Primary Therapist Tali Yuz Berliner, PsyD has run a body image group at Oliver-Pyatt Centers for almost three years. In her group, she works with clients on accepting their bodies and letting go of the “thin ideal”. In her writing, she shares about her use of cognitive fusion in aiding clients through this process.
After almost three years of running body image group at the comprehensive level of care, I have learned a lot from the many incredible clients I have had the pleasure to sit with. One significant theme that is revisited time and time again in my group is the need for the women to “grieve the thin ideal.” It has been important for these women who suffer with eating disorders to not only accept that they cannot strive for thinness any longer but also to accept that the body that they have been chasing will not bring them the fantasy life they envision. I often use the ACT(Acceptance and Commitment Therapy) term cognitive fusion, to explain this concept to the group. Cognitive fusion proposes that certain attachments are made through verbal interactions that people spend endless amounts of energy trying to prove or disprove. People will do so despite the thought not being accurate in the present moment or having evidence to the contrary.
The way we (I say “we” since the process is always collaborative with the clients) tackle this theme in my group is two-fold. First, it is imperative to challenge the distorted thought that a specific body type will lead them to happiness. This is done through a variety of exercises from several modalities, such as:
Looking for evidence that challenges the thought
Exploring body image development
Identifying and connecting other values
Challenging the media
In addition to the exercises, it is important to openly process and review the topic of body image acceptance and how it occurs on a continuum. We explore how it begins with tolerating the body, then accepting the body, then liking it, and eventually one day learning to love it. Exploring where the woman is on the continuum and moving them through it allows the loss of the thin ideal to be less painful.
Second, it’s important that we validate the loss of this ideal. The work can often mirror general grief and loss work whereas the women can experience similar emotions to the loss of a loved one. It is necessary that they process how this void has and will impact them in the future. We continuously reinforce the significant need to strengthen and connect to other roles and values outside of the body/appearance and the eating disorder. The women explore the integration of values to replace what is lost and to reinforce the message that the idealized body will not bring them to a happy life but instead being connected to others and immersed in their values will lead them to life satisfaction. The above is a snapshot into a very complex process that is inherent in both group and individual sessions. My hope is for these women to start to trust their values and their healthy voice to come to the understanding that there is more to life than the thin ideal.
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