Therapeutic Tango: Recognizing Signs of Mismatch in Eating Disorder Therapy

Understanding and Overcoming Misalignment in Your Therapeutic Relationship with Your Therapist

Dec 15, 2023

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“You look amazing Zeynep!” says my therapist as soon as I enter the room.

Her comment brings a smile to my face because as I had been working hard to look good since I last saw her (6 days ago): I had been on a strict diet consisting of 2 meals a day, and was allowed to eat low-fat protein only. And I had dropped weight quite quickly.

“I feel good actually” I said, to which she answered without hesitation “Yeah, I really can see it!”.

Having someone recognize the transformation (I’m sure you could see drastic changes on my body with the water weight I lost) made me feel proud. Sadly, it validated all the hardship I put my body through the last few days.

The session had a very uplifting vibe because I felt like I was on fire. I was feeling lighter and motivated, almost ecstatic. After 4 years of struggling, I thought “ This is it. I broke free from my eating disorder; this is the time I finally lose weight and go back to being the happy girl I used to be ”.

This only lasted until my next binge, which was definitely triggered by the next “effective and realistic” diet that I came up with.

Reflecting on this experience from my perspective as a therapist now, I see that I was under the spell of the Eating Disorder Voice. This is what we refer to as Overcontroller mode in Schema Therapy (see my blog post below “Schema Modes in Eating Disorders”).

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Schema Modes in Eating Disorders

Zeynep·January 30, 2022Read full story](https://realisticbodytherapist.substack.com/p/schema-modes-in-eating-disorders)

Overcontroller is the side that offers restriction as the solution to feeling not good enough. Unfortunately, it is a very compelling mode as it offers you a solution, gets you out of that pit of pure despair. When this mode is active, you feel active, hopeful, as if you could achieve anything and everything. Only with one condition… You have to listen to its rules and do exactly as it says. The Overcontroller is a problem solver, tries to protect you from shame and humiliation by minimising all basic emotional needs (connection, acceptance, fun) and “fixing” the “problem” by concretizing it (Feeling inadequate: “ The problem must be your weight and it is a number we can monitor and control ” “ You need to lose weight and go on a diet to not feel adequate again ”).

If you are not working with Schema Therapy model and not familiar with how EDs work, making sense of the Overcontroller is quite complex. This is because this mode is highly skilled at mimicking the Healthy Adult mode. To my previous therapist, it probably seemed as though I was genuinely improving and making progress. This appearance was pumped up with the adrenaline of the Overcontroller and the high of the dopamine rush that came with detailed planning of diets and workout routines.

It's important to emphasise that my purpose in expressing this is not to blame my therapist or suggest that she wasn’t doing a good job, quite the opposite: I recognize the efficacy of the therapy in addressing my interpersonal difficulties at the time, even though it didn't effectively address my eating disorder. While I had moments of doubt about my therapist's methods truly addressing my specific needs, I now recognize that a significant part of the struggle stemmed from both the misattunement of her approach with my emotional needs and my own inclination to invalidate my progress , erroneously believing that something was inherently wrong with me. Reflecting on it, if I were in the therapist's position back then, I would openly acknowledge my limited understanding of the complexities of the eating disorder I was addressing and share my limitations in meeting those needs. To ensure the well-being of both parties, it might have been necessary to reassess the therapeutic relationship at that point.

Therapy is like a harmonious dance; it requires both sides to feel connected with each other. A therapist's personal style and their choice of therapy model should align with the needs of the client. It works best when the values of both parties match.

I went on for 1.5 more years with that therapist until we realised what we were doing wasn’t working. Not because she was a bad therapist or my situation was so critical that no one could help me, but because we simply were not a good fit. And that is totally okay!

Reflecting on my current perspective as a therapist, I encourage my clients to communicate when they feel our approach is ineffective or if we are not a good match. This way, we can explore alternative solutions together, such as having a feedback session, adjusting treatment goals or plans, or finding a new therapist who may be a better fit.

Subtle signs that you are not a good match with your therapist (aside from the typical indicators of boundary violations and feeling judged):

1 – You don’t feel a strong sense of connection.

I really liked my therapist. It was nice to have someone to chat with weekly and there were moments where I truly felt understood but this could have been with someone else too. I had formed this strange image of her in my head as an authority figure, not a person that I had a secure attachment with. When something happened during the week, I didn’t feel entirely safe to tell her about it, but I would have this anxious feeling in my stomach trying to guess how she would react.

2 – Your therapist's approach does not meet your needs or align with your values.

As a person, I often struggle with asking for what I need (because I feel like I am being rude to the other person), which makes it extra difficult to write this: I felt like she often missed the mark about what I needed or what I was upset about. And often I felt like I was being asked to do things that I wasn’t ready for. I felt powerless, small, scared and confused. For example, I wasn’t ready to leave my toxic relationship at the time but was asked to. We both knew it was the right thing to do, but I still felt like I had feelings for that person and she could not make sense of that (Well, I could not either, but a good question to explore would have been “Why was I attracted to that type of person?”).

3 - You feel that your eating disorder is enabled.

During the therapy process, your emotions and experiences are validated. The same goes with eating disorders too. As a therapist, I affirm the underlying reasons for my clients' development of an eating disorder , recognizing that it served as a survival mechanism in an emotionally unsafe environment. I acknowledge and understand the intentions of the Overcontroller mode - addressing clients' needs, such as fostering a sense of safety and recognition. However, it's essential to emphasise that endorsing eating disorder behaviours as a means to achieve these goals is never acceptable.

4 – You have communicated the first 3 points above and explained how you feel about the therapeutic relationship between the two of you, yet you feel like nothing has changed.

Therapy is a collaborative process, and open communication with your therapist about your concerns is important. You can discuss any issues you're experiencing and work together to find solutions. If, after addressing your concerns, the issues persist, it might be a sign that a change is necessary for your well-being.