4 Ways Body Image Work Goes Wrong in Therapy
If you’ve ever done all the “right” body image work…
Challenged the thoughts, said the affirmations, stared into the mirror like you were told to, and still felt exactly the same… this episode is for you. And honestly? You’re not broken. You’re probably just being asked to do body image work that was never deep enough to begin with.
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Today’s conversation comes from a place of deep respect for clients, for clinicians, and for how hard this work actually is. Because let’s be real: showing up to talk about body image at all already means you’re doing something incredibly brave. This episode isn’t a takedown. It’s more of a gentle (okay, sometimes pointed) “hey, let’s zoom out for a second.”
Body image is often treated like a thinking problem. If you could just reframe the thought, correct the distortion, or repeat the affirmation enough times, surely it would click… right? Except so many people intellectually get it and still feel awful in their bodies. That disconnect is where things start to stall.
What we miss is that body image isn’t just about mirrors or appearance. It’s about emotion regulation, identity, shame, control, safety, and relationships. It organizes so much of someone’s internal world. When we oversimplify it, even with the best intentions, the work can quietly go nowhere.
We also talk about how easy it is to rush people into body acceptance (or neutrality, or positivity — pick your buzzword) before there’s enough emotional safety to actually tolerate what comes up. When that happens, people often learn how to perform the right language without truly processing the feelings underneath. From the outside, it can look like progress — until symptoms spike, resistance shows up in other ways, or someone emotionally checks out altogether.
This episode is really about curiosity. About asking better questions. About noticing what’s happening between people in the room, not just what’s being said about bodies. And about understanding body image as communication, not the core problem itself.
So if you’re feeling stuck in your own body image work or you’re a clinician wondering why this keeps looping, this conversation might help you see what’s been hiding in plain sight.
In this episode, I’m talking about…
How body image work goes wrong when it’s treated primarily as a cognitive distortion problem.
Why insight, reframing, and affirmations often don’t change how someone feels in their body.
How body image distress functions as emotion regulation, shame management, and identity stabilization.
Why jumping to body acceptance or exposure work too early can increase threat and shutdown.
The difference between resistance and protection and why allowing ambivalence in and exploring it is the work.
How poor body image can’t be separated from relational, historical, and psychological context.
The ways body image struggles are often tied to attachment, visibility, morality, gender, and worth.
How focusing on body image alone can obscure deeper relational dynamics happening in therapy.
Why the therapeutic relationship itself is a primary mechanism of change and what happens when we miss that.
Key questions to ask when body image work feels stuck, including what the distress might be doing for the person.
Tweetable Quotes
“Any clinician or client that comes to the room with any sort of body image concerns, you’re already doing a really, really important thing.” - Rachelle Heinemann
“Body image is rarely just about appearance or what happens in the mirror. It’s something that organizes our entire internal experience.” - Rachelle Heinemann
“Exposure without increased tolerance actually increases the person’s sense of threat.” - Rachelle Heinemann
“Ambivalence is not resistance. That’s not an annoyance we have to get through — that is the work.” - Rachelle Heinemann
“When we isolate body image from psychological context, we miss almost everything.” - Rachelle Heinemann
“Body image work is very central to eating disorder treatment. Body image work isn’t effective enough when we treat body image as the problem, rather than the communication.” - Rachelle Heinemann
Resources
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Related Episodes
Episode 176. Body Image with Sydney Greene, MS, RDN
Episode 156. Women's Hormones, Body Image, and Facts with Dr. Esther Rollhaus
Episode 151. Body Image is the Last to Go
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Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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