When Therapy Meets Hunger: Why We Must Talk About Eating Disorders in the Counselling Room - by Becky Stone
- fe9chr
- May 1
- 4 min read
Below I showcase the work of my colleague Becky Stone who can be reached via https://www.counsellorwhocares.co.uk/. If you are someone who struggles with eating and body image or a professional who is seeking supervision with someone knowledgeable in this area, why don't you get in touch with Becky - she is an experienced and welcoming practitioner who will support you along the way!
Becky writes:
“Have you eaten today?”
It might seem like a simple question. But for some of our clients, it’s one of the most important and overlooked ones we can ask.
As a therapist who specialises in eating disorders, I’ve come to see just how often these struggles are missed, misunderstood, or misinterpreted, even by well-meaning professionals. Clients present with depression, anxiety, OCD, burnout, low self-esteem… and beneath the surface, there’s often an unspoken relationship with food and body image that has gone undetected for years.
Eating disorders aren’t always what you expect.
Many people think eating disorders only show up as extreme weight loss or a visible frailty. But the reality is far more complex. Binge eating is one of the most common and underdiagnosed eating disorders, and often affects people living in larger bodies. It can present as emotional eating, secretive behaviours, or cycles of shame and guilt that leave a person feeling stuck and exhausted.
When clients arrive in the room, tired, overwhelmed, and struggling to concentrate, there’s huge therapeutic value in gently asking:
When was the last time you ate?
How do you usually eat during the day?
How does food feel for you: safe, stressful, or forgotten?
These are not invasive questions. They’re clinical indicators. Because skipping breakfast, bingeing at night, or eating in a way that disconnects from hunger cues can significantly impact emotional regulation, mood, and therapeutic engagement.
Eating disorders as survival strategies
What’s often missed in therapy training is this: eating disorders are not about attention-seeking. They’re about survival. For many people, disordered eating is a way to:
➔ Numb pain
➔ Switch off difficult emotions
➔ Find control in chaos
➔ Build protective walls (especially after trauma)
For some, a larger body becomes a form of protection, particularly after unwanted sexual attention or complex trauma. For others, extreme control over food may offer a false sense of safety when everything else feels out of reach.
We need to get curious, not judgmental, about these behaviours.
The ethical dilemmas we face as therapists
It’s natural to want to help. But when eating disorders show up in the room, many therapists experience fear, doubt, and ethical uncertainty.
Here’s the line we often walk:
Am I supporting autonomy? Or colluding with harm?
Should I refer to? Or am I abandoning a client who finally trusts me?
What if they’re medically unwell and I miss it?
How do I know when I’m out of my depth?
And here’s the truth: your client might lie to you. Not because they don’t trust you, but because the eating disorder voice is louder. It tells them to hide, to minimise, to stay in control.
That’s why supervision is so necessary.
Supervision: a space without shame
I believe supervision should be a place of non-judgmental reflection, where therapists feel safe enough to say:
“I think I’m out of my depth.”
“I feel unsure of what to say.”
“I’m scared I’ll get it wrong.”
That doesn’t make you a bad therapist. It makes you a brave one.
If you’re holding space for a client with an eating disorder, even if it’s not your specialism, you’re doing powerful work. But you also need to check:
Are their medical needs being met?
Have they had recent blood tests, an ECG, or a GP review?
Is a multidisciplinary approach in place?
Do you need a second opinion, a one-off supervision, or to refer on for specialist care?
And are you, deep down, avoiding the conversation because you don’t feel trained enough?
I’ve been there too.
My learning journey: from fear to confidence
Years ago, I found myself working with four clients with severe anorexia at the same time. I hadn’t sought them out, but somehow they had seen me. And I was terrified. I cared deeply, but I didn’t have the tools.
Luckily, they were able to access eating disorder services, and I worked alongside them. But it was a wake-up call. I realised that if I was going to support people properly, I needed to train.
So I invested in high-quality eating disorder training and surrounded myself with supervisors and peers who could support me as I grew.
If you’re reading this and feel the same, please don’t panic. You’re not alone. And it’s okay to ask for help.
An invitation to deepen your skills
If you’re a therapist and you’d like to understand more about eating disorders, or you’ve found yourself working with a client and you’re unsure how to navigate the next step, I’d love to support you.
You can book a one-off ad hoc supervision session with me to discuss your client case or regular supervision using the booking link linkhttps://counsellorwhocares.selectandbook.com/, explore ethical options, and build confidence in this area.
Recovery is messy, and that’s okay
We need to talk more openly in our profession about the messiness of recovery. It’s not linear. It’s not clean. And it doesn’t always look like progress from the outside.
But when we, as therapists, hold space without shame… when we ask those small, brave questions… when we challenge our own fear gently but firmly…
That’s when real healing begins.
About the Author
Becky Stone is a qualified eating disorder therapist, supervisor, and neurodivergent practitioner. She specialises in trauma-informed support for adults and teens, particularly those with ADHD, binge eating, and body image struggles. Becky offers supervision, online therapy, and training for therapists who want to feel more confident supporting clients with disordered eating.
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