When I first encountered expressive therapy, I was working towards my own recovery from an eating disorder. I wasn’t in my role as a therapist at the time, so I wasn’t thinking much about theories, or evidence, or why and how it was effective for treating eating disorders. But even so, I immediately knew it was for me. I knew it was going to help me. I just felt it.
I remember sitting in a chair in the center of the group room at a residential treatment facility, and the therapist leading group asked me to embody my eating disorder: “How would it sit? How would it move? What would it say?”
I sat with the questions for a moment, and then felt my body sink into the right pose: I leaned back, felt my face twist into a scowl, crossed my arms defensively over my chest, slipped into a mindset that felt like something from my teenage self: aggressive in a fake way, “too cool for school,” performative, uncaring. And underneath it all, utterly terrified.
As the therapist and the group members asked me questions, (the activity was, appropriately, called “interview your eating disorder”) I answered from the perspective of the eating disorder. The questions started easy, and then trended towards a “no holds barred” directness. The answers I gave—that the eating disorder gave—came out of my mouth like I was an interpreter conveying the information, rather than it being me speaking them directly. Most of the answers shocked me; they were things I didn’t want to hear, didn’t want to accept. But they were all true.
One of the last questions they asked was this: “if River tries to stop you, or get rid of you, what will you do?”
The eating disorder didn’t miss a beat: “I’ll kill them.” After the words leaped out of my mouth, I sat there, with everyone else, in a stunned silence.
When I think about that moment, years later, the first thought that comes to me is gratitude. I’m still here. It didn’t kill me. I survived. I’m healing.
This morning, I sat with that same therapist in her office at the outpatient practice where she now works, and I asked her what it’s like to see how far I’ve come. I wasn’t facing her when I asked, but I could hear the smile on her face when she answered: “It’s so cool. It’s amazing to see people move past surviving and really start living again.”
There were a lot of therapy modalities that brought me to where I am today. They helped me start living my life again, instead of hanging on by a thread. They helped me build up my own capacity to return to clinical work as a therapist. They helped me hold space for my clients’ emotions, after years of not even having the space to attend to my own. But expressive work has always been at the core of my process. Creative expression has been a source of comfort and healing for me for as long as I can remember. And now, I get to help bring that healing power to my clients as well.
And of course, now that I am back in my role as a social worker and therapist, I get to dive into the theory and research behind Expressive Arts Therapy. Whether you are a client wondering if expressive arts might be able to support you in your recovery journey, or a therapist curious about the role of expressive arts in treating eating disorders, I’m excited to tell you about this modality that I love so much. So, without further ado, here are five ways that expressive arts therapy supports folks who are recovering from eating disorders.
1. Expressive Arts Therapy helps clients connect to their bodies.
Most folks who struggle with eating disorders and disordered eating have trouble connecting to their bodies in a healthy way. We may struggle with perfectionism and self-criticism related to how our bodies look, or we may have harmed our bodies as a result of eating disorder behaviors, self-harm, or substance use. For those of us who have experienced trauma, we may also struggle to stay present in our bodies if we have learned to dissociate to cope with distress.
Often, rebuilding a healthy relationship with our body is a foundational part of healing from an eating disorder. However, connecting to our bodies after a long period of disconnection can be incredibly scary. In my personal therapeutic work, and in my work with clients, I’ve learned that reconnecting with our bodies is a process that usually needs to be slow, careful, and intentional.
Expressive Arts Therapy provides an excellent foundation for reconnecting with our bodies in a careful, gradual way. We can connect to our sense of touch when we use art materials with different sensory qualities. We can build positive experiences of joyful movement when we engage in dance, drama, or play activities. Listening to music–or creating it–can help us get in touch with our felt sense of rhythm and movement.
By choosing expressive activities that meet my clients where they are at, I can help them access embodiment in a way that is challenging, but still safe. Over time, they can increase their capacity to be present in their physical bodies, treat their bodies with respect and compassion, and connect to a felt-sense of safety.
2. Expressive Arts Therapy values the healing power of storytelling.
Trauma-informed expressive arts therapy uses the MSSS model to describe four different ways that expressive therapies promote healing: movement, sound, storytelling, and silence. Storytelling facilitates healing, because it allows us to share our experiences with others, and helps us make meaning of our experiences. This is especially healing for folks who have experienced trauma. Since the vast majority of people who develop eating disorders have experienced some type of trauma during their lifetimes, storytelling is a key part of eating disorder recovery.
Telling our stories allows us to be seen for who we really are. When we share our experiences, and we receive helpful and affirming responses from others, we gain evidence that it is safe for us to show up authentically, without performing for others. This helps us challenge shame and self-criticism. It also helps us connect to others and build meaningful and safe relationships.
Expressive arts therapy provides so many opportunities for us to tell our stories. Whether we are creating a playlist of songs that tell the story of an important life experience, writing poetry about a lost relationship, or creating art about a traumatic experience, creative expression provides opportunities for us to harness the healing power of storytelling.
3. Expressive Arts Therapy emphasizes the importance of process over product.
One of the most frequent questions I get asked by new clients is “what if I’m not any good at art?” So many of us were told as young children that we should only make art that is “beautiful” or “good.” We may have been told from a young age that we’re not “creative enough” or “talented enough,” or we may have been told that our art is only valuable to others if it looks a certain way. Either way, pretty much every client I have ever worked with has shared insecurities with me about their creative skills. Whether we have a degree in art, or we’ve never touched a paintbrush, we all seem to be worried that we aren’t good enough.
One of the reasons I first connected with expressive arts was that it values the process of creation over the finished product. As an expressive arts therapist, what I spend the most time discussing with clients is how it feels to express themselves creatively, not the actual creation itself. Sometimes that looks like connecting to the physical sensations of using art materials. Other times it means processing the thoughts that come up for us as we write or draw, or tuning in to how our body feels as we move and dance.
Focusing on process over product can be especially healing for folks who struggle with perfectionism and self-criticism, which are common struggles for folks with eating disorders. Whether it’s our attempts to control the food that we eat, the way that our bodies look, or any other aspect of our lives, we are often trying to feel in control so that we can feel safe. By learning to lean into the process of creation, and letting go of our anxieties about how the final piece looks, sounds, or feels, we can learn to approach ourselves, our bodies, and our lives, with the same patience and acceptance.
4. Expressive Arts Therapy supports clients in regulating their emotions.
One of the most common misconceptions about eating disorders is that they are all about food. While food and eating are important, the truth is that as an eating disorder therapist, I don’t actually spend most of my time in sessions talking to clients about food. At their core, eating disorders are about safety, emotion regulation, and getting our emotional needs met. Disordered eating is just one of many tools that people may learn to use to regulate their emotions.
Our bodies need food to survive, so we are biologically wired to enjoy eating. When we consume food, our brains release dopamine, which makes us feel good. Food can give us a sense of comfort when we feel lonely, sad, or scared. Many folks, with and without eating disorders, turn to food as a way of coping when we feel distressed.
Other eating disorder behaviors, such as purging and restricting food, can also be emotion regulation tools. Some folks who engage in these behaviors report feeling a “head rush” or a “high feeling” when they purge or restrict food. Others report that engaging in these behaviors helps them regain a sense of control when they feel overwhelmed or scared. Whatever the reason, most people with eating disorders use behaviors to regulate their emotions at least some of the time.
Expressive Arts Therapy can be very helpful for folks with eating disorders, because it provides many opportunities for using our bodies and sensory experiences to regulate our emotions, without relying on behaviors that are harmful to our health. Rhythm, movement, creative expression, and connecting to our felt senses are all excellent ways of self-soothing and regulating our emotions. By working with these in therapy sessions, I also help my clients build up the repertoire of coping skills that they can use when they are feeling overwhelmed, upset, or dysregulated.
5. Expressive Arts Therapy is an attachment-focused approach.
Attachment refers to the ways that our relationships with our caregivers during our childhood impacts our mental health and relationships as we grow up. If all of our attachment needs were met during early childhood, we are more likely to develop secure and healthy relationships as adults. However, if one or more of our attachment needs are not met, we may struggle to connect to others in a healthy way, which can make it harder to lead a fulfilling and happy life. Attachment concerns often go hand-in-hand with experiencing childhood trauma, and as such, they are particularly common among people with eating disorders.
Expressive Arts Therapy can be very effective for supporting folks who may have experienced attachment injuries during childhood. This is because Expressive Arts Therapy emphasizes the importance of attunement and synchrony between the therapist and client, or between multiple clients in group settings.
In Expressive Arts Therapy, the therapist is often focused on being “in sync” with the client. Like other types of therapists, we often mirror statements or body language to show that we are interested or engaged in what clients are saying. But we also bring synchrony into creative and expressive activities–a dance movement activity might involve mirroring body movements, a music activity might involve repeating sounds, a drawing activity might involve copying one another’s marks on a piece of paper.
Creating these opportunities for synchronization between the therapist and client helps us build a safe therapeutic relationship. This can help clients develop a more secure attachment style, and relate to others in their life in a healthier way.
If you are struggling with an eating disorder, or disordered eating, and Expressive Arts Therapy sounds like it would be helpful to you on your healing journey, please don’t hesitate to reach out. You deserve the chance to feel safe in your body. You deserve the chance to tell your story. And most of all, you deserve the chance to heal.
River Chew is a Licensed Master Social Worker and Expressive Arts Therapist. They are currently undergoing the supervision requirements to become a Trauma-Informed Expressive Arts Therapist (EXAT) and Registered Expressive Arts Therapist. They have over 175 hours of training in a variety of expressive therapy modalities, including visual arts, drama therapy, play therapy, sandtray therapy, and psychodrama. They specialize in working with clients impacted by trauma and eating disorders, and they are passionate about working with folks who are disabled, neurodivergent, trans, and/or queer. If you are interested in working with River for individual therapy, you can schedule a free 15-minute virtual consultation with them here.