How Narrative Therapy Can Help People with Eating Disorders

In this blog, Credentialed Eating Disorder Clinician, Jaclyn Cunningham, explains how narrative therapy can support eating disorder recovery.

What is narrative therapy?

Narrative therapy is a counselling approach that helps people understand and reshape the stories they tell about their lives. It focuses on telling these stories in ways that highlight strengths, skills, and acts of resistance, rather than focusing primarily on problems.

Even when problems are big or life-threatening, narrative therapy is based on the belief that people are never passive in the face of difficulties. Instead, it assumes that people are always resisting and responding – developing new skills, strategies, and ways of coping, as they navigate and survive the impact of these problems over time. ¹ ²

Narrative therapy views people with lived experience as the experts in dealing with their own challenges.

Narrative therapy refers to this as “insider knowledge”, and part of narrative therapy can also involve supporting people with lived experience to share their “insider knowledge” with others dealing with the same kinds of problems.

What does “experience near” mean?

Eating disorders are serious and complex mental health conditions that involve disturbances in behaviours, thoughts and feelings towards food, eating, and the body. Everyone’s experience of an eating disorder is different. For example, someone may have a diagnosis of anorexia nervosa, but it isn’t assumed that the therapist knows exactly what they’re experiencing or that the symptoms and problems will be exactly as described by the DSM-V criteria for that disorder.

The concept “experience near” is regularly used in narrative therapy, and focuses on understanding a person’s experiences from their own perspective, often using their own language and word choices.

For someone living with an eating disorder, an “experience near” description means exploring the specifics of their experience and how it may have changed over time. This can include food-related behaviours, emotional challenges, and thought patterns. This may be the same as the medical diagnosis, like “anorexia nervosa”, or someone may prefer to describe their experience in another way, such as saying “ana”, “the ED voice”, “food noise”, or the “binge eating monster”. It’s about whatever feels more accurate to the individual.

Separating the person from the eating disorder identity

In narrative therapy, the concept “externalising the problem” is used to create a sense of separation between the person having the experience and the problem itself. In this way it’s possible to take a position against the eating disorder, and work together with a therapist, perhaps with the support of family and friends, to break free from or resist the ‘problem’ and reconnect with those stronger stories.

People living with an eating disorder may believe that there is no problem with their behaviours, and that everything is ‘fine’ – despite experiencing significant physical and psychological impacts.

Working with a therapist who specialises in narrative therapy can support people in identifying the impacts of the eating disorder and start questioning if the eating disorder is really ‘delivering’ on its promises.

Eating disorders can also impact people’s family, friends, and other important relationships, often leading to worry, distress, and even conflict. Family and friends can support the person living with the eating disorder by viewing the person as separate from the ‘problem’ and supporting their loved one in working out ways to resist or break free from the eating disorder.

One way to do this is to explore the ideas, beliefs, and stories that may be fuelling the eating disorder, such as the belief that someone’s worth is defined by their weight or appearance. Often these beliefs and stories are internalised from broader cultural messages.

Narrative therapy encourages people to ask:

Where did these ideas come from?
How do they impact me?
In what environments are they stronger?
Do these ideas really benefit me?

Family and friends can further support by questioning these ideas themselves and not perpetuating, even accidentally, these harmful messages. This includes things like not making comments about other people’s weight or size, not talking about food choices as ‘good’ or ‘bad’, and not focusing solely on weight as a measure of someone’s health or wellbeing.

Resisting or breaking free from these ideas, and from the influence of an eating disorder, can take time. The recovery journey is often not linear. However, every moment of ‘resistance’ is important – from being able to enjoy a meal with friends, to attending a support group.

Narrative therapy explores these moments to understand what they might say about someone’s hopes, intentions, desires, values, or purpose. What do these actions reveal about that person’s preferred identity?

Narrative therapy within a multi-disciplinary treatment approach

Eating disorder care and treatment may involve a multidisciplinary approach, which can include medical monitoring and nutrition rehabilitation. Within this team, narrative therapy practitioners recognise the importance of medical stabilisation while working alongside the person, their family, and their health team to prioritise the individual’s agency. This collaborative effort supports the person to remain the author of their own journey towards eating disorder recovery. ² ³

References

¹ White, M. (2007). Maps of Narrative Practice. W. W. Norton & Company.
² Grieves, L. (1997). “From the Inside Out: Narrative Therapy and Eating Issues.” International Journal of Narrative Therapy and Community Work, (1), 48-56.
³ Maisel, R., Epston, D., & Borden, A. (2004). Biting the Hand that Feeds You: Inspiring Resistance to Anorexia/ Bulimia. W. W. Norton & Company.

About the Author

Jaclyn Cunningham is an Accredited Mental Health Social Worker (AMHSW) and a Credentialed Eating Disorder Clinician based in the Northern Rivers, NSW. While Jaclyn is trained in a range of clinical modalities, she is most passionate about narrative therapy and its effectiveness in situating problems in context and restoring a sense of power to individuals. Jaclyn provides psychological therapy both in person and online via jaclyncunningham.com and can see people independently or with an Eating Disorder Plan (EDP) referral. When she’s not working, she’s usually at the beach, reading, dancing, or at home with Kitty.

Get Support

If you’re struggling with an eating disorder, disordered eating or body image concerns, please know that help is available. For confidential and free counselling, call the Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or chat online or email, 7 days a week, 8am-midnight (AEST/AEDT).

Find an eating disorder professional – search Butterfly’s National Referral Database to find eating disorder practitioners closest to you.