What to Expect in Eating Disorder Therapy (And What It Actually Feels Like)
Written by Dr. Colleen Reichmann- clinical psychologist, and director of Wildflower Therapy
If you’re here, you’re probably wondering some version of:
“What am I walking into?”
“Are they going to make me eat? What happens if I can’t handle gaining weight?”
“What if I’m not ready to recover?”
So-Let’s get into it. Because we are a group of therapists that specialize in the area of eating disorders. And, many of us have been through this kind of therapy and recovery ourselves. So we want to give you the honest low-down.
Because eating disorder therapy isn’t just a checklist of what happens in session.
It’s also a very human, often messy experience that most blogs don’t fully capture. It’s a science and an art, which makes it tough to capture in words, but dammit we’re going to try.
First: The Basics (What Actually Happens)
So as you probably know, most eating disorder therapy starts with an intake session. (Similar to any other kind of therapy.)
This is where your therapist gets to know:
• your relationship with food, exercise, and your body
• your history (when things started, what’s changed)
• what’s bringing you in now
• other things about you and your life experiences outside of just food/body image struggles
• what you want-even if that’s unclear
You don’t need to have the “right” answers. Early sessions are often about understanding you and building a plan, not forcing immediate change. They are often the session in which you will receive your diagnosis. The therapist will also likely create some goals for you at the end of the session (these are just to structure the therapy, and to help make sure you and both on the same page and staying on course throughout the treatment!)
From there, therapy typically includes:
• exploring thoughts, emotions, and patterns around food and body image
• learning coping tools (for anxiety, urges, and overwhelm)
• gradually working toward more consistent nourishment
• addressing underlying factors (perfectionism, childhood, trauma, identity, relationships)
High quality eating disorder therapy is highly individualized. There is no one-size-fits-all approach, and good therapists know that because these illnesses are so tricky, a certain amount of creativity needs to be infused into the process.
Often, therapy is also part of a broader support system that may include nutrition and medical care. Those recommendations (dietitians and doctors) will likely also be provided at the end of the first session, and the therapist will help you connect with these people. They will then coordinate with them with weekly or biweekly calls to ensure continuity of care, and to make sure that all members of the team are helping you in the most consistent, best way possible.
Now: What It Actually Feels Like (The Part No One Tells You)
This is where most blogs stop. But this is the part that actually matters, right? It’s probably why you found yourself searching for answers around this topic. How will I feel during this process?
1. You might feel deeply ambivalent
Part of you wants recovery.
Part of you really, really doesn’t.
Both parts are welcome here. You don’t have to be “ready” to start. This is actually a key differentiating factor for eating disorders from other mental health struggles. There is often a deep ambivalence towards getting better. Good therapists get this, and will be patient and steady throughout your ebbs and flows in motivation. Promise.
2. You might cry about things that feel “irrational”
Like:
• a snack
• a number
• a comment someone made years ago
And your therapist won’t think it’s ridiculous-because it isn’t. (It’s also not just a snack, or a number. It’s about what it represents for you- but that’s a topic to get into in your sessions, areweright?)
3. You might feel worse before you feel better
Not because therapy is harmful, but because you’re:
• paying attention instead of numbing
• eating more consistently
• challenging long-held beliefs
This is all wildly uncomfortable. It almost feels like frostbite as it thaws. But just remember, no one ever got better from frostbite by running back into the blizzard.
4. You don’t have to “perform recovery”
You don’t need to:
• say the right thing
• be perfectly motivated
• make progress at the “right” pace
Showing up is enough. Full stop.
5. The relationship matters more than the techniques
Yes, we use evidence-based approaches like CBT and DBT.
But research shows us that a huge amount of what actually drives change is:
• feeling understood
• feeling safe enough to be honest
• trusting your therapist
Therapy works best when it feels like a deeply connected, compassion-filled relationship-not a performance.
A Note on the Food (Because You’re Probably Wondering)
Depending on your needs, therapy may include:
• talking about eating patterns
• setting small, collaborative goals
• exploring fears around certain foods
In some cases, you may also work with a dietitian.
But therapy is not about:
• forcing
• shaming
• taking control away from you
It’s about helping you build a relationship with food that feels more stable, flexible, and free.
How Long Does Eating Disorder Therapy Take?
There’s no universal timeline.
Recovery depends on:
• how long the eating disorder has been present
• what it’s serving for you
• your support system
• your pace
The research indicates that 6 months to 2+ years is most common length of ED therapy for outpatient care. Many clients find some degree of relief after 9–18 months of consistent therapy.
For many people, this is not a quick fix. It’s a process of building something new.
How to Know If It’s Working
Progress doesn’t always look like loving your body or never thinking about food. (In fact, we would venture to say it rarely looks like this…)
Sometimes it looks like:
• eating the thing anyway
• staying at the table
• asking for help
• noticing the thought instead of obeying it
• Feeling 2% more flexible over time.
• Finding that you randomly went a few days without having those cruel thoughts about your own body
'Small shifts matter! And they slowly build upon one another.
If You’re Still Unsure About Starting
That makes sense! Eating disorders are complex, and letting go of them can feel scary, even if they’re hurting you. You don’t have to be all-in to begin.
You just have to be willing to be curious about what might be possible.
Looking for Eating Disorder Therapy in Philadelphia or the Main Line?
At Wildflower Therapy, we specialize in working with children, teens, adults struggling with body image and eating disorders (as well as parents and caregivers navigating children or teens who are struggling with eating disorders, body image concerns, highly selective eating, and the emotional toll of caring for a struggling child).
Our therapists also support children, teens, adults, and families who are navigating things like ADHD, anxiety, depression, OCD, and maternal mental health/infertility.
We provide therapy in Philadelphia (and virtually for anyone in Pennsylvania, New Jersey, Delaware, Florida, South Carolina, Vermont, Virginia, Ohio, and Massechusetts.) We work with children, adolescents, and adults. We are neurodivergent-affirming, queer-celebratory, and feminist-relational in our work.
You do NOT have to do this alone. Many of us have been in your shoes. We know how hopeless it can feel. And we want to shine the flashlight in-and show you the way out.
Reach Out Today!
If you’re looking for therapy for your child or yourself in one of the states mentioned above, or are seeking virtual parent coaching or consultation anywhere in the world, we invite you to reach out for your free consultation call.