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You've been there. Sitting across from a client who intellectually understands their eating disorder is harmful, who wants a better life, and yet they keep returning to the same destructive patterns. The restriction continues. The binging persists. The compulsive exercise resumes.
As therapists, we can find ourselves feeling frustrated, even helpless. We've tried cognitive restructuring, meal planning, motivational interviewing, behavioural interventions. We start to wonder: Are they just not ready? Are we missing something critical?
In Focal Psychodynamic Therapy (FPT), we understand eating disorders as more than disordered behaviours - they're symbolic of a deeper pain. Your client's symptoms aren't just happening to them; they're actively communicating complex emotional states, unmet needs, and internal conflicts that may be too dangerous or overwhelming to express directly.
When your client restricts food, they might be saying: "I need control over something in my chaotic world."
When they binge, the message might be: "I'm emotionally empty and desperately need filling."
When they purge, they could be communicating: "I need to expel these toxic feelings from my body."
Each behaviour serves as both protection and communication - a creative solution to an emotional problem, even when it creates more problems than it solves.
Understanding eating disorders as symbolic language explains why traditional behavioural interventions often fail to create lasting change. We're essentially asking clients to abandon their primary method of communication without first understanding what they're trying to say.
Our clients are often temporarily able to follow meal plans, resist destructive behaviors, and might even feel good about making these changes. But often the initial relief of "doing recovery right" quickly gives way to the return of underlying loneliness, distress, trauma, or profound emptiness. The eating disorder behaviours may have paused, but the emotional drivers remain untouched and unaddressed.
Without their familiar coping mechanism, clients find themselves face-to-face with the very feelings the eating disorder was helping them manage. The anxiety feels unbearable. The emptiness feels bottomless. The sense of powerlessness feels overwhelming. Naturally, they return to what they know works - even if it's harmful.
This is why we can't just treat the eating disorder; we have to target what's driving it. Often, clients aren't even consciously aware of these underlying drivers. They know they feel bad when they don't engage in ED behaviours, but they can't articulate why. This is where symbolic exploration becomes invaluable - it helps us decode what the client might be unconsciously trying to express through symptoms.
Rather than pathologising symptoms, frame them as meaningful communication: "I've been thinking about how your body might be trying to tell us something important through these symptoms. What if your eating disorder is your unconscious way of expressing feelings that are hard to put into words?"
Ask questions that invite symbolic thinking:
Help clients see how their solutions create new problems:
Link behaviours to underlying emotional experiences:
Restriction often symbolises:
Binging might represent:
Purging could communicate:
Compulsive exercise may express:
Symbolic exploration is effective because it:
When clients can't let go of eating disorder behaviours, it's rarely about lack of motivation or insight. More often, it's because the symptom is still serving a vital psychological function. By learning to speak the symbolic language of eating disorders, we can help clients find healthier ways to express their deepest needs and conflicts.
The symptoms hold wisdom. Our job isn't to eliminate them, but to understand what they're trying to communicate - and help our clients find new ways to express those same truths.
Ready to explore symbolism with your eating disorder clients? Download our free resources on symbolic exploration techniques and start seeing symptoms as the meaningful communication they truly are.
Free resources:
Your Clients Symptoms Are Speaking. Learn the Language (focuses on restrictive eating disorders)
What Your ED Clients Are Actually Trying To Tell You (And How To Respond) (focuses on other ED behaviours)
For comprehensive training:
Focal Psychodynamic Therapy for Anorexia Nervosa
We do not offer a one size fits all but instead see each client as a whole person requiring an individualised approach.
View our servicesOur psychologists and dietitian are skilled in the areas of neurodivergence, eating disorders, & complex trauma.
Meet the teamOur approach is neurodiversity affirming, trauma-informed, weight neutral, and intersectional.
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