EDeology: The People Behind Today's Eating Disorder Treatment Landscape

Periodically, I hear someone describe a past therapist, a particular therapy modality, or a treatment center as “just in it for the money.”On the flip side, I’ve had many conversations with therapists and other mental health providers about how hard it is to hold fees, guilt for raising fees, strain strain related to enforcing cancellation policies, weak boundaries, and frustration with insurance policies that can make financial survival in this field difficult.Money is an unavoidable part of mental health care.My work brings me into regular contact with the depths of human suffering and the profound complexity of each person’s internal world. At times, I'm trusted with stories that haven't been told to another living soul. It is humbling. It's a gift. The fact that mental healthcare is both a deeply human relationship and a paid service is an uncomfortable reality. Which makes it a topic worthy of conversation.In this episode, Robyn Keivit shares her story as a female entrepreneur, business owner, registered dietitian, and nurse practitioner. We explore the tension between providing affordable care and supporting ourselves and our families, the relationship between money and self worth, and the personal narratives that shape how we engage with the business side of mental health care.Robyn Kievit is a nurse practitioner and registered dietitian with more than 25 years of clinical experience. She specializes in supporting women through perimenopause and menopause using hormone therapy, medical science, and psychopharmacology, with particular expertise in eating disorders, disordered eating, and body image concerns.Robyn is a sought-out speaker at professional conferences and events and has been featured in numerous national media outlets. More on Robyn: https://robynkievit.com/Robyn’s course, Integrating Hormone Therapy and Psychopharmacology in Eating Disorder Treatment During Perimenopause and Menopause: https://robynkievit.com/resources/course-for-dietitians-beyond-nutrition/ Roby's podcast, NPRD: https://open.spotify.com/show/05VKEcGOKE8ZefoaLIe4ol?si=jbhI9chKRhOlAPJdsMMe9g More on Elka: https://cubacubcounseling.com/

In this episode, I discuss why this podcast has no content rules and how I address information that might be triggering to the listener. I also do a deep dive into the question, can words cause harm?More on Elka: https://cubacubcounseling.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

How do we know what is real? There is a growing number of treatment modalities, each with its own acronyms and catchphrases. There is also a large diversity of opinions around issues related to food, health, and eating disorder recovery. How do we know what treatment approach to follow? In this dialogue, I have two guests who are both highly skilled and experienced in their respective, and very different, approaches. Abby Sarret-Cooper practices Family-Based Treatment and Dialectical Behavior Therapy, presents on these topics, and has studied under some of the most prominent leaders in these modalities. Rachel Lewis-Marlow is the director of the Embodied Recovery Institute, where she facilitates and trains clinicians in somatic, trauma-informed, and attachment-based treatment.They each briefly touch on their modalities and share how they determine whether an approach is useful, what guides the way in which they approach clients, the roles of confrontation, gentleness, and top-down vs. bottom up approaches. In many ways, this is a conversation about the science and the art of psychotherapy.More on Abby: https://partnersincounseling.net/ More on Rachel: https://embodiedrecovery.org/ More on Elka: https://cubacubcounseling.com/ For complete solo interview with Abby, see episode titled “Evidence Based Treatment is Flexible and Compassionate”For complete solo interview with Abby, see episode titled “Your Eating Disorder is not your Enemy

When we argue with other clinicians about treatment-related issues, it’s natural to focus almost exclusively on content. And when it doesn’t go well, we often attribute that to the wrongness of the other person’s position. We might accuse them of perpetuating harm, or being small-minded or out of touch with reality or science.I would argue that process is equally, if not more, important, particularly when we’re trying to bridge ideological divides. By process, I mean how we’re relating to one another. Process is closely tied to meta-emotion: how we see emotions and the role they serve? What do we believe about the value of expressing or not expressing emotion in different contexts.With me today is Dr. David Wiss. David has been on this podcast for two prior episodes about food addiction. I’ve read and watched some of his work and have a lot of respect for it. And in previous conversations, we’ve also bumped into some of our differences in process and in how we approach emotion and lived-experience.In this episode, we talk through some of those differences, what they brought up for each of us, and what it is to create a container that can hold differences, not only in what we believe, but in how we communicate.We also discuss to what extent lived-experience is valuable while in a professional role. If you’ve listened to other episodes of this podcast, you likely know that I focus a lot on people’s lived experience, with the goal of bringing people together by understanding the contexts and stories that shape our positions.At the same time, in this conversation, David helps me understand that dogmatic overemphasis on lived-experience can also drive people apart.David Wiss, PhD, is a researcher, mental health nutritionist and Institute of Functional Medicine Certified Practitioner (IFMCP) who bridges nutritional science and psychiatric care through comprehensive root-cause analysis. He founded Nutrition in Recovery and the Wise Mind Nutrition app, integrating cutting-edge personalized nutrition protocols into substance use disorder and eating disorder care. David’s work has been cited in National Geographic, The New York Times, and The Washington Post, and he has authored over 30 peer-reviewed publications examining the complex relationships between ultra-processed food addiction, eating disorders, and mental health. As someone who witnessed firsthand how ancient wisdom can restore hope when traditional treatments fall short, David practices and trains clinicians in whole-person, integrative mental health.Blog post from David about bridging divides: https://medium.com/@drdavidwiss/risking-belonging-how-mental-health-recovery-principles-can-heal-our-fractured-world-d7166f45748c More on David: https://drdavidwiss.com/ More on Elka: https://cubacubcounseling.com/ 

It can be taken for granted that there are many non-disordered ways of eating. In addition to food preferences and aversions, allergies, food-sensitivities, and body composition, our food choices can be also shaped by spiritual, cultural, and ethical values. In eating disorder treatment, this simple truth becomes much more complicated for two reasons:Firstly, because of the acuity and potential lethality of eating disorders, restoring weight and providing adequate nutrition takes priority over all else. Secondly, eating disorder behaviors can be subtle and hard to recognize. It can be difficult to determine whether food-related values are masking or being mistaken for eating disorder behaviors.For example, our topic today—veganism. Veganism can be used to justify food restriction which can be deadly in certain eating disorders. And at the same time, ethical veganism is a legitimate belief system that exists outside of disordered eating.Decisions about how much to accommodate food-related values and beliefs in treatment settings are practically and clinically complex. Regardless, the very least we can do is recognize the lived experience of the person in treatment and how conflicting values may impact them.In this episode, Maneva Gill shares her experience grappling with ethical veganism during eating disorder recovery, the internal conflict this created, and how she ultimately chose recovery. She reflects on what she wished her treatment providers had understood at the time, and speaks to the challenges of feeling torn between the social constructs associated with ethical veganism and the demands of recovery.Maneva is an Eating Disorder Recovery Coach based in California and certified through the Carolyn Costin Institute. Her training focused on working collaboratively with treatment teams and supporting clients in making meaningful behavioral changes toward recovery. Her approach integrates the 8 Keys to Recovery (a recovery framework developed by Carolyn Costin and Gwen Schubert Grabb that focuses on practical skills, mindset shifts, and sustained behavior change) alongside exposure and response prevention, Health at Every Size, and her own lived experience of full recovery.Before becoming a coach, Maneva worked for over six years in banking and financial technology, and she volunteered for two years as a peer support group leader and peer mentor with the National Association of Anorexia Nervosa and Associated Disorders. Her work is grounded in compassion, practicality, and hope through example. She offers fully online coaching and is available for in-person and virtual speaking engagements.More on Maneva: https://manevagill.com/ (website under construction)More on Elka: https://cubacubcounseling.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

The therapeutic relationship is, in some ways, a bizarre one. On one hand, it’s a meeting between two people, a space where you share so much of yourself, your deeper emotions, and experiences. And at the same time, there are very clear and firm ethical and professional boundaries.Human nature alongside the depth and vulnerability of the therapeutic space can create the conditions for attraction, love, and romantic or sexual feelings. And because these feelings cannot ethically evolve into a personal relationship, they can feel confusing and unspeakable.In this episode, Rebecca Prolman shares her own story of falling in love with her therapist and navigating a relationship that was both healing and incredibly messy. She also talks about how she responds now, as a therapist herself, when a client shares that they’re attracted to her. We talk about making these kinds of feelings speakable, exploring the meaning behind romantic and sexual fantasy, and maintaining the personal and professional boundaries that make therapy safe.Rebecca Prolman is a Licensed Marriage and Family Therapist who specializes in healing childhood attachment wounds, complex trauma, and eating disorders. She also offers affordable, self guided courses to support deep, lasting healing at rebeccaprolman.com. More on Rebecca: https://www.rebeccaprolman.com/Instagram, TikTok, and YouTube at @rebeccaprolman.More on Elka: https://cubacubcounseling.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

Is it a therapist’s responsibility to advocate for social justice, to take a stance on political issues that impact the lives of their clients and/or minoritized groups? Or are therapists supposed to be apolitical, to enter the therapy space without an ideological agenda so they can hold space for whatever belief systems the client brings in?When we remove the “shoulds” the “supposed tos”, the moralistic judgements of what makes a good or bad therapist or a good or bad person, what we’re left with are very impactful clinical questions: What role do systemic forces play in the issues we face as individuals? What impact does acknowledging those systemic forces have on a person’s healing process? How do we address shame and internalized oppression in a way that empowers rather than disables? And how do we make impactful political issues speakable in the therapy space?In this episode, Allyson Inez Ford talks about the role that understanding systemic oppression played in her own recovery from an eating disorder. She talks about the systems that shape us, the role that politics plays in how she holds the therapy space, and how she relates to clients and others who hold different, and potentially very triggering, political viewpoints.Because one thing that is for certain is that so many people are holding so much pain around current events. We cannot shy away from these topics.Allyson Inez Ford, LPCC, is a licensed mental health therapist specializing in eating disorders and obsessive-compulsive disorder. She has experience working with adults and adolescents in individual, group, and family therapy across multiple levels of care. Her work is informed by a liberatory and anti-oppression perspective.She has a particular interest in supporting individuals with multiple marginalized identities, informed by her own experience as a multiracial, neurodivergent, and queer clinician. Allyson owns and operates a group private practice, hosts a podcast focused on eating disorders and social justice, and participates in speaking engagements and professional trainings. She also provides consultation for complex clinical cases.More on AllysonInstagram: @bodyjustice.therapist Website: www.eatingdisorderocdtherapy.comBody Justice Podcast: https://open.spotify.com/show/1jvTCV9IJ1YpIym9YmZQda?si=e9872c6dbef24dc5More on Elka: https://cubacubcounseling.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

Bariatric surgery is a medical procedure that modifies a person’s stomach and sometimes intestines to help them lose weight. In the eating disorder recovery world, this topic isn’t discussed often because so many professionals take an active stand against fat phobia and, by extension, intentional weight loss.Our guest today brings together two worlds that don’t typically converge. She entered the field of bariatric psychology as an eating disorder professional. She shares her own lived experience of recovering from disordered eating through intuitive eating, her belief in rejecting dieting, and her awareness of fat phobia and how it shows up across society and in the lives of the individuals she assesses. At the same time, she is part of the process for one of the more invasive weight-loss procedures.You may be wondering why we’re talking about weight loss surgery on a podcast focused on eating disorders. And I agree that there are settings, like meal support groups, where discussing this would clearly be harmful. However, on this podcast, my goal is to create a space where nothing is unspeakable, where the human experience in all of its complexity is welcome, where people from different disciplines and ideologies can come together. I enter this conversation with trust in you, the listener, to take care of yourself and feel free to skip any content that doesn't feel right for you.Alisha B  (pseudonym used for reasons we’ll share in the episode) is a clinical psychologist. She began her work as a clinician focused on eating disorders and disordered eating and has her own history struggling with food, substances, body image, and emotion. As her professional life evolved, she became a bariatric psychologist who is passionate about her work and has helped over 1800 patients on their weight loss surgery journeys. She works in private practice in a rural community where she is the sole bariatric psychologist. She has published a chapter on bariatric psychological evaluations and presented at the annual meeting of the American Society of Metabolic and Bariatric Surgery (ASMBS).More on Elka: https://cubacubcounseling.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

In healthcare, we know that the same set of symptoms can reflect different underlying causes. The more we understand the range of causality and underlying dynamics in eating disorders, the more we can offer truly individualized and effective care.In previous episodes, we’ve discussed the role that trauma, complex trauma, dissociation, and genetics can play in the development of an eating disorder. In this episode, our guest Rebecca Berg, talks about the link between eating disorders and adoption. She shares her story as an adoptee with an eating disorder history and challenges the misconception that adoption during infancy has less impact on a child. She also discusses preverbal trauma and how it can be addressed in the therapy setting which so often centers around recounting verbal memories. Rebecca Berg, MS, RDN, is a registered dietitian, adoptee, and self-proclaimed neuroscience nerd. Based in Los Angeles, California, she is the owner of No Strings Nutrition, a weight-inclusive virtual nutrition therapy practice dedicated to the thoughtful treatment of eating disorders, disordered eating, and body image concerns.Rebecca is committed to empowering her clients to notice and refute the influence of diet culture in their lives through relational nutrition counseling. She provides compassionate, realistic support and challenges the oppressive systemic forces that make being in a body difficult. She helps each client understand that their interactions with food, body, and movement are shaped by unique individual perspectives, sociocultural factors, and systems.Rebecca’s professional background as an eating disorder specialist, combined with her lived experience as a domestic infant adoptee, has fueled her passion for helping clinicians and all members of the adoption constellation better understand this unique intersection.More on Rebecca: https://www.nostringsnutrition.com/ More on Elka: https://cubacubcounseling.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

Is an eating disorder the result of past trauma? When we see someone stuck in self-destructive and potentially life-threatening behaviors, it’s natural to ask what terrible event created this?Clinicians often debate the importance of addressing past trauma in eating disorder treatment, versus targeting present symptoms. Psychodynamic and embodied approaches typically emphasize past history and complex roots of a disorder, whereas behavioral approaches, such as family based treatment and cognitive behavior therapy, generally focus on reducing eating disorder behaviors and the associated distorted perceptions. In defense of both positions, people like to cite research studies identifying the percentage of individuals with eating disorders who have a trauma history versus those who don't. As a clinician, while percentages and probabilities can help me understand general trends, they cannot tell me what is true for the individual or family that is right in front of me.In this episode EMDR certified psychotherapist, Angela Harris, discusses how she assesses whether someone is using eating disorder behaviors to mask or cope with trauma, how recovery might differ between someone whose disorder is trauma-driven versus someone whose symptoms are driven by other factors, and what happens when a client with a trauma history is treated using a primarily behavioral approach.We also discuss the timing of trauma treatment relative to eating disorder recovery. Many clinicians delay addressing trauma until a client achieves symptom reduction, because trauma work can surface painful memories and be temporarily destabilizing. This creates a kind of double bind: the person is expected to reduce symptoms before trauma can be addressed, yet cannot reduce symptoms without addressing the trauma driving them. In some cases, this leads to cycling from treatment center to treatment center, repeatedly relapsing. In our conversation, Angela explains how she balances safety while treating trauma and eating disorders simultaneously.Angela is a Licensed Clinical Social Worker, Certified Eating Disorder Specialist Consultant, and an EMDR Consultant in Training. Angela specializes in treatment of eating disorders, trauma, and dissociative disorders. Angela owns a private practice, Angela Harris Counseling, in Dallas, TX and is dually licensed in Oklahoma.

In this episode, Dr. Marcia Nickow talks about anti-racism, DEI, and white privilege.Marcia shares how her upbringing as the child of Holocaust survivors influenced her interest in these topics. She discusses how she approaches racially charged issues in therapeutic contexts, including group therapy and clinician DEI groups. She also talks about what it is to be a white-presenting clinician in DEI spaces.We talk through difficult questions: What does it mean to acknowledge white privilege as someone who has fair skin, but whose life story and history don’t align with the archetype of the white oppressor? We also touch on the Israel–Gaza war, and how each of us relate to it as people who hold a Jewish identity.If you’re someone who is sensitive to injustice and the suffering in the world around you, you will likely have strong reactions while listening. Those reactions are valuable, and I want to make space for meaningful conversation around them.Because of this, I’d like to begin recording reaction episodes. These will be open to both clinicians and non-clinicians and will focus on exploring listener reactions to concepts from prior episodes.Two points to note:1. We will be exploring your personal story as it relates to the topic, rather than debating the truth or legitimacy of particular positions. For example, if you are reacting to something that I said in this episode, rather than each of us bringing in proof and data to support our own positions, my goal is to understand your story and the values, life experiences and emotions that are contained within your reaction.2. To keep this a safe space, one of my guiding principles is: talk to me, not about me. This applies to myself and my guests. If you are responding to a point made by a prior guest who is not present, we’ll extract the concept you are reacting to and explore your response to that concept rather than critiquing the individual guest.Marcia Nickow, Psy.D, CADC, CGP, is a clinical psychologist and group psychotherapist specializing in treating multi-generational legacies of trauma and addiction. She designed and implemented an intensive group psychotherapy program in her private practice and leads 16 weekly ongoing process groups: men’s, women’s, multigender, professionals, artists/writers, and clinical supervision groups. She also co-leads couples’ groups. Her clinical interests include manifestations of racial and historical trauma; legacies of family and community trauma and healing; thriving after trauma; pedagogies of oppression; and anti-racist clinical practice.Marcia serves as an organizational and clinical consultant at a Residential and Outpatient Treatment Center where she co-leads supervision groups for clinicians and staff of color. Marcia has presented nationally and internationally on trauma (complex, intergenerational, historical, collective); the full spectrum of addictions and eating disorders; de-colonizing approaches to treatment; group dynamics and group processes; and, more recently, on collective trauma including sequelae of COVID-19, racial violence, and mass shooting pandemics.Marcia has co-presented intensive experiential workshops on the link between intergenerational addiction and historical trauma at American Group Psychotherapy Association conferences and at Haymarket House in Chicago.I met Dr. Marcia nearly a decade ago, soon after completing my undergraduate in psychology and am grateful to consider her a teacher and mentor.Resources mentioned in episode:The People's Institute for Survival and Beyond https://pisab.org/My Grandmother's Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies book by Resmaa MenakemTo connect with Marcia, visit https://marcianickow.com/To connect with Elka, visit https://elkacubacub.com/ and https://www.psychologytoday.com/profile/1155490If you would like to be interviewed in a future episode, please complete this form: https://forms.gle/rzCYiAwUNtWX6AFu9

So much of Western medicine has been tied up with body weight. Weight is often disproportionately and inaccurately associated with health. Weight loss is a common recommendation for many health conditions. Although eating disorder treatment typically emphasizes body acceptance and weight neutrality, weight remains central to so many aspects of the treatment process.Body mass index (a measure of weight in relation to height) is used to diagnose: Is this anorexia, atypical anorexia, or OSFED? It's used to monitor recovery progress: Is this person “weight restored”? It is used to determine what level of care is needed, and when a person is ready to reintroduce physical activity. Taking a person’s weight is easy. It's clear, objective, and requires only that they step on a scale—all of which makes it an appealing assessment measure. However, like most shortcuts, it carries the risks of promoting inaccurate conclusions about the individual and perpetuating harmful stereotypes and biases. In this episode, Cathryn Williams, PsyD, discusses decentralizing weight as a marker of health and recovery. She shares her experience teaching Health at Every Size and eating disorder awareness to medical students, and touches on alternative physical and psychological markers that can provide more accurate, weight-neutral indicators of someone’s eating disorder status and recovery progress.Cathryn Williams, Psy.D (she/her) is a licensed clinical psychologist and graduated with a doctoral degree from Massachusetts School of Professional Psychology ( William James College) in 2014. Dr. Williams completed her post-doctoral fellowship  at the Cambridge Eating Disorder Center and has expertise in the treatment of eating disorders (cognitive-behavioral therapy, Radically Open Dialectical Behavioral Therapy, Family Based Treatment), substance use disorders (Motivational Interviewing, Dialectical Behavioral Therapy, Acceptance and Commitment Therapy) and Borderline Personality Disorder (Dialectical Behavioral Therapy; Internal Family Systems therapy). Prior to joining the department of psychiatry and behavioral sciences at UMass Chan Medical School  in 2022, Dr. Williams provided individual and couples’ therapy and served as the clinical director of two outpatient mental health clinics. She has provided clinical supervision and didactic seminars for pre-doctoral trainees, post-doctoral fellows, and psychiatry residents.Connect with Elka https://elkacubacub.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3 

In eating disorder treatment, do we focus on managing symptoms or addressing root causes?There are so many issues tied into this question, at both a theoretical and very practical level. Treatment focused on symptom management often rests on the premise that the issues encountered in eating disorder recovery are the result, not the cause, of food restriction. From this perspective, when a person is nutritionally rehabilitated and weight-restored, many co-occurring symptoms like mood disturbances and body dysmorphia will naturally resolve.In contrast, an approach that emphasizes addressing the underlying root causes sees disordered food behaviors as coping strategies for difficult and painful biopsychosocial events, past or present. From this perspective, sustainable recovery requires that we understand and address these deeper, more complex, dynamics.In practice, symptom management often involves allocating food related decisions to healthy adults, parents, caregivers, or treatment centers, until the client demonstrates readiness for increased autonomy. An approach centered around exploring root causes may involve more input from the client, working gradually toward behavioral stability in ways that feel accessible and manageable to them.How much and how deeply do we enter a client’s internal, subjective experience?What one school of thought sees as essential to recovery, another might view as a distraction. What one sees as respect for a client’s right to self-determination, another might view as colluding with the eating disorder.Like most things in recovery, these questions require non-binary thinking.In this episode, Kirsten Hunneyball shares how these issues showed up both in her own recovery and in her work with clients. She reflects on the aspects of behavior modification that were necessary and even life-giving, as well as the places where those approaches fell short. Together, we discuss managing risk and safety while also moving beyond mere survival toward holistic health and well-being. We explore somatic treatment, the reality that eating disorders can be subtle and manipulative, and the importance of knowing when to challenge a client versus when to approach with gentleness.Kirsten Hunneyball is a trauma-informed recovery coach, yoga teacher, and wellness facilitator based in South Africa. Having lived experience with an eating disorder, she supports individuals and small groups through meaningful personal evolution, particularly but not limited to the space of disordered eating. Kirsten integrates intuitive coaching, embodiment practices, and creative expression to help people reconnect with themselves, move through transition, and lead purpose-driven lives. She also has a podcast called “Curious About Recovery - Diving into Eating Disorders” Which is available on Spotify. You can find her website at More on Kirsten: www.kirstenhunneyball.co.za Kirsten's podcast, Curious about Recovery: https://open.spotify.com/show/1TwaZ2ID4FRQthckqfjR0h?si=gbHRZstJTByPEARZ41svTg Connect with Elka https://elkacubacub.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3 

How do you know?So many challenges to any particular position boil down to this question. How do you know that what you're saying is accurate? How do you know that the modality you're using is effective? In the medical and academic communities, we're often taught that the only acceptable answer to this question is scientific study, preferably double blinded and/or within a randomized controlled trial.But there are other types of knowing:The knowing that lives in one's own gut. The knowing that is passed down through millennia of history. The knowing that is found within the collective.And while the particulars of an intuited, spiritual, or collective experience cannot be generalized, the question “how do you know?” extends to how we teach our clients to know.Do we encourage them to trust the experts? To believe only what is written in peer reviewed journals? Or do we help clients get in touch with the knowing that comes from deep within themselves?In this episode, Dana Sedlack shares how spiritual practices helped facilitate her own recovery. She talks about how these differ from, and complement traditional therapy, and describes particular alternative healing methods including sound healing and Biofield tuning. We discuss the challenges of translating spiritual practices into traditional therapy settings, and the importance of creating space for clients, who are so inclined, to integrate spirituality with the growth they achieve in therapy.Dana Sedlak, LCSW, CEDS-C is a Certified Eating Disorder Specialist and Consultant with over a decade of experience in the mental health field. She has led multidisciplinary teams and developed comprehensive treatment programs for eating disorders and co-occurring mental health conditions.Dana offers individual clinical supervision and mentorship for clinical teams. She also provides consulting to help organizations develop and implement effective mental health and eating disorder treatment programs.Connect with Dana https://www.ourinnerwellness.com/ Connect with Elka https://elkacubacub.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

In this episode, Elka Cubacub provides a framework for understanding the "what, why, and how" of dialogue in this podcast.To participate in dialogue, please complete the following interest form https://docs.google.com/forms/d/e/1FAIpQLScgWTg0mo532TUlfRBAawQ9uh9pmPr1O9IsKlFgBmO7NOji_g/viewform?usp=sharing&ouid=107239699529464533283Connect with Elka https://elkacubacub.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

This is our first dialogue episode on the podcast. In it, we have Libby Supan, a therapist and certified intuitive eating counselor and David Wiss, a registered dietitian with a PhD in public Health. We're coming together to talk about food addiction.I hesitated a lot before publishing this episode. This was a difficult conversation in ways that both guests had predicted and hoped to avoid. At many points, we unwittingly highlight the challenges of conversing across ideological divides while immersed in the level of stress these conversations trigger. We also share with you our very raw and human attempts at moving through these and back toward each other. I’ve since processed individually with both Libby and David so I can create a safer space in the future. I'm afraid that you’ll listen and be pulled toward one narrative or one person’s presentation and assume bad intentions on the part of the other. The urge to pick a side is so natural and expected. And I hope that, alongside that, you’ll remember that what you see of each person is only snapshots, not the entirety of who they are. We all entered this conversation with the same goal: to build bridges between us and become better humans and clinicians.To hear more from David, check out the episode "Ultra Processed Food Addiction: What it is, what it’s not, & why it matters."To hear more from Libby, listen to"I Spent 15 Years in Overeaters Anonymous—Here’s Why I Left.Connect with David https://drdavidwiss.com/Connect with Libby https://www.libbysupan.com/ Connect with Elka https://elkacubacub.com/ Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

When I studied psychology, I learned about psychoanalysis as the id, ego, and superego, the mind depicted as an iceberg, with the subconscious submerged beneath the surface. We covered psychosexual development and the Oedipus complex. Some of it seemed relevant, and other parts seemed overly speculative. Mostly, though, it was presented as part of the history of psychotherapy—a relic of the past that had been absorbed into mainstream thought and then largely been replaced by more targeted, manualized treatments.And then I met Denise, who is now my supervisor, during a job interview. Denise made the bold claim that if Freud had lived another 200 years, he would have discovered everything we now know about psychotherapy. Her office had an entire shelf filled with volumes of Freud’s work, and she had studied psychoanalysis intensively, part of which included undergoing her own psychoanalysis. Denise shared books and articles where I could read about contemporary psychoanalysis and I began to see how it overlaps with the somatic, embodied approaches I am most drawn to.In this episode, Denise shares how and why she was drawn to psychoanalysis. We talk about the role of the unconscious, symptom management vs. root causes, the somatic experience, the therapeutic relationship, and whether or not the therapist is actually a blank slate. We touch on the setting where the patient lies on the couch and spills out the contents of their mind, and discuss psychosexual development, the Oedipus complex, and erotic transference. This episode isn’t specifically about eating disorders, but more broadly about psychoanalysis.Denise is a psychotherapist, practice owner, and certified psychoanalyst. She specializes in working with adults and adolescents dealing with depression, stress and anxiety, bipolar disorder, ADHD, PTSD, relationship concerns, and attachment issues. She also offers couples counseling, family therapy, and parenting support.Denise earned her Master of Social Work from Loyola University and a graduate certificate in adult psychoanalysis from the Wisconsin Psychoanalytic Institute, where she now teaches. She also supervises psychology graduate students at Northwestern University, where she earned her bachelor's degree in engineering.Binge eating recovery with Elka https://elkacubacub.com/

Perhaps the single most charged issue in eating disorder recovery is intentional weight loss. In the general population, we know based on research that the long-term success rates of intentional weight loss diets are abysmally low. In the world of eating disorder recovery, not only are the success rates low, but so many people have been deeply harmed by diet culture.For so many in this field, the very idea of intentional weight loss brings up all of the fatphobic and destructive messages they've received throughout a lifetime and a history of feeling at odds with and abusing their own bodies. Because of this, the idea that somebody can pursue intentional weight loss after recovering from an eating disorder in a way that is safe, kind to their bodies, and aligned with their best interests, feels almost untouchable. In this episode, Cheryl Burton Murphy who is a body-positive yoga instructor, has recovered from an eating disorder, and is now pursuing intentional weight loss, shares her story. She talks about her health and weight related goals, experience with GLP-1s, how this is all different from her disordered eating history, and how she’ll respond if weight loss attempts don't have the desired outcomes.I mention this in the intro to every episode, but because this is such a charged topic, I want to reiterate that this is not professional advice or advocacy for a particular position. We’re not asking that eating disorder professionals start promoting intentional weight loss. This is one person’s story. And if it’s one person’s story, it’s probably other people’s stories too.If you find it activating your own food and body insecurities, please take care of yourself. You don’t have to listen to this episode.I also want to acknowledge that Cheryl is taking a very vulnerable position by sharing something of herself here. Please be respectful.My goal is to create a safe space where nothing is untouchable and we can hold space for the massive diversity of the human experience. If you have an alternative perspective, as I’m sure many people do, feel free to reach out and share your story. Cheryl Burton Murphy is a certified Curvy Yoga instructor and body-inclusive wellness advocate with over 25 years of yoga practice. She specializes in making yoga accessible for plus-size individuals through the use of props, variations, and a supportive, judgment-free approach. Cheryl brings warmth, humor, and deep compassion to her teaching, creating spaces where every body feels welcome and empoweredConnect with Cheryl: https://curvybodyinmotion.com/  Instagram: @CurvybodyinmotionBinge eating recovery with Elka https://elkacubacub.com/

Many traditional approaches to eating disorder treatment focus primarily on behaviors such as meal plan compliance, and strategies that aim to support and reinforce these behaviors. In higher levels of care, and some outpatient settings, the goal is to make eating disorder behaviors non-negotiable. This may be accomplished through contingency management, where access to certain privileges depends on meeting specific behavioral expectations.In this model, the eating disorder is the enemy that sabotages a person's life and medically compromises their health. Clinicians and clients are positioned as working together to challenge this enemy by reinforcing more adaptive behaviors.The harm reduction model, in contrast, focuses on the complex inner world of the client and acknowledges when meal plan compliance is inaccessible. Rather than enforcing symptom abstinence from the outset, harm reduction focuses on meeting the client where they're at, and collaborating around manageable goals while reducing immediate risk. In this episode, Gabby Morreale shares her story around why she adopted a harm reduction approach and how she applies it in her current practice. We also discuss how to manage high-risk situations within this model and how to clearly communicate when a different level of care or approach is needed. Gabby is the owner and clinical director of Recovered and Restored Eating Disorder Therapy Center, where she leads with a relational, social justice-oriented approach rooted in compassion and encouragement. She is a Licensed Professional Counselor in Pennsylvania, Delaware, New Jersey, Connecticut, Maryland, South Carolina, and Florida. Gabby has over 12 years of experience in the field and holds certifications in cognitive behavioral therapy, dialectical behavior therapy, and trauma-informed care. She is currently pursuing certification in exposure and response prevention. Gabby specializes in treating eating disorders, maternal mental health, OCD, anxiety, depression, and PTSD. She is a professional presenter on topics related to eating disorders, anxiety, and maternal mental health, having presented at eating disorder conferences, universities, and community organizations.For more on GabbyInstagram: @gabriellelpc and @recoveredandrestored  Website: Recoveredandrestoredtherapy.com Email: [email protected] eating recovery with Elka https://elkacubacub.com/

Food addiction: does it exist or not? Is it helpful or harmful? Does science support it or disprove it? These questions have become so polarizing, especially in the eating disorder and substance abuse communities, where people often take a hard yes or no stance.In this podcast, we look at it differently.The fact that there are such strong, diverging opinions on this topic is the best indication that both experiences are real. There are people who are helped by the food addiction model and people who are harmed by it. Otherwise, why would so many be so emotionally invested in defending one position or the other?In our last episode, we talked about the importance of acknowledging food addiction so that we can hold space for those who experience it. In this episode, we explore the pitfalls of adopting a food addiction framework for people whose loss of control around food is actually rooted in restriction.Our guest, Libby Supan, shares why she joined and why she left Overeaters Anonymous. She talks about the hope and sense of community she initially found in OA, a space where she could speak openly about her food struggles. And also discusses how the abstinence-based model, which positions certain foods as addictive substances, ultimately perpetuated the food struggles she was trying to recover from.Libby talks about the shame she felt as an “unsuccessful addict in recovery,” the growing dependence on her sponsor that left her unsure of her own judgment and unable to trust in herself.Libby is a licensed marriage and family therapist and a certified intuitive eating counselor. As someone who has personally recovered from a 20-year struggle with an eating disorder, she has a deep understanding of what it's like to live with, and heal from, an unshakeable eating disorder.Libby runs a therapy and coaching practice, specializing in supporting individuals who are exhausted from obsessing over food and body image. Most of her clients are caught in the binge/restrict cycle and are seeking to break free from it. She is dedicated to guiding as many people as possible toward intuitive eating and a life of true food freedom.Connect with LibbyEmail: [email protected]: libbysupan.com (https://libbysupan.com)Tik Tok: foodfreedomwithlibby (https://www.tiktok.com/@foodfreedoomwithlibby)IG: foodfreedomwithlibby (https://www.instagram.com/foodfreedomwithlibby)FB: foodfreedomwithlibby (https://www.facebook.com/FoodFreedomwithLibby)Binge eating recovery with Elka https://elkacubacub.com/ 

Does food addiction exist?This question is the topic of heated debate within the eating disorder recovery community.We know that binge eating and compulsive overeating can share some characteristics with substance use disorders, such as loss of control, repeated unsuccessful attempts to quit, and continued use despite negative consequences.However, the question is whether this loss of control around food is the body’s response to food restriction, as is often the case with chronic dieting and binge eating disorder, or the result of disinhibition, similar to patterns seen in substance use disorders.In this episode, David Wiss explains what ultra-processed food use disorder is, how it differs from deprivation driven binge eating, and why it's important to recognize clients who present with it and feel misunderstood by the eating disorder narrative.He touches on his own substance abuse history but also emphasizes his value for acting on a sense of purpose and engaging with clients and the larger systems that impact them in a way that extends beyond his own story. David is a mental health scientist and registered dietitian nutritionist. He has a PhD in public health with a minor in Health Psychology. He founded Nutrition in Recovery, a group practice based in Los Angeles, CA, that integrates nutritional care into substance use disorder treatment. David also founded the Wise Mind Nutrition mobile app, which bridges the gap between nutrition and mental health. As a clinician and researcher, he has over a decade of experience working one-on-one with patients. He has authored more than 20 peer-reviewed journal articles on topics related to disordered eating and ultra-processed food addiction. David is dedicated to disrupting the status quo and contributing innovative solutions to the mental health crisis.Nova food classification https://ecuphysicians.ecu.edu/wp-content/pv-uploads/sites/78/2021/07/NOVA-Classification-Reference-Sheet.pdf Review of the research on ultra processed food addiction https://www.mdpi.com/2072-6643/16/12/1955 More on David https://drdavidwiss.com/ Wise Mind Nutrition App https://wisemindnutrition.com/featuresBinge eating recovery with Elka https://elkacubacub.com/

In the West, medical treatment tends to be highly specialized. In eating disorder recovery, dietitians are typically responsible for specifying and monitoring clients' food intake. Therapists are responsible for helping clients build coping skills and navigate their internal worlds. Psychiatrists or nurse practitioners are responsible for prescribing psychiatric medication and monitoring medical risk. And so on...However, human beings are not easily compartmentalized. It is near impossible to change physical health behaviors without navigating a person's emotional reality, and vice versa.In this episode, Tracy Brown talks about meeting what's in the room with clients as a registered dietitian who is also trained in Internal Family Systems and Somatic Experiencing, both therapy modalities often associated with trauma recovery. Tracy talks about the personal and professional experiences that led her to seek out these trainings, and how she uses them in her practice as a dietitian working with food-related challenges. She also discusses when and how she collaborates with therapists around deeper issues that come up in her sessions.Tracy is a somatic nutrition therapist, registered and licensed dietitian, and attuned eating coach in private practice. For almost 2 decades, she has provided in-person, phone, and online counseling to individuals seeking support with eating disorders and eating-related challenges. She specializes in working with both adults and children, addressing concerns such as disordered eating, overextension of the body, adrenal fatigue, hormonal imbalances, PCOS, and gut health.In addition to her clinical work, Tracy regularly teaches intuitive eating workshops and gives talks on disordered eating throughout Florida. She has presented at institutions including the University of Florida and Santa Fe College in Gainesville, Flagler College in St. Augustine, and Florida Gulf Coast University in Fort Myers. She also serves as the guest Nutrition Therapist for Feast, an online intuitive eating program, and has been featured on many podcasts discussing topics such as intuitive eating, trauma healing, body image, and recovery.Her approach is grounded in the belief that healing food and weight concerns is ultimately about choosing to live fully—embracing the richness of being human in the diverse and amazing bodies we inhabit. She encourages clients to feel deeply, live courageously, and commit to the fullest expression of who they are.To connect with Tracy and her team, visit https://www.tracybrownrd.com/ For binge eating recovery with Elka, visit https://elkacubacub.com/

GLP-1s, such as Ozempic, Wegovy, and Mounjaro, are a class of medications originally developed to treat type 2 diabetes. More recently, they've become a hot topic in the mainstream for their weight loss effects. A quick Google search brought up the following headlines:“Weight loss is finally easy with a prescription to GLP-1 medication” “Join 100,000+ patients and transform your health, body, and life”.“A natural approach to medicine”Media and marketing promote these medications as the key to finally feeling at home in your body.Eating disorder recovery professionals, however, tend to be much more skeptical. Many have lived through countless fad diets and “miracle” weight loss drugs, none of which delivered on their promises, some of which did more harm than good.In this episode, Winter Groechl talks about how her perspective on GLP-1s has evolved. She shares her initial hesitation and how her stance became more nuanced and flexible as she observed both positive and negative client experiences.We also touch on the broader question of how we, as professionals, approach intentional weight loss—acknowledging the painful reality of weight discrimination while making space for clients who hold this as a goal.This conversation is about stepping away from dogmatic thinking and approaching clients with openness, a willingness to learn, and deep respect for the diversity of the human experienceWinter Groeschl (she/her/they/them) is a Licensed Professional Counselor in Arizona, dedicated to providing competent, compassionate care for individuals healing from substance use disorders, eating disorders, disordered, body image issues, depression, anxiety, trauma, and more. They have experience across all levels of care in Arizona’s mental health system and draw from ACT, mindfulness, DBT/CBT, polyvagal theory, Compassion Focused Therapy, and Client-Centered approaches.Winter practices from a social justice, weight-neutral, and inclusive lens. As a member and advocate of the LGBTQIA+ community, they are committed to creating an affirming, safe space for people from all backgrounds.Their vision is to help each client explore their true self and connect with their capacity for growth, a restored sense of self, and lasting empowerment.Book Recommendation:Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs by Johann HariEating disorder recovery with Winter: https://eatingdisorderrevealed.com/ Binge eating recovery with Elka: https://elkacubacub.com/ 

The most fundamental question in treating eating disorders is “What works?” Eating disorders are so painful and can be so fatal; we want to use the treatment that has the best chance of giving our clients their lives back.We live in a time when empirical observation can be used to answer this question as more and more research studies examine the effectiveness of various interventions. Family-Based Treatment (FBT), sometimes referenced as the gold standard for treating eating disorders, is a manualized treatment that gives parents the responsibility for restoring their child's weight and managing eating behaviors. Critics of FBT are concerned that in cases where a parent is abusive, neglectful, or psychologically unstable, this type of parental involvement may increase family dysfunction and in some cases enable a child’s abuser. Others are concerned that FBT addresses only the eating disorder behaviors without understanding the underlying psychosocial dynamics.In this episode, Abby Sarrett-Cooper discusses her experience combining Dialectical Behavior Therapy (DBT) with FBT to help clients achieve tangible improvement, while also navigating theirs and their families’ emotional realities.Abby shares her history of struggling with an eating disorder while in an unstable family environment during a time before targeted, evidence-based treatment was available. She speaks about how now she navigates complicated family dynamics and uses FBT and DBT to help parents support loved ones.Abby challenges the assumption that evidence-based treatment is rigid and distant, and talks about how individualized, client-centered care is a key component of evidence based intervention.Abby is a Licensed Professional Counselor in New Jersey and Pennsylvania and a Certified Eating Disorder Specialist. She has been in private practice for 20 years, focusing on evidence-based, Health at Every Size (HAES)-informed approaches to treating eating disorders. Her postgraduate training includes certification in FBT and intensive training in standard DBT, DBT for adolescents (DBT-A), DBT for families, and DBT for eating disorders. Abby is an early adopter of FBT in community private practice, and of integrating DBT with FBT to empower families and manage the dysregulation common in treatment.Outside her practice, Abby served on the psychology faculty at Caldwell University in New Jersey for 10 years, teaching Child Development, Adolescent Development, and Psychopathology, and designing the university’s first Positive Psychology course. Throughout her career, she has been a vocal advocate for evidence-based treatment that is nonjudgmental, stigma-reducing, and myth-challenging. Abby is a member of the International Association of Eating Disorder Professionals and has been active in the Academy for Eating Disorders for 15 years, currently serving as co-chair of its Special Interest Group Oversight Committee.This is our second time recording this episode so to begin, we briefly reflect on our first time recording and what we'd like to shift this time around. One of the challenges in the current digitized climate, is that the things we say become so solid and permanent, while as humans we are constantly evolving. I cringe inside when I look at so much of what I’ve written or produced in the past. And I hope that we approach this episode, and all the others, with flexibility and forgiveness, recognizing that each of us is perpetually reflecting, growing, and changing. To work with Abby, visit https://partnersincounseling.net/meet-the-partners/For Elka's binge eating recovery program, visit https://elkacubacub.com/

What happens when someone with a high acuity eating disorder needs more support than can be provided in outpatient settings, but refuses a higher level of care?Considering the high mortality rate of eating disorders, this question can quite literally be a matter of life and death.In a previous episode on harm reduction, we discussed the value of meeting clients where they’re at and how high-risk behaviors can, and sometimes must, be mitigated in outpatient settings, especially for those with treatment trauma.In this episode, we explore the flip side: the importance of acknowledging when a client’s needs exceed our limitations and, at times, challenging a client to seek higher levels of care, despite their apprehension, in the interest of preserving their safety. Psychotherapist, Amber Cardemil reflects on how she supports and, when necessary, challenges clients with treatment ambivalence. We discuss the benefits and limitations of treatment contracts which clarify the minimum requirements for maintaining safety in outpatient settings and outline the conditions under which more intensive treatment becomes necessary. Amber also shares the nuanced, individualized nature of decisions as to whether to refer out or continue a therapeutic relationship based on the quality of rapport and individual client’s needs. Beyond the sticky, complicated ethical questions, Amber speaks to what it is to be a human being supporting someone who struggles deeply—what it's like to celebrate their growth, grieve their setbacks, and let go when it's time to move on.Amber is a Licensed Clinical Social Worker with extensive experience treating eating disorders, food-related concerns, and co-occurring conditions. She is trained across all levels of care—inpatient, residential, PHP, and IOP—and has worked in admissions, assessment, individual, family, and group therapy. She is a certified Health at Every Size® provider and has advanced training in Family-Based Treatment for adolescents with Anorexia Nervosa.She uses evidence-based treatments tailored to each client, with attention to individual and family dynamics. She empowers families to support recovery and collaborates closely with other providers to ensure effective, multidisciplinary care. In addition to eating disorders, she treats anxiety, depression, and life transitions.Amber also provides psychoeducation to schools and universities on early detection and prevention of eating disorders, and serves as a Body Project facilitator through NEDA. She is a member of Project HEAL and is committed to equitable treatment access.Treatment with Amber https://www.collectivehealingtherapy.com/about Binge eating recovery with Elka https://elkacubacub.com/ 

What is an eating disorder? We know it can involve symptoms such as food restriction, binge eating, or purging behaviors. But what underlies these behaviors? What causes an eating disorder, and how do we treat it? These are questions that do not have a universal, clear-cut answer. Is an eating disorder a coping strategy developed in response to trauma, an attempt for control, a cry for help, a response to societal pressures, or a biological susceptibility triggered by food restriction. Is an eating disorder about food and body image or some deeper biopsychosocial dynamic? How we answer these questions determines the type of treatment we provide.In this episode, Rachel Lewis-Marlow discusses her work in eating disorder recovery using a comprehensive approach that includes trauma-informed, attachment-based, and somatically integrated methods. We break down what each of these mean and how they relate to eating disorder etiology and treatment. Rachel shares how attachment in her personal relationships impacted her ability—or inability—to eat at various periods in her life. She also discusses powerful moments of connection and co-regulation she’s seen as a clinician. From Rachel's perspective, an eating disorder is a form of communication to listen to rather than a pathology to erase. Recovery, then, is an additive process focused on building a client’s resources and support, rather than an eliminative process aimed at removing behaviors. Rachel is the co-founder and director of the Embodied Recovery Institute. She is a somatically integrative psychotherapist, dually licensed in counseling and therapeutic massage and bodywork. She is a Certified Advanced Practitioner in Sensorimotor Psychotherapy and has advanced training and 25 + years of experience in diverse somatic therapies including Craniosacral Therapy, Energetic Osteopathy, Oncology massage and Aromatherapy.Rachel began her work with eating disorders in Residential, PHP and IOP treatment programs. There she developed the Embodying Recovery group therapy protocol which forms the basis for the Embodied Recovery for Eating Disorders (ERED) treatment model. She provided program development, training and supervision for the implementation of this model to enhance the effectiveness of current best practices, such as DBT, Interpersonal Process, ACT groups. She also developed the Body Wisdom group protocol, an alternative to the traditional body-image group, which focuses on enhancing the mind-body relationship through mindful experience of and through the body.She has extensive experience as a teacher and presenter, focusing on accessing the body’s unique capacity to give voice to the subconscious and to lay the foundation for healing and maintaining psychological and physical health. In her private practice in Chapel Hill, NC, Rachel specializes in working with people exploring recovery from trauma, eating disorders, and dissociative disorders.Rachel and the Embodied Recovery Institute https://embodiedrecovery.org/Elka’s binge eating recovery program: https://elkacubacub.com/

If you’ve had a client who has been through multiple treatments, tried countless medications, received diagnosis after diagnosis—bipolar disorder, borderline personality disorder, depression, eating disorder—leaving their treatment team confused and unable to find a path that sticks, it might be dissociative identity disorder (DID). Many people with DID go years, even decades, cycling through the mental health system without a clear understanding of what’s really happening. In a previous episode with Annie Goldsmith, we discussed how DID is far more common—and less dramatic—than how it's often portrayed. In this episode, Monica Ostroff takes us deeper into this topic, sharing her own experience of being diagnosed with DID—then known as Multiple Personality Disorder—in the early 1990s. This was a time when the False Memory Syndrome Foundation had just been established and was questioning the validity of repressed memories of severe abuse uncovered in therapy. Monica also reflects on the harmful effects of media portrayals that depict people with DID as either fantastical or violent—representations that are dehumanizing, disempowering, and most importantly out of touch with the lived experience of real people with this condition.As an accomplished professional, Monica began sharing her story publicly in an effort to break these misconceptions and show what it actually means to live with DID. Through conversations like this, we move closer to a world where people with DID are met with respect—not just for their suffering, but for their strength, creativity, and humanity.Monika is the Executive Director of the Multi-Service Eating Disorders Association, Inc (MEDA). Prior to leading MEDA, she directed several residential, partial hospital and intensive outpatient eating disorder programs in addition to having owned a thriving private practice. Monika is the co-author of Anorexia Nervosa: A Guide to Recovery and a contributing author to Self-Harm Behavior and Eating Disorders. With more than 25 years of experience in the field of eating disorders, Monika has presented at many national conferences, taught at the university level, and appeared on many media broadcasts, publications & podcasts. Practicing from a trauma informed, social justice and staunchly HAES® aligned lens, Monika is a dedicated ally and strong advocate working to ensure access to equitable, compassionate, and affirming care for all. Her passion for treating eating disorders and mentoring other professionals was borne out of her own struggle with severe and enduring anorexia nervosa and life experiences.Additional resourcesUnderstanding DID:Healing my Parts substack and podcast https://healingmyparts.substack.com/ The CTAD Clinic https://www.youtube.com/@thectadclinic/videos An Infinite Mind https://www.aninfinitemind.org/ Katie Keech https://www.katiekeech.com/ Assessing dissociation:https://www.mid-assessment.com/mid/ Research on Dissociation:Dr. Bethany Brand https://bethanybrand.com/ More from Monica https://www.medainc.org/ Elka’s binge eating recovery program: https://elkacubacub.com/

Does weight affect health?For many years, the scientific and medical communities assumed the answer to this question as an obvious yes. After all, studies show correlations between higher BMI (body mass index) and various medical conditions, one of which—PCOS—is the topic of today’s episode.When we look at studies showing a correlation between weight and PCOS or other medical conditions, two key questions arise:1. Does weight cause the condition, or is there a third variable that influences both weight retention and the condition?2. Are the treatment recommendations based on this association helpful or harmful to the patient?In this episode, Lauren Hirschhorn-Tieu shares her experience as someone diagnosed with PCOS and prescribed a rigid weight loss diet. She discusses the negative impact of the diet on her quality of life, eating patterns, social life, and self-perception. She describes the shame, the belief that her body was somehow “different”, and the lack of substantiated impact the diet had on her PCOS.When Lauren talks about the meal plan she was prescribed, we also briefly touch on censorship, trigger warnings, and the impact of sharing specifics about food restriction. We settle on sharing the specifics and allowing you, the listener, to decide whether you want to listen and to process your reactions if you choose to engage. I debated whether to cut this from the episode. On one hand, in the context of our conversation, the particular snack Lauren was prescribed was legitimately not important. On the other hand, it touches on a broader question about the recovery environment we create: To what extent are we responsible for monitoring ourselves to shield one another from potentially painful or triggering information, versus sharing our stories openly and in enough detail to bring them to life while also validating, owning, and processing our reactions to each other?Lauren is a non-diet, HAES-aligned registered dietitian and owner of Note to Self Nutrition LLC. Lauren started her career in the clinical side of nutrition, working in hospitals and skilled nursing facilities, which provided her with a solid medical foundation and a deep understanding of the complexities of the body and the medical field. She now combines that experience with her HAES®-aligned approach to help clients navigate medical conditions like diabetes, chronic kidney disease, and hormonal imbalances, all while supporting their relationship with food and their bodies.Having her own history of struggles with nutrition and body image has shaped Lauren’s gentle approach to nutrition therapy. She deeply understands the grief that comes with a changing body and the pressure to fit into societal ideals. She also recognizes that her own lived experience is just one part of the story, and she continues to learn from the diverse clients she works with.At the heart of Lauren's work is a desire to help clients reconnect with their authentic selves—the person they were before diet culture took hold. She believes that the joyful, carefree parts of ourselves are still within us, waiting to be rediscovered.Lauren’ nutrition practice: https://www.notetoselfnutritionllc.com/ Elka’s binge eating recovery program: https://elkacubacub.com/ 

There’s a stereotype that eating disorders are a young woman’s illness. Many treatment centers cater primarily to young people, and even adult treatment centers often have a predominantly young adult population.As a result of this, when someone experiences an eating disorder in midlife or later, they may face not only the challenges and stigma of the diagnosis but also a sense of isolation, feeling as though others in their age group don’t share their struggle. The reality, however, is that eating disorders can affect people of any age. In this episode, Betsy Brenner shares her story of confronting and recovering from an eating disorder in midlife. She discusses her experience living parallel lives—outwardly maintaining her image as the happy, perpetually positive person she was taught to be, while secretly struggling deeply, and what it was like to finally confront painful emotions after decades of suppression. Betsy is a recovery speaker, peer support mentor, and author of the memoir The Longest Match: Rallying to Defeat an Eating Disorder in Midlife.Betsy is a former hospital attorney and longtime high school tennis coach. She has also been a hospice volunteer and speaker on grief and end-of-life decision-making. For the past decade, she has led a bereavement group in her community. Now, her primary focus is on speaking, mentoring, and leading support groups in the eating disorder field. She has shared her story at treatment centers, conferences, and through webinars and podcasts, offering hope and guidance—especially to women in midlife facing similar challenges.Betsy holds a bachelor’s degree in psychology from Brown University and a Juris Doctorate from American University Law School. https://betsybrenner.com/

Periodically, I come across social media posts or comments questioning the legitimacy of work by a non-credentialed author, healer, or influencer. These questions stem from the fact that, as mental health becomes increasingly recognized as its own discipline, standards are developed to monitor and legitimize it. Academic degrees and clinical licensure help ensure credibility, ethical standards, and accountability. Scientific study moves therapy from the subjective experience of the practitioner to empirical observations of an intervention’s effectiveness. Seeking mental health treatment puts a person in the vulnerable position of sharing their most raw and painful experiences with a stranger. All of these measures can inform who to trust to provide safe and effective careAnd yet, while modern psychotherapy is a relatively new invention, psychosocial and spiritual healing have been part of societies perhaps since the beginning of human civilization. The complexity of the human mind makes it impossible for any one group to claim a monopoly on understanding how we heal.Many people in recovery encounter the limitations of professional fields like therapy or dietetics, raising the question: What is the role of coaches, spirituality, and alternative paths to healing? How can we open our minds to healing in all its forms—wherever it may be found—while also protecting ourselves and others from the harm caused by unskilled or unethical practice?In this episode, Haley Schiek and I discuss the role of coaching, spirituality, and alternative paths to healing. Haley shares her journey encountering the limitations of traditional treatment, then on the advice of her dietician, seeing an alternative healer with initial skepticism, and finally experiencing the profound effects of this type of work firsthand. Haley shares how she now integrates energy healing, emotional frequencies, and chakra yoga into her work, using what helped her to support others. Haley Schiek is a Certified Professional Coach (CPC), Yoga Teacher (E-CYT 250), & Peer Educator (CPE) who specializes in eating disorder recovery and psycho-spiritual wellness. She is the owner and founder of Cosana Coaching, “co” meaning “with” and “-sana” meaning health, wholeness, and healing. Cosana speaks to Haley’s belief that the deepest healing happens in community, when we work together. Having overcome anorexia, binge eating, and bulimia herself, Haley integrates her professional training in western psychology & eastern spiritual practices with her lived experience in eating disorder recovery to empower clients to overcome self-hate, reclaim their health, and achieve tangible recovery goals that enable them to live a pleasurable, present, values-driven life free from the horrific cycle of dieting for weight loss and the fear of losing control with food.Haley’s work focus on restoring hope and personal power. She uses a holistic, systemic lens, taking particular care to understand how her clients’ socio-cultural status, gender, and identity intersect with external power structures to impact their wellness. Haley has a decade of experience teaching yoga and facilitating classes and workshops across the United States, from the Coral Pink sand dunes of southern Utah to oceanfront classes in Puerto Rico. Understanding that each individual is a source of divine knowledge, Haley facilitates classes that encourage students to connect to the teacher within. Finding your groove in Ed recovery (group coaching – starts April 9th)https://www.yoga4eatingdisorders.com/finding-your-groove-in-ed-recoveryChakra Yoga Group Program (2025 Dates TBD)https://cosanacoaching.com/embodiment-activities/chakra-yoga-energy-healing-group-recovery-coaching-program/Summer Body Support Group (2025 Dates TBD, 4-week & 8-week options available, usually mid June- mid August)https://cosanacoaching.com/product/summer-bodies-group/Cosana Coaching Instagramhttps://www.instagram.com/cosanacoaching/?hl=en

As we learn and grow, we also begin to recognize the inadequacies of what we once believed. For healthcare professionals, this realization comes with the added weight of knowing that our past lack of knowledge may have hurt the people we worked with and cared for. In the eating disorder recovery field, there is an increasing movement away from restrictive dieting as research emerges showing that restrictive diets are unsustainable and often damaging. For a dietitian, the challenge of making this shift is often twofold: both personal and professional. How does a person navigate a shift that involves not only their relationship with their own body but also their professional identity?In this episode, Jenna Talleda shares her story of being shamed for her weight, engaging in restrictive dieting and weight loss, training as a dietitian in a weight-centric health model, ultimately discovering intuitive eating, and beginning to share it with her clients. Jenna reflects on her feelings about the work she did before discovering intuitive eating and gives us insight into the challenge of shifting one’s professional approach while also coming to terms with the past.This is a real, raw, and honest conversation—one that does not whitewash the difficulty of change but instead embraces it as part of what it means to be an evolving, growing person and professional.Jenna is an anti-diet dietitian and Certified Intuitive Eating Counselor with nearly 20 years of experience in the field. She works with women, female-identifying, and nonbinary people who struggle with feeling comfortable in their bodies, emotional eating, and the fear of body shaming in medical or family settings. A strong LGBTQ+ ally and weight-inclusive provider, Jenna encourages people to take up space and reject the idea that weight defines worth or health.Jenna also leads a group called Permission to Exist, which helps people in larger bodies navigate living in a fatphobic world.Work with Jennahttps://your-nutrition-ally.com/Learn more about her group:https://permission-to-exist-prof.my.canva.site/permission-to-exist

Eating disorders can be deadly. They have some of the highest mortality rates among mental illnesses, both as a direct result of medical complications and the increased risk of suicide. Because of this, clients with severe symptoms often require continuous support and medical monitoring that can only be provided in higher levels of care. Active suicidality and severe malnutrition can warrant hospitalization, sometimes involuntary hospitalization.But what happens when patients have experienced treatment trauma in higher levels of care? This question is especially painful in light of stories of abuse emerging from some of the larger treatment facilities. How do we support someone who has been traumatized by the very treatment they are now being recommended? How do we help a client who refuses higher levels of care despite engaging in life-threatening behaviors? And how do we balance the need for treatment without pushing someone into a place that has deeply hurt them before?In this episode, Sandi James shares her experience cycling through hospital stays and higher levels of care, being subjected to a "tough love" approach while struggling with opioid misuse and disordered eating, and ultimately finding recovery through purpose and harm reduction rather than abstinence and containment. Sandi discusses how she now works with high-risk clients in outpatient settings. She explores how to navigate suicidality while creating an environment where clients can share their deepest, most painful experiences without fear of hospitalization as an immediate repercussion.This episode contains some heavy topics that elicit strong feelings for anyone who supports someone with an eating disorder. Please take care of yourself and, as always, feel free to reach out with any reactions.Sandi is a registered psychologist with over 20 years of experience in mental health, eating disorder treatment, substance abuse recovery, and trauma care. She takes a harm-reduction, client-centered, inclusive approach to healing.Her primary focus is trauma recovery, especially in individuals with co-occurring substance use, food-related challenges, or compulsive exercise behaviors. She integrates evidence-based therapies with family coaching, and somatic and experiential therapies where appropriate. She is also a Certified Eating Disorder Recovery Coach through the Carolyn Costin Institute, and provides real-time support for recovery challenges. Sandi is currently pursuing a PhD on the intersection of eating disorders, substance use, and trauma. She brings both professional expertise and lived experience to her work, offering compassionate, informed guidance through recovery. You can find Sandi at https://www.sandijames.com.au/ or on instagram @sandi_in_the_world and @surfing_diving_psychologist

Does food choice affect mood, energy level, and quality of life? Are some foods healthier than others? Do whole foods, processed foods, and ultra-processed foods impact the body differently? What constitutes a healthy diet—if such a thing even exists?In the eating disorder recovery community, these questions have become highly charged and controversial. Many professionals in the field, having seen firsthand the harm caused by restrictive weight loss diets, adopt an "all foods fit" approach, emphasizing that any and all foods can provide nutrients and fuel for the body. Others argue that ignoring the potential negative effects of highly processed foods—and the ways in which profit-driven motives, rather than consumer well-being, influence their production—does a disservice to those whose bodies are sensitive to excessive food additives.In this episode, Rebecca Prolman approaches these questions with nuance and compassion. She shares her experience of altering food choices to manage small intestinal bacterial overgrowth (SIBO), a rare condition that significantly compromised her ability to function in daily life, and left her unable to remain awake past mid-day. She discusses making dietary adjustments while staying in touch with your body's signals rather than overriding them—and approaching these in a way that is wholesome and kind rather than anxiety-provoking.Rebecca is a licensed marriage and family therapist specializing in complex trauma and eating disorders. She approaches eating disorder treatment from a holistic, trauma-informed perspective.As a survivor of the troubled teen industry, Rebecca specializes in working with other survivors and serves as an expert trauma consultant for an attorney seeking justice for those affected. She also provides educational courses on healing from complex trauma, which can be found on her website,https://www.rebeccaprolman.com/Articles referenced in episode:On food additives banned in European countries that are allowed in the US: https://www.everydayhealth.com/diet-nutrition/why-are-some-food-additives-that-are-banned-in-europe-still-used-in-the-us/ Ultra-processed foods and addiction:  https://www.scientificamerican.com/article/food-can-be-literally-addictive-new-evidence-suggests/GMOs:  https://pmc.ncbi.nlm.nih.gov/articles/PMC3791249/ Pesticides:  https://pmc.ncbi.nlm.nih.gov/articles/PMC11664077/ Seed Oil Health Risks:  https://health.clevelandclinic.org/seed-oils-are-they-actually-toxicFood Dyes and ADHD:  https://pmc.ncbi.nlm.nih.gov/articles/PMC9052604/

Dissociative identity disorder (DID) is a condition in which an individual's personality fractures in response to extreme trauma. It is often portrayed in its most extreme and obvious iterations and is thought to be so rare that a clinician is unlikely to encounter it throughout their career. Because it has been designated to the realm of niche expertise, very few clinicians recognize DID when they do encounter it. As a result, people with comorbid dissociative and eating disorders may cycle through treatment centers without receiving appropriate care.In this episode, registered dietitian Annie Goldsmith shares how she became aware that DID is, in fact, much more prevalent and less obvious than mainstream rhetoric suggests. We discuss how, as providers, when we don't understand the protective function of symptoms, we can unintentionally perpetuate a dissociated person’s tendency to disconnect from internal experiences and create a dynamic that mirrors power structures from their past. Annie shares how recognizing dissociation in clients impacts the way she approaches treatment.Annie has an undergraduate degree in Brain and Cognitive Sciences and has completed graduate coursework in Human Nutrition. Her work has always been guided by a strong curiosity about how biology and psychology interact to shape human experience. Before pursuing a career in nutrition, Annie worked in a neuroscience research lab. She has experience treating eating disorders in PHP, IOP, and outpatient settings.Annie now runs Second Breakfast Nutrition, an outpatient group practice centered on weight-inclusive, social justice-oriented, and trauma-informed eating disorder care. She studied somatic and polyvagal-informed approaches to nutrition therapy at the Embodied Recovery Institute, where she now serves as faculty.Annie has presented on the intersection of eating disorders and dissociation at the ISSTD World Conference, EDRD Pro, and the Healing Together Conference through An Infinite Mind. She recognizes that her clients—many of whom are survivors of complex trauma and live with dissociative identities—are her greatest teachers. She is passionate about working with clients from a bottom-up approach, centering and supporting the wisdom of the body and its innate capacity for healing.To find Annie, visit https://www.secondbreakfastnutrition.com/

In eating disorder treatment settings, meal plan compliance is often used as the objective measure of safety and recovery, which then determines readiness to step down to lower levels of care. It follows that meal plan non-compliance is assumed to be a form of treatment resistance. The reality, however, is that meal plan non-compliance is not always a sign of resistance but can also indicate a mismatch between the meal plan and the unique characteristics of the person prescribed it. In this episode, registered dietitian, Brenna Veles, discusses how traditional eating disorder recovery expectations often fail to acknowledge the unique ways people on the autism spectrum experience the world. She explores how sensory sensitivities and differences in black-and-white versus nuanced thought processes, can affect recovery. Brenna shares her personal experiences and professional insights on creating environments that foster healing, rather than encouraging masking and conformity. Brenna is a registered dietitian with advanced training in treating eating disorders through the International Association of Eating Disorder Professionals. She works with clients to manage nutrition concerns that arise with ADHD, autism, anxiety, PTSD, depression, and eating disorders, whether these are physiological, like nutrient deficiencies or high/low blood pressure, or psychological, like guilt, and anxiety. As someone who is autistic, ADHD, and queer, Brenna is deeply connected to her work. She regularly attends neurodiversity and anti-racist trainings to ensure a healing space for all clients. Brenna currently practices in Texas and Wisconsin, with plans to expand to more Midwest states, and she is accepting new clients. She can be found on her website, https://www.breadbutternutrition.com/

Traditional medical and dietetic rhetoric around the relationship between food, weight, and health emphasizes correlations between BMI range and medical conditions. However, it often fails to consider how these correlations are interpreted and how they subsequently impact individual patients and society. In this episode, Laura Cohen shares her personal journey as a former registered dietitian trained in a weight-centric environment and parent of a loved one with an eating disorder who was harmed by many of the messages she was taught would promote health and well-being.Laura serves as a lead family mentor with Equip, which provides evidence-based care for eating disorders. She is also a board member of F.E.A.S.T, an organization that supports families of people affected by eating disorders. Laura is also an eating disorder recovery coach and shares insights on her website, https://noweighway.com/.

Can a clinician treat eating disorders while themselves in active recovery? Many of us in the eating disorder recovery field have our own lived experience. It follows that, just like for our clients, recovery is often nonlinear, clinicians are no exception. What happens when a clinician experiences a relapse? Can they still be trusted to effectively treat clients whose symptoms, in some ways, mirror their own? Will they be triggered by their clients' symptoms? In this episode, psychotherapist Lucie Waldman shares her experience grappling with these questions and the conclusions she has reached. Intro music: Isolated" Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 4.0 Licensehttp://creativecommons.org/licenses/by/4.0/

In this episode, I explain what this podcast is, why I created it, and how future episodes will be structured. The eating disorder professional world has become so politically and ideologically charged.  Issues related to food, health, body image, disordered eating, and the impact of these on marginalized communities spark heated debate among ED treatment clinicians and researchers. Many of us have personal recovery experience and care deeply about these issues. We've experienced the harm caused by dominant narratives firsthand and want to make a change. EDeology is a space for difficult conversations among professionals—not to debate the facts, but to share the personal and professional experiences that shape each of our narratives. Specifically, we’ll have two types of conversations: Personal story. Share your experience of recovery and/or working with the ED population and the conclusions it has led you to. What messages are you passionate about sharing? Why are these meaningful to you and how do they influence your approach with clients? Dialogue. Converse with another person holding different viewpoints on a mutually meaningful topic. Answer the above questions while holding space for another person to do the same. The goal is not to debate objective truth but to allow both stories to coexist harmoniously. This podcast aims to represent the political and ideological spectrum without tone or language policing.  My hope is that if, as professionals, we can hold each other’s stories with honesty, empathy, and compassion, we’ll be better able to do so for our clients.