At some point in almost every therapist’s career, someone arrives in therapy with a complicated relationship with food. It might be named clearly, as binge eating or bulimia, or it might surface as a passing comment about dieting, a pattern of emotional eating, or a deep ambivalence about the body. Whatever form it takes, working with people who misuse food calls for something specific from us: not just empathy, but understanding about the root of the problem.

That understanding begins, argues Professor Julia Buckroyd, with attachment. And once you see disordered eating through that lens, a great deal begins to make sense.

Join us on Friday 2nd October with the amazing Professor Julia Buckroyd, whose career working with disordered eating and eating disorders spans over 40 years. She brings with her not just a wealth of experience, but also a teaching style described by previous delegates as engaging, approachable, energising and humorous. Click here to read more and book your place on “Working Therapeutically with Disordered Eating and Eating Disorders”.

Food as Communication

One of the most important shifts a therapist can make when working in this area is to stop seeing the eating behaviour as the problem and start seeing it as a solution. A provisional, imperfect, sometimes dangerous solution, but a solution nonetheless.

Food misuse, whether restriction, bingeing, purging, or chronic emotional eating, is often a form of self-regulation. It is what a person reaches for when they have not developed, or have lost access to, other means of managing overwhelming feeling. The food is not the enemy. It is, in its own way, a coping strategy that once worked, or at least worked well enough.

This reframe is clinically significant. It changes how we assess, how we listen, and how we intervene. And it places the therapeutic relationship, rather than behavioural change, at the centre of the work.

The Role of Attachment History

Julia Buckroyd, Emeritus Professor of Counselling at the University of Hertfordshire, has been working in the field of eating disorders since 1984. Her approach places attachment theory at the heart of clinical work with this client group, and the evidence supports her.

Poor attachment history is closely associated with alexithymia, that is, difficulty identifying and naming emotional states, with low self-esteem, poor body esteem, difficulty in self-soothing, and challenges in forming and sustaining close relationships.

For many people food can become a substitute for what early relational experience failed to provide: comfort, predictability, self-regulation, a sense of control. Understanding this means we can begin to build something different alongside the client, rather than simply asking them to stop doing what, for now, holds them together. Food is rarely just food. When we learn to hear what it is saying, our clients benefit enormously.

What This Means in Practice

Effective work with clients experiencing disordered eating requires attention to several overlapping areas: the client’s emotional language, or the extent to which they can name and locate feeling in the body; their attachment history and the relational templates they carry; self-esteem and body esteem; identity; and the quality of their current relationships.

Crucially, this is active work. It is not enough to provide a warm, containing space and hope that insight follows. People in this group often need help developing concrete skills for emotional regulation, alternative self-soothing strategies, and a narrative that makes sense of why food became so significant. The therapist’s role is not passive. It involves curiosity, challenge, and a willingness to engage directly with the client’s experience of their body, their hunger, and their history.

A Word on Weight Loss Medications

The clinical landscape has shifted notably in recent years with the widespread availability of GLP-1 receptor drugs, the injectable weight loss medications that have become a significant presence in many clients’ lives. Therapists working with food and body issues are increasingly encountering clients who are using, considering, or being pressured towards these medications.

This raises important clinical questions. If food is functioning as emotional regulation, what happens when appetite is chemically suppressed without addressing the underlying need? How do we support a client navigating rapid body change, and the relational and identity shifts that come with it? These are not straightforward questions, and they deserve considered, informed responses.

Knowing When You Are the Right Therapist

One of the most useful things any therapist can develop in this area is the capacity to assess clearly (you may not call it assessment, but you get what we mean here). Not every practitioner is the right fit for every client, and some presentations, particularly those involving significant medical risk, will require specialist input or referral. The ability to identify a narrative that gives meaning to a client’s eating behaviour, and to know when that narrative is beyond our current scope, is a clinical skill in itself.

Good assessment in this area means understanding the spectrum from disordered eating, the patterns that cause distress or dysfunction without meeting full diagnostic criteria, through to the clinical eating disorders. It means being able to hold complexity without rushing towards a hypothesis or formulation, and to sit with someone who may be ambivalent about change.

Developing Your Practice in This Area

If this is an area you want to develop, Professor Julia Buckroyd’s workshop, *Working Therapeutically with Disordered Eating and Eating Disorders*, offers a thorough and grounded introduction. Running online via Zoom on Friday 2nd October 2026, for a full day (10am to 4pm GMT). A catch-up recording is available for 28 days for those who cannot attend live.

You can find full details and booking information here: Working Therapeutically with Disordered Eating and Eating Disorders. Tickets: £119 or £99