Is It Time to See an Eating Disorder Therapist? What Outpatient Therapy Can and Can't Do in NYC

If food, eating or your body is taking up more of your mind than you want it to, it may be time to talk to an eating disorder therapist. You don't need a formal diagnosis, and you don't need to look a certain way. At CAP, we see disordered eating as a way the nervous system tries to regulate overwhelming states, not a failure of willpower.

This guide covers signs it may be time to reach out, who outpatient therapy is for, what it can and can't do, and when more support is needed. You can also read about our approach to eating disorder therapy in NYC.

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What are signs it might be time to see an eating disorder therapist?

There's no single threshold. Many people wait because they don't think they're "sick enough." Eating disorders happen at any weight and in bodies of all sizes. It may be time to reach out if:

• Thoughts about food, eating, exercise or your body crowd out other parts of your life
• You feel driven to restrict, binge, purge or exercise in ways that feel hard to stop
• Eating comes with a lot of secrecy, guilt or shame
• Food has become one of the main ways you calm down, numb out or feel in control
• You avoid meals with other people, or plan your day around food rules
• People close to you have said they're worried

The National Institute of Mental Health describes eating disorders as serious illnesses that can be life-threatening. It also notes they can be treated successfully (NIMH, n.d.). Reaching out early helps.

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Who is outpatient eating disorder therapy for?

Outpatient therapy means regular sessions, usually weekly, while you live your normal life. It's a fit for people who are medically stable enough for weekly therapy. At CAP, that includes people working with:

• Binge eating
• Bulimia
• Restrictive eating
• ARFID (avoidant/restrictive food intake disorder)
• Orthorexia
• Compulsive exercise
• Body image distress

It's also for people stepping down from a higher level of care, such as a day program or residential treatment, who want ongoing support in recovery.

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What can outpatient eating disorder therapy do?

At CAP, we see eating disorders through the same lens as other compulsions. They're ways the nervous system tries to regulate states that feel overwhelming. Therapy can help you:

• Understand what the eating struggles are doing for you. Often they're a way of coping with feelings that had nowhere else to go. Understanding that tends to reduce shame.
• Build other ways to regulate. Somatic Experiencing helps you notice hunger, fullness, tension and emotion as separate signals, slowly and at a pace your system can tolerate.
• Find words, or images, for what's hard to say. Art therapy can give form to feelings that show up as "I feel fat" before they have words.
• Work with what's happening between you and others. Gestalt therapy looks at shame, control and closeness as they show up in the present, including in the room with your therapist.

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What can't outpatient therapy do on its own?

Being honest about limits is part of good care.

• It isn't medical care. Eating disorders can be medically serious. For anyone with an active eating disorder, we strongly recommend also seeing a medical provider who monitors your physical health.
• It isn't nutrition counseling. We also strongly recommend working with a registered dietitian. With your consent, CAP coordinates with your medical provider and dietitian, so your care works as a team.
• It isn't the right level of care for everyone. Some situations need more support than weekly therapy can safely give. More on that below.

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When is a higher level of care needed?

If you need more support than weekly therapy can safely give, we'll help you find a higher level of care and keep supporting you through that transition. Signs include:

• Medical instability
• Rapid weight loss or very low weight
• Frequent purging
• Being unable to interrupt behaviors between sessions
• Safety concerns

Higher levels of care include intensive outpatient programs (IOP), partial hospitalization programs (PHP), residential treatment and inpatient care. We help clients connect with established eating disorder programs in the NYC area and the tri-state region. When you step down from a program, you can return to CAP for ongoing outpatient support.

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What about children and teens?

For children and teens, we work closely with parents and with the child's pediatrician and dietitian. When family-based treatment (FBT) is recommended, we refer to FBT-trained providers. CAP can offer individual or creative arts therapy alongside FBT.

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What should I ask an eating disorder therapist?

1. What's your training in eating disorders?
2. How do you work beyond talk therapy, for example with the body or art?
3. Do you coordinate with medical providers and dietitians?
4. How do you decide when someone needs a higher level of care, and how do you help them find it?
5. What's your view on weight? (Look for a therapist who doesn't make weight change a goal of therapy.)
6. Are you licensed in the state where I'll be during sessions?

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How does CAP approach eating disorders?

CAP Therapy NYC is weight inclusive and body neutral. Weight change is never a treatment goal here, and we don't minimize the medical risks eating disorders can carry. We work with eating disorders and disordered eating through Somatic Experiencing, Gestalt and art therapy, in coordination with your medical provider and dietitian. Our founder, Jennifer Byxbee, LCAT, ATR-BC, SEP, is currently training in eating disorders, addictions and compulsions at the William Alanson White Institute.

Learn more about somatic therapy and art therapy at CAP. We see clients in person at 150 W 28th St in Chelsea or online across NY, NJ and CT, always with a clinician licensed in the state you're in. Book a free 15-minute consult.

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FAQ

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Do I need a diagnosis to see an eating disorder therapist?

No. You don't need a formal diagnosis to start. If eating or body image is causing you distress, that's enough reason to reach out.

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Can I have an eating disorder at a "normal" weight?

Yes. Eating disorders happen at any weight and in bodies of all sizes.

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Is outpatient therapy enough?

For many people who are medically stable, yes, especially with a medical provider and dietitian on the team. If you need more support than weekly therapy can safely give, we'll help you find a higher level of care.

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Does CAP work with dietitians and doctors?

Yes. We strongly recommend both for anyone with an active eating disorder, and with your consent we coordinate with them.

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Do you work with children and teens?

Yes. We work closely with parents, pediatricians and dietitians. When family-based treatment is recommended, we refer to FBT-trained providers and can offer individual or creative arts therapy alongside it.

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Can I come back to CAP after a program?

Yes. If you step up to a higher level of care, you can return to CAP when you step down.

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Where can I find support outside therapy?

The National Alliance for Eating Disorders offers a free helpline staffed by licensed, eating-disorder-specialized therapists: (866) 662-1235, weekdays 9am–7pm ET.

Eating disorders can be medically serious. A medical provider should be part of your care, and if your health is at risk, a medical evaluation comes first. Some situations need more support than outpatient therapy, and we'll help you find it.

National Alliance for Eating Disorders helpline: (866) 662-1235, weekdays 9am–7pm ET.

This post is for education and isn't a substitute for professional care. If you're in crisis, call or text 988.

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References

• National Alliance for Eating Disorders. (n.d.). What is an eating disorder helpline? https://www.allianceforeatingdisorders.com/what-is-an-eating-disorder-helpline/
• National Institute of Mental Health. (n.d.). Eating disorders. https://www.nimh.nih.gov/health/topics/eating-disorders