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

Moralistic judgment is the root of so much division in our field and in our society. The perception of ideologically opposing groups as uninformed, evil, or inherently harmful is the surest way to eliminate any possibility of dialogue. Moralistic judgment can be a way of naming oppressive systems that have been enabled or whitewashed; but when directed at individual people, it becomes a painful and dehumanizing form of exclusion.

There's a particular brand of moral outrage that is reserved for fellow mental health practitioners. It's designed to protect the integrity of our profession and is expressed in statements such as “how can you_________, and still be a therapist”, or “this person should never have been treating eating disorders to begin with”. In clear cases of abuse and exploitation, this is true. However, when applied more broadly, we run the risk of flattening the humanity of the practitioner and the experience of those who benefited from their work 

I recently came across an Instagram post by Kayla Perry, our guest today, where she spoke about a psychotherapist who had benefited her tremendously, who she later discovered served a jail sentence for unlicensed practice and insurance fraud. In this episode, we dive deeper into Kayla’s experience with this therapist before her sentencing and her perceptions of her afterward.

I hope that you, the listener, will understand that this conversation is not condoning deception, but inviting you into the contradictions that live inside each of us, and exploring the question: are we defined by our worst behaviors?

Kayla Perry is a Licensed Behavior Analyst with master’s degrees in Clinical Psychology and Applied Behavior Analysis. Known for her bluntness, curiosity, and love of debate, she takes a practical, direct approach that emphasizes common sense, critical thinking, and honest conversation over rigid clinical jargon. You can find Kayla on her Instagram and substack accounts linked in the show notes.

Connect with Kayla

Subtack: honestlyunorthodox.substack.com. 

Instagram: @kaylas.common.sense 

Connect with Elka

Website: https://cubacubcounseling.com/

Email: [email protected]

Many of the hot topics in eating disorder recovery—health at every size, food neutrality, whether some foods are manufactured with addictive qualities—extend beyond eating disorders and to the messages we hold and teach our children about food and bodies.

In this episode I am joined by Katie Gilder and we talk about how we address these issues with young kids. We discuss whether there's “healthy” vs. “unhealthy” foods in our homes, if we communicate distinctions between food types (such as meal time vs dessert) to our kids, how we respond to the children's comments about different body types.

Katie is a registered dietitian with 15 years experience supporting clients across the lifespan. She specializes in treating adolescents and young adults with eating disorders, and has extensive training FBT(TAY). Katie works through a Health at Every Size lens and helps clients access intuitive eating. Katie is also a Board Certified Specialist in Sports Dietetics, and has a special interest in working with athletes.

Connect with Katie: https://www.cultivatecounselingmn.com/katiegilder

Connect with Elka:https://cubacubcounseling.com/

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.

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 Allyson

Instagram: @bodyjustice.therapist

Website: www.eatingdisorderocdtherapy.com

Body Justice Podcast: https://open.spotify.com/show/1jvTCV9IJ1YpIym9YmZQda?si=e9872c6dbef24dc5

More on Elka: https://cubacubcounseling.com/ 

Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3