A Psychodramatic Approach to Working with Eating Disorders

Psychodrama is an excellent modality to use when working with clients who have an eating disorder. Frequently this population is plagued by the “voice of the eating disorder”.

This voice has a constant stream of negative messages for the client, such as “you are too fat, no one will love you if you gain weight, your stomach is too big” and, “I don’t want to feel”  among a barrage of others. These messages repeatedly play in the client’s head, taking up significant mental space.

A technique in psychodrama, called concretization is helpful in challenging these thoughts. In the psychodrama session, the client may ask a group member to play the role of the eating disorder and externalize the voices of the eating disorder through the role play. 

The client is then able to use their own voice and challenge the voices of the eating disorder. Being able to hear herself/himself/themselves say positive, affirming messages out loud can be powerful. 

Another aspect of psychodrama is role reversal. In this example, the client would then change places with the voice of the eating disorder and step into that role, speaking back to the client to challenge the affirming messages. The client is then able to dialogue with the eating disorder itself to help distance her from the eating disorder role. 

Clients often are fearful of giving up the role of the eating disorder, as it has become wrapped up in the person’s identity. When we are able to separate the voice of the eating disorder and externalize it, the client is able to take a step toward recognizing he/she/they is more than their eating disorder.

If the client would like more support, we can also bring in the voice of recovery to help have an ally in healing from the eating disorder. Sometimes clients receive messages from family members or coaches about their bodies, food, or their weight. 

Psychodrama is helpful in assisting the client to have a conversation with the family member or coach about how he/she/they felt being criticized by the person and the impact this had on their life.  It is not uncommon for the messages received from family members or coaches to be the same messages the client has internalized as the voice of the eating disorder.

Psychodrama, with its focus on putting issues/situations into action gets the client out of the head and into their body, to promote healing.

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