This feature by Leslie Karwoski Anderson, PhD is Part 2 of 2 in a series about DBT for eating disorders. In the first part, Leslie addresses her experience working with DBT as an eating disorder clinician and the first of five Eating Disorder skills she will discuss in this blog. In this second part, she will discuss the remaining four Eating Disorder skills, including Radical Acceptance, Validation, Effective Eating, and Non-judgmentalness.
Here in part two of this blog, I continue with some of the DBT for Eating Disorders skills that we teach our clients, and some thoughts about how we, as clinicians, might apply them in our own lives. In the last blog, we addressed Radical Genuineness. In this part two, we will cover Radical Acceptance, Validation, Effective Eating, and Non-judgmentalness.
Radical acceptance: We all know radical acceptance means accepting reality just as it is, including the parts we like and don’t like. This means we accept our bodies: their shape, their size, what they can do for us, and what their limitations might be. We also accept that the society we live in is often very critical of our bodies, and that much of that messaging comes from a capitalist system that profits from selling us products that promise to help us change our bodies. Radical acceptance can be one of the hardest DBT skills, and I think it can be so powerful to accept ourselves as we are rather than buying into the self-judgment that society is so quick to encourage.
Validation: how do you practice validation with ED clients? I used to unhesitatingly validate their wish to be thin. “Of course you want to be slim and attractive. We all do.” I think it could even be invalidating NOT to acknowledge how normative that is. More recently I have started questioning the way that I validate that wish. I don’t want to give the impression that I agree with the importance that society places on being attractive and thin. I was taught the same thing, but that doesn’t mean it’s true. It really feels like an important dialectic to balance personally — understanding fully how powerful and true these thoughts may feel while also remembering that they are not.
Effective Eating: DBT defines effective eating as eating a variety of foods from each food group (“All foods are good foods in moderation”), and eating according to hunger and fullness cues. I will add the disclaimer that many ED patients do not experience hunger and/or fullness cues because their disordered eating has changed how their body responds. However, the eventual goal is to eat when hungry and stop eating when full. This is in direct contrast to Diet Culture, which tells us to eat in a restrictive way regardless of whether we are hungry, and that (depending on the current diet trends), any food that is processed, or with fat, or sugar, or carbs is “bad.” We as ED therapists want our clients to be able to both enjoy some cookies or ice cream when they feel like having some and to avoid binging on the whole package because they don’t notice when they are satiated. And perhaps we can be much more effective advocates of this approach if we practice it ourselves.
Non-judgmentalness: I can’t think of any humans that don’t struggle with self-judgment and comparisons, and I think ED patients may struggle the most! Our ED patients have harsh judgments towards themselves: their shape, their size, their level of exercise, their grades, even their right to exist. They judge foods as “good” or “bad,” “healthy” or “unhealthy.” They judge others, especially by making comparisons that make them feel worse about themselves. As therapists, we have to be aware of our own judgmental language. It might be acceptable to tell a friend that you are struggling not to eat “junk food” and have been “lazy” about working out lately, but this is exactly the type of self-judgment that we want to help our ED clients to get away from. And maybe dropping this type of self-judgment would be just as helpful to ourselves as it is to our clients.
This blog is meant to be more “food for thought” than prescriptive. I know that it is possible to be an effective therapist while struggling with some of the same issues that your clients struggle with. We all navigate our personal journeys with our bodies and appearances differently. At the same time, it is important to be mindful of your own approach to these issues when treating clients with ED. As DBT therapists, we know the value of applying DBT skills in our own lives. The specific DBT for ED skills can be so impactful for us to employ in our own lives and model for our patients.
Leslie Karwoski Anderson, PhD, FAED, is an Associate Clinical Professor and the Training Director at the UC San Diego Eating Disorders Center for Treatment and Research. She trains nationally and internationally on DBT and DBT for Eating Disorders. Read her full bio here.