely befuddling for a few years of my career as a therapist. You see, there are so many ways that people have come up with to try to treat body image. There are body tracings, and using visual effects (somehow?!) to try to help those with eating disorders see themselves more reasonably. There are many other approaches, I am sure, but I don't search for them anymore.

I eventually realized, when it comes to body image, I truly have no idea how my clients see themselves, and they truly have no idea how I see them. So, discussing it has very little effect, in my experience. In my thesis, I used some body size scale by Stunkard and Stunkard (clearly, research was a big enough pain that i remember the names all these years later!), but would I ever use that with a client? No.

So then, what do I do when it comes to body image. I would say the main thing that changed my view of body image treatment was being told last minute that I needed to run a body image group at a treatment center I worked at many moons ago. When it's such an intimidating topic, it is NOT fun to hear last minute that it has just landed in your lap. My groups were fairly well known for being "no holds barred" and I sure didn't follow any script. So, as we sat outside, someone asked me something about body image. I don't even know what question I was asked. But, what came out of my mouth was something like, "The way I handle body image is to look in the mirror long enough to make sure I do not look like a freak. I know I won't always like how my body looks. But I tell myself, 'I have sh!t to do,' and I head off to work. Because working with eating disorders is way more important to me than what my body looks like." Now, when you work in a treatment center, or even individually with clients, you never know when what you say has an impact. I don't remember anyone really reacting to what I said in the moment, but over the next few years, I was told about how those words impacted members of the group, and changed their view of body image also.

I mean, we live in the US. Our society/media does not easily allow for positive body image. To try to get someone to love their body is truly fighting our culture. Is it  possible? Sure! Is it my goal? Actually, no. For some, that's setting the bar way too high. My goal is acceptance, a neutral view of their body, but more so, a focus on what is actually important in one's life. The sh!t they have to do.

But, the other piece that I realized along the way was that body image concerns are often an indicator that the person is upset about something else completely. So, I've come to talk about body image concerns as a "translation" of some other emotion. "I'm stressed out about a test at school," or "I'm mad at ___," or "____ hurt my feelings" becomes "I hate my body." And why would I brain do this translation for us? Because if you make it about your body, then theoretically you can do something about it. (Theoretically being the key word here.) If it's about your body, then you can engage in an ED behavior to "do something" about it. It also is a translator for when you don't want to feel. You don't want to feel emotional pain, so you focus instead on your innocent body, and you beat it up.

The body image focus is very "effective" in some ways. It's an incredible distraction from stuff you don't want to think about or feel. But, focusing on your body doesn't change the actual problem, so it becomes this persistent thing that you have to focus on all the time. And that feeds the eating disorder.

These thoughts have come from my own work in this field. I don't know that they are backed up by research, or commonly espoused, though they may be. This is just what I have pieced together through my own experience, and through time with clients, and each time I present the idea, it seems to fit for my clients. So, if it fits for you, use it! If other body image approaches work for you, also brilliant! But, please, stop targeting your innocent body.

I should add...another effective body image approach, in my experience, is becoming an advocate AGAINST our society and its focus on body and weight.