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A Systemic Approach to Working with Eating Disorders

A Systemic Approach to Working with Eating Disorders

by Esther Kane, MSW, RCC, RSW

Although it seems unreal to me, I have been working as an Eating Disorder therapist for almost twenty years. Now, at the age of 45, I am even more blown away by the fact that I have lived just over half of my life thus far without being in the grips of the eating disorder which nearly killed me during my first half. I am honoured to be writing this post for other BCACC members and my hope is that I will offer something you can use in your work with clients who struggle with food and body image.

Also, if you live in Victoria, I will be presenting a Counsellor Café on this topic on March 15, 2017 from 7-9 p.m. I’d love it if you would join us to discuss this important issue which affects so many of our clients.

I’ll start off by giving you some startling statistics:

  • A study on eating problems in Canadian women found that 90% “dislike” the shape and size of their bodies and 70% are constantly dieting. 20% of these women develop serious problems concerning food and weight.
  • At least 50% of young girls in Canada begin dieting before the age of nine: 81% of 10-year olds diet and at least 46% of 9-year-olds restrict eating
  • The fear of fat is so overwhelming that young girls have indicated in surveys that they are more afraid of becoming fat than they are of cancer, nuclear war, or losing their parents
  • One US survey found that one out of every two women are on a diet and that the majority of women fear becoming fat more than they fear dying

Through my personal and professional journey with this issue, I have come to the conclusion that eating disorders do not exist in a vacuum, and that in order to understand and effectively work with people affected by disordered eating, we need to step outside of an individualistic focus, and get curious about all of the systems affecting an individual’s life and its role in maintaining or healing the eating disorder. The following is an overview of an approach I have developed over many years which I have found to be highly effective in working with women with eating disorders.

A Systemic Perspective

The following diagram outlines the various systems I include when working with someone with an eating disorder:



Eating Disorder and the Self:

In the centre of the diagram above is the aspect of self- the individual struggling with an eating disorder. When working within a systems framework, I like to explore the following questions with clients coming from a place of curiosity and kindness towards this aspect of selfhood:

Who do I see myself as right now? (Exploring who that person is besides someone with an eating disorder)

Why an eating disorder?

What is the wisdom which led me to its development? (i.e., I assume that clients originally developed an eating disorder as a ‘solution’ to a problem they were having at the time, but at this stage, their original ‘solution’ has now become another problem in their life)

What has my journey up until this point been? How did I get here?



Exploring family systems in the therapeutic context is essential because everybody is attached to family members. Whether a person is cut off from family or has contact with them every day, family relationships are a powerful force in how we conduct our everyday lives. By exploring family systems, people can learn more about their own self-definition and how they function in relationships in every area of their lives.

Once we understand where our definition of self comes from, we can be empowered to redefine our “self” in a new and freeing way. By revisiting family-of-origin experiences from a place of curiosity, we can come from a powerful place of choice, rather than emotional reactivity.

I find family-of-origin work incredibly important because eating disorders are often passed down through the generations; therefore it’s important to explore the history of disordered eating in families and to break the cycle in this and future generations.

Here is an exercise I often use with clients to explore concerning family-of-origin and eating disorders:

Conjure up in your mind a memory of what meals were like in your family when you were growing up- draw the table and everyone there.

What was the atmosphere like- pleasant, unpleasant, mixed?

Who was present at the table when you ate the main meal of the day?

Who served the food?

Did you eat everything on your plate? Were there any rules about wasting food?

Did you have a choice about what or how much you ate?

Was food used as a reward or punishment?

Do you remember any meals in particular?  What was happening in the family at those times? Describe these in detail.

Was anyone in your family on a diet or obsessed with food and weight or how they looked?  Who was it?  What did you learn about food and your body from that person?


Ethnocultural Perspective:

One’s ethnicity and cultural heritage shape us in many ways and often greatly influence how we define ourselves:

For example, in working with a client who was half First Nations and half Caucasian, she saw herself mostly as “white” and felt shame about being “half Native”. This led to an exploration of how her eating disorder was shaped by the contradictions she experienced within herself and from the culture at large about being two-dimensional in terms of her ethnicity and heritage. A lot of her healing came from reexamining what it meant to her to “look Native” and to embrace, rather than shun that part of herself.


Being Female In A Patriarchal Society:

Clients who struggle with food and body image issues often find it helpful to explore society’s beauty standards and how they have attempted to “fit” them. I explore with clients the socio-cultural elements that promote disordered eating  (thinness ideal, female beauty ideal, so much focus on how you look rather than who you are) and help them to examine them and externalize them and make choices based on their own needs; rather than externally-based expectations:

Whose voice is it who tells you that you need to be a size zero?

When you look at women in magazines and on television, how do you feel about yourself? Why?

When you think of your closest girlfriend, what qualities in her do you admire? Why? Do any of them have to do with the shape and size of her body?


Body/Mind/Spirit Connection:

Lastly, I find it very helpful to help clients connect their concept of self and all of the systems they are connected with to the ‘bigger picture’- exploring existential questions such as:

If there is a Higher Purpose to my suffering, what could it be?

What gives my life meaning and purpose?

Do I believe in a Higher Power? If so, what would I ask for from him/her/it?


If you are interested in knowing more, don’t miss Victoria’s upcoming Counsellor Cafe on March 15th where she will be presenting on her system’s based approach to eating disorders.

Esther Kane, MSW, RCC, RSW is a psychotherapist in private practice in Victoria, B.C. and author of, It’s Not About the Food: A Woman’s Guide To Making Peace with Food and Our Bodies.

Interested in being a guest blogger? Email your suggestions and feedback to: [email protected]