How Therapy for Eating Disorders Actually Works
For the person who has looked into this before, and wants to understand how change happens before deciding to try again.
In-person in Silver Spring, MD · Virtual in Maryland, New York, and all PsyPact states
If you have looked into this before, you have probably read that therapy helps and been given very little sense of how. That gap is fair, and it matters more for the people I work with than for most, because you are used to understanding how something works before you commit to it. So this page is about the how: how change actually happens in this work, what our sessions are like, and why therapy for eating disorders, perfectionism, and anxiety in high-achieving adults often has to go about it differently than the therapy you may have already tried.
What working together actually looks like
Sessions are a conversation, not a worksheet. We start where the pressure is, and over time we work toward what is underneath it. Early on, much of the work is simply saying things out loud that you have never said to anyone, in a room built to hold them without judgment or alarm.
From there it becomes more active: noticing the patterns as they happen, understanding where they came from, and slowly building other ways to meet what they have been managing. I am not a blank screen. I reflect, I push gently, and I am direct with you, because the people I work with tend to want honesty more than reassurance.
How does change actually happen?
The patterns I work with, disordered eating, perfectionism, chronic anxiety, are not held in place by a lack of information. You likely understand yours better than most people around you. They persist because they are doing a job, and because they run below the level of conscious choice. Change happens by working on more than one layer at once.
The thought and the moment
COGNITIVE BEHAVIORAL THERAPY
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Some of the work is close to the surface: the all-or-nothing rules, the catastrophic read on a small mistake, the inner critic treated as if it were simply telling the truth. We make those visible and testable rather than automatic, so they stop running unchecked. This is where a lot of the early relief comes from.
Where it came from
PSYCHODYNAMIC WORK
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Underneath the patterns is almost always a history: what the control, the restriction, or the achievement was originally for, and what it has been protecting you from. Understanding that is often what actually loosens a pattern's grip, more than any technique aimed at the surface. It is also the layer that more general or more manualized therapy tends to skip.
Living differently while it's still hard
ACCEPTANCE & COMMITMENT THERAPY
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Insight does not automatically become change. The last layer is building the capacity to act on what matters to you before the discomfort lifts, and to stay with a feeling without the old strategy for escaping it. This is how the changes hold once the sessions end.
I do not run these as separate protocols. In practice they are braided together, matched to you and to what a given week needs. The point is not the method. It is that a pattern this old usually has to be met on more than one level to actually move.
How is this different from therapy I've already tried?
Most of the people I work with have tried therapy before, and the most common thing they tell me is that it treated the surface without reaching the pattern underneath. The anxiety got managed, or the eating got monitored, but the perfectionism and the need for control driving both never got named.
Three things tend to make this different. I specialize in the high-functioning presentation, the version that looks fine from the outside, which is easy to miss and often treated as milder than it is. I treat the underlying pattern, the perfectionism and control, as the root rather than a footnote, because for high-achievers it usually is. And I integrate the three layers above rather than running a single method, because one approach tends to reach one layer and leave the others intact.
None of that is a knock on the therapy you had. It is a different focus, aimed at a different reader.
How this works for perfectionism, anxiety and body image
The same layered approach carries across what I treat, because these patterns share the same roots. Most of the people I work with are navigating more than one of them at once, which is exactly why treating them as connected matters.
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Perfectionism
The work is separating your worth from your output, so the drive stops running on self-criticism.
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Anxiety
Understanding what the alarm is really responding to, and building the capacity to be steadier without controlling everything.
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Body image
The work is on the meaning the body has come to carry, control, worth, safety, rather than on the body itself.
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Eating disorders
Understanding what the eating has been holding, and building something that holds it better.
What this work is not
It is not advice. I am not going to hand you a meal plan, a set of rules, or a list of tips you have already tried. It is not weight-focused. I do not weigh you or set targets, and weight is not how we measure progress. It is not endless. The aim is for you to need me less over time, not more. And it is not a higher level of care. This is individual outpatient therapy for people functioning well enough to work at that level. If your situation needs more, medically or otherwise, I will say so and help you find it.
A place to start
I’d love to talk
If what you have tried has not reached the thing underneath, that is worth a conversation. The free consultation is a place to talk through what you are navigating and how this work might fit, with no pressure to decide anything.