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

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

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

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 Menakem

To connect with Marcia, visit https://marcianickow.com/

To connect with Elka, visit https://elkacubacub.com/ and https://www.psychologytoday.com/profile/1155490

If 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=107239699529464533283

Connect 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/