Podcast Transcript

Episode 49: Eating Disorders & Romantic Relationships: Supporting Your Partner in Recovery with Ashley Moser, LMFT, CEDS

[Bouncy theme music plays.]

Sam: Hey, I’m Sam.

Ashley V.: Hi, I’m Ashley. And you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Sam: There’s a phrase we repeatedly say on this show, we heal in relationships. Eating disorder treatment is often so much more than just individual sessions with a therapist. Loved ones are often invited into the therapy room, spouses, partners, significant others. At Renfrew, we believe that having even one supportive, loving, validating relationship outside of a treatment center can be one of the most powerful sources of healing. Eating disorder recovery isn’t a one-way street. As someone in recovery makes changes, we invite their loved ones to make changes too by teaching them how to support differently, how to communicate with compassion, validate emotions, lean into their own discomfort and repair wounds within their relationships. Many find the process of treatment and recovery to provide the unexpected side effect of deepening and strengthening their relationships. But what exactly happens in these therapy sessions? What challenges do people face in relationships when someone has an eating disorder? How do therapists help people navigate the inevitable ups and downs of recovery? What skills and tools are taught in couples therapy? And what do you do? What do you say? When it’s clear your partner is struggling. These questions come up so much and we knew our guest Ashley Moser would have the answers. Ashley Moser, licensed marriage family therapist, certified eating disorder specialist, is a clinical education specialist at The Renfrew Center. She received her bachelor’s degree in psychology from the University of Illinois, Urbana-Champaign, and her master’s degree in marriage and family therapy from Northwestern University. Ms. Moser has extensive experience in providing therapy and clinical supervision with a focus in the treatment of eating disorders and relationships. She is a frequent speaker on the topics of body image, evidence-based treatment of eating disorders, and engaging families and partners in the treatment process.

Sam: Welcome back to another episode of All Bodies. All Foods. I’m your host, Sam, and I’m here with your other host, Ashley Vacari, and we’re very excited for our guest today, Ashley Moser. Welcome to the show, Ashley.

Ashley M.: Thanks so much for having me. I’m so excited to be here.

Sam: I’m so excited to talk about this topic. You recently did a webinar called in Sickness and in Health: Romantic Relationships in the Context of Eating Disorder Treatment. And it was very popular, very popular webinar. And I was thinking to myself, we have to have Ashley on the show to talk more about this. I think there’s so many people out there that want to know, how do I support my partner? How do I support this person that I’m in a relationship with and their eating disorder recovery? And so we’re going to dive into all of that. But before we do, I wanted to ask you, you’ve been in the eating disorder field for a while. What got you interested in eating disorders, but specifically, what got you interested in helping people in romantic relationships navigate eating disorder treatment and recovery?

Ashley M.: Yeah, absolutely. And yes, I’ve been here for a minute doing this, but originally my interest in becoming a therapist was about relationships. I specifically sought out a license that was going to be focused on relationships. I’m a marriage and family therapist by training. And so, I’ve never done therapy that wasn’t through the lens of relationships. So that’s just been very natural to me. It’s always been a part of my career. And it was really interesting to me to think about approaching eating disorders from this lens, bringing relationship work into something that sometimes on the surface feels like such an individual problem when we think about how eating disorders present. But we know eating disorders aren’t just about the individual who’s experiencing them. We know that mental health isn’t just about the person who’s experiencing it. And our relationships have a huge impact on who we are, how we’re functioning, and our day-to-day lives. So for me, my interest was bringing relationship and relationship-focused work to what felt like not necessarily a relationship presenting issue and to sort of see what happened. And so I was really privileged to be able to be hired by Renfrew who focuses on relationships as well. And so I think it just felt like a really great place to sort of bring these two worlds together. And it’s been a lot of fun and really interesting and fulfilling to do this work.

Sam: Yeah, thanks for bringing that up about Renfrew because even back in the 80s, when eating disorders were being treated basically just in a hospital, Renfrew knew, no, people healing connection. And let’s get, let’s get people in a community healing together. And you talk to any client even today and what do they say? Like the biggest healing component was the community and their relationships, which is why family therapy is part of… family therapy, couples therapy is part of treatment really, hopefully, no matter where you go. But yeah, that’s so cool. I’m so excited to dive in to all this.

Ashley V.: Yeah.

Ashley M.: Yeah, me too.

Ashley V.: Ashley, I’m curious. So like relationships and eating disorders… so we’re going to look at kind of both of those today. So this is kind of a two part question. So first, what are some like big pressures like life stressors in general in relationships. And then added onto that, what are some pressures and some life stressors in relationships when one or both partners might have an eating disorder, disordered eating, body image, all of that jazz?

Ashley M.: Yeah, big questions. I think I might be able to answer both of them at the same time. So I think what we see is that there are different almost relationship pressures and stressors, depending on where you are on the relationship spectrum, right? So I see a lot of folks struggling with relationships and eating disorders that are trying to establish relationships, right? There’s this drive to be in a partnership, to have a committed relationship, and there’s a lot of pressure if we think about it societally to be in a relationship, just like we see that same pressure coming through to be in a certain size body. So it’s interesting. There’s like this overlap that happens that I really want to be in a relationship. I want companionship. I want partnership. And I also hear all these messages that I have to look or be a certain way to achieve that. So I see people who are trying to establish (inaudible) be able to obtain a relationship, engage in eating disorder symptoms because they believe that their body size increases the likelihood of them finding a partner. They’re more attractive, they’re more desirable, they’re less needy, they’re less emotional, which is all of these criteria that I think there’s a lot of messages out there about that tell us that that’s what we need to be in order to be attractive and desirable and to be chosen to be in a relationship. And I think that’s a real pitfall, right? So regardless of if someone was struggling with an eating disorder before, during, or after, I think that comes up. This belief that our body and our physical self is a huge factor in whether we’re going to be chosen and ultimately determined lovable. So no wonder we spend so much time focusing on trying to change and alter our physical selves because it feels like it’s the way we’re going to be receiving the confirmation that were lovable by someone else.

Ashley V.: You said like this determines if I’m able to be chosen. And I’m just sitting here like that hit me in such a way that I’m just like, oh. But honestly, I think that is something that so many people sit with. Like am I good enough? Am I lovable enough just as I am to be chosen?

Sam: Oh yeah and you think about all the dating apps out there that are entirely image based. And it’s valid to have that fear. Will I be chosen because people are literally looking at your picture and either choosing you or not choosing you, you know, swiping, you know, right or swiping left. And I can’t imagine I’ve actually never been on a dating app, but I can’t, I was, you know, I sort of got married before dating apps even existed, kind of like revealing my age here, but like, I can’t imagine the pressure of, I mean, just putting your pictures out there and waiting for people to like them. Do you, Ashley, do you work with folks in eating disorder recovery who are on dating apps and what’s that experience like?

Ashley M.: As challenging and as painful as you can probably imagine. It’s so difficult especially whether you know you’ve just gone through the process or you’re trying to have sustainable recovery and you’ve been given all these messages about how what’s on the inside matters most and being true to yourself and being authentic is really what matters and nourishing yourself regardless of you know all of the pressures out there. But then to be confronted with a dating system that really does emphasize all of the things that you’ve been told to de-emphasize as a part of your recovery. It’s a real dicey, dicey dynamic. I think being in therapy while you are trying to engage in dating, especially if you’re choosing to do so through dating apps, which makes sense, it’s like the most easily accessible way to do so. It’s so important because it’s going to activate a lot of the same things that were connected to the eating disorder in the first place, because it’s very hard to go into a dating environment knowing you’re going to be judged based on your appearance, but have to remind yourself that should not push you to then try to alter your appearance or your size with your eating disorder behaviors. So it is dicey and challenging and painful and full of ups and downs.

Sam: Yeah, absolutely.

Ashley V.: It’s really hard to have a sense of like, self-esteem or like ego strengths when it is like you, you know, you meet and you chat on those for however long and then it’s like, quote unquote, like the big reveal and so I can imagine anytime you go on like an in-person date, like, what are they thinking about me? Do they look like, or do I look like what they think I look like in my photos, right? It so much more just spinning in their heads, I’m assuming, you know.

Ashley M.: Absolutely. Well, and what pictures do you put up? Do you put up the pictures of your recovered body? Do you put up the pictures of your body before recovery? And there’s pros and cons and risks and emotional impacts of both, right? And so I think it can be a very challenging. experience, you’re right, whether it’s just be choosing what pictures to post or agreeing to meet someone in person, there’s just this constant kind of anxiety and thought process that’s running through your head. Am I going to be accepted? Am I going to be seen as desirable, attractive? And especially for those who very much want a relationship or want a relationship and a future family, sometimes it can feel like, well, my body is the thing I can control to ensure I can have those things. It’s so hard to control if someone is going to choose us, love us, swipe right, swipe left. And sometimes we get this false sense of control by trying to alter our bodies to feel like this is going to be the thing that’s going to get me what I want out of life. This is going to be the thing that’s going to get me what I need. When in reality, it doesn’t. It either gets us the wrong type of partner, or sometimes it even makes us so isolated and disconnected we end up being further and further away from these things that we want. So I totally get and validate and normalize for anyone who feels like an eating disorder, feels like a vehicle to being chosen through dating apps or just dating in general. But I think it’s so important to also pay attention to what the flip side of that is that even though that seems like that may make sense in reality, being more disconnected, more inauthentic, more isolated and more not well overall decreases our ability to actually obtain and sustain healthy relationships.

Sam: That makes a lot of sense. And I think these thoughts come up for people who are actively in a relationship. Yeah. You know, it’s not only these thoughts, okay, will I get chosen, but will I continue to be chosen by my partner? Right.

Ashley M.: That’s huge.

Sam: Yes. And I was hoping we can talk about folks who are actively in a relationship, and we’re using the term romantic relationship, hopefully to capture many different types of relationships. I realize it’s sort of like outside the scope of this episode to talk about every type of possible relationship. But let’s say, you know, you’re working with someone who’s actively in a romantic relationship, maybe a long-term relationship. What are some of those challenges that folks navigate in a relationship when they’re in eating disorder recovery or actively in treatment?

Ashley M.: Yeah. Well, I think in a similar vein, the eating disorder behaviors can sometimes be activated as a way to maintain our lovability and to maintain that relationship. And it’s again, that false sense of control weight, right? Because we can’t whether someone is going to choose or continue to choose us, commit to us or continue to commit to us. But sometimes, and I think, again, there’s a lot of messaging out there that unfortunately supports this. There’s this belief out there that it’s my responsibility to maintain my level of attractiveness in order as, as a qualifier to maintain my relationship. And so sometimes the eating disorder behaviors can become a way of maintaining my physical attractiveness so that I continue to maintain the attention and commitment and lovability from my partner. And I think there’s a lot of, again, that false sense of control because that doesn’t necessarily have to guarantee much of anything at all, but it feels like it does. And there’s a lot of messages out there. And I work with a lot of folks that feel that feel that pressure on a very serious level. And it’s not even just from a physical standpoint in terms of appearance, I also see a lot of that showing up with physical intimacy as well. There’s this feeling of like, I need to not only be my most attractive self to keep this relationship viable, but I also need to be very physically intimate and very sexualized as well in the relationship. And like, these are my responsibilities. And I think what ends up happening is that that’s another piece that can very easily be funneled into the eating disorder as a way to try to deal with that pressure as well. But yeah, it’s interesting in order to maintain a relationship, it feels like there’s these things you have to do or those things you have to be in order to keep someone committed to you, which I think there’s a lot of things wrong with those messages, but they show up a lot.

Sam: Sure. And it reminds me so much, we had another episode all about attachment style. And I imagine this is especially challenging for someone in eating disorder recovery who is also navigating maybe insecure attachment and you’re in a relationship and feeling like that eating disorder or trying to pursue that ideal body will help you feel more secure in that relationship.

Ashley M.: Yes.

Sam: And it’s a false sense of security and you know it ends up causing more harm than good but it’s that like false sense of safety that is so reinforcing.

Ashley M.: Absolutely. Well, and I think we all, at the end of the day, just really want to be loved and have that reflected back. And sometimes it feels like we can’t control if that’s going to happen, or there’s some core beliefs in there that we believe that there’s something inherently unlovable about us. And so I think anything that we can do to give ourselves that sense that maybe we are lovable or achieve that feels worth it sometimes. And I think that’s where the eating disorder can definitely come in and be really tricky to navigate and pull out of the equation if it feels like it’s serving that function.

Sam: Absolutely and so there’s this pressure around appearance, wanting to feel lovable, there’s pressure around intimacy and wanting to feel desirable and all of that. How about the practical, I mean, when we think about eating disorder recovery, there are so many things that your team recommends to stay on track, following a meal plan and sometimes if you’re early in recovery or there’s going to therapy and doing all of these things, in what ways do the recovery sort of tasks impact a relationship? What kind of bumps in the road do people find themselves navigating?

Ashley M.: Yeah, I think especially in romantic relationships, the dynamic shifts significantly. And I think sometimes with these recommendations that are part of recovery, that are part of discharge planning, that are part of kind of maintaining routine and consistency, there can sometimes be this feeling that instead of us being on an equal partnering playing field, we’ve now shifted into a bit of like a parent-child dynamic. And I think that can happen if the partner feels that they are now responsible for things like meal planning and accountability and ensuring that things are happening the way that they should. And I think that can be a real misstep for anyone who’s in the recovery process that’s in a romantic relationship, because we are still wanting that partnership to feel on equal footing. And I think the disempowerment of someone in this process is the exact opposite of what we want to see happen. But it feels like we need someone to be their coach, to be their advocate, to be someone who can help with accountability and monitoring. I think, though, we tend to miss the mark by focusing so much on how the partner can support behaviorally. Instead, I really like to shift people to how can you support your loved one emotionally? That’s the piece that I think we really have to emphasize because it’s going to be that much easier to follow a meal plan. It’s going to be that much easier to go to those therapy sessions. If you have a supported, connected partnership that is picking up tasks that are not related to the eating disorder to give you more mental bandwidth so that you can do the things that you need to do to attend to recovery. Or if you have a partner that’s very emotionally connected, you’re going to feel like you have someone to turn to instead turn towards the eating disorder. So I really encourage people, instead of kind of applying some of those family therapy techniques and recommendations that we see in eating disorder recovery to the couple and to a partnership, we want to really be focused on emotional connection. Because connection in that relationship is going to be a huge predictor of long-term sustainable recovery.

Ashley V.: I love that you said that, Ashley. I have had the experience of having clients go through their eating disorder recovery, their treatment, and exactly like what you’re saying, kind of come out on the other end, come out in recovery. But what does recovery mean for them? It also means a massive mental and emotional shift, right? They have the capacity to experience these emotions now and tolerate them at a level that just was not there previously, right? And so if their partner, if their loved ones, whoever that may be, isn’t encouraged or taught how to increase their emotional capacity as well, then the client coming out is, you know, sometimes has the experience of feeling like they’re talking to a brick wall. Like it’s not landing well with the partner or the loved one. And so educating the partner on, yeah, again, just like their emotional response, their ability to navigate anger, sadness, fear, that it’s okay to have these emotions. It’s okay like increasing our distress tolerance for them, I think is such a critical piece. And I’m curious if that’s been missing for, you know, some of our folks.

Ashley M.: I think that’s the case. I mean, I think we sometimes can easily default to the checklist and to the things that we need to do instead of focusing on what we need to feel and how we need to create emotional connection, safety, intimacy in our relationships so that we have a safe space outside of a treatment environment, outside of a therapeutic relationship to be able to show up and share all of it, the good, the bad, the ugly because again, that’s the stuff that is going to ultimately result in us feeling most loved and more than the eating disorder ever will or could, right? Having someone be able to see you and recognize you even in the places that you don’t like to see or recognize in yourself and love you anyway, like that’s it. That’s it right there. And so if we can help our folks get to a place where they can do that for each other. And again, I encourage it not just to be a one-sided dynamic. This is how you can do this work so that you can support your loved one with an eating disorder. But how do we all do this work together so that we change the narrative around emotions, so that we change the narrative around what does it mean to support each other? What does that look like? I just think that goes so much further. And I get it. We’re not talking about behaviors and food and body image but I think this is the stuff that’s underneath it, nine times out of 10. And if we can go after this, I just think we’re going to make a much bigger impact.

Sam: Yeah, I think one of the big misconceptions with partners and families is when their loved one first goes into treatment or goes into therapy, it’s sort of like, okay, now go fix your eating disorder. And then it’s like, they realize after working with the team that we’re not just asking your loved one to make changes. We’re asking you to make changes and they are emotional changes. And a lot of times people are like, what do emotions have to do with this? Eating disorders are about food and weight. And it’s surprising to a lot of people that the work is so emotionally deep. And it’s most of it, it’s most of the work.

Ashley V.: It makes me think Sam, what you just said. So like, talking about the function of emotions, right? Like emotions are valid and they serve a purpose. Anger serves a purpose, sadness serves a purpose. In that same vein, we talk a lot with our clients about the function of their eating disorder. Like what is that doing? What purpose is that serving in their lives? And usually it’s doing something that kind of keeps them safe or makes them feel good, you know? So what is that function that the eating disorder is doing? And I’m curious, Ashley, like, how does that show up in relationships too? Like, and again, kind of taking the food out of that picture, but like, what is the function that eating disorder might be doing and how can our partners and loved ones support, you know, their loved ones in that recovery too?

Ashley M.: Yeah, I think that’s a great question. And I think the first thing that comes to mind is like, disconnection is probably the number one thing that I think I continue to see in those relationships. And I guess the question I always ask myself, like, is it the chicken or the egg? Was the disconnection and the relational tension and disconnect pre-existing the eating disorder and then cause, you know, the eating disorder to function as a way to soothe and get their needs met in a relationship that was just too disconnected to not be able to do so. Or did the disconnection come after the fact? Did the disconnection follow the use of the eating disorder? And if that’s more of the case is the eating disorder functioning as a default coping mechanism that maybe didn’t have anything to do with this specific relationship, but it’s just an individualized default coping mechanism from, you know, many moons ago. There’s also, you know, a lot of times it can show up as the eating disorder being almost a partner and a little bit of like another person in the relationship at times. So I’ve heard, I’ve heard partners of those who struggle with an eating disorder say that they almost feel like it’s a betrayal, that the eating disorder is almost like a level of infidelity in a way in the sense that instead of turning to the relationship, you know, the identified patient or the person struggling is turning to the eating disorder. And that is really, it feels like a betrayal, especially if it’s something that the partner didn’t know about. I’ve had partners of clients say, you know, they’re not married to me anymore. They’re married to their eating disorder. That’s who they think about first. That’s who they prioritize first. When they have an opportunity, that’s who they go to first. And that in itself can be a huge, huge disconnector and cause a lot of pain and relational rupture in that relationship because of that and not for the identified client necessarily, but for the partner in the dynamic feeling like I am deprioritized in our relationship over something that of course isn’t an actual person, is an actual thing that we can put our hands on, but is something that becomes more important than anything else, including me, the partner.

Sam: You know I imagine in the process of healing from an eating disorder, there are so many opportunities where you can actually deepen your relationship with your partner, heal ruptures. It’s sort of like this unexpected side effect of eating disorder recovery, because you maybe realize the ways in which your relationship wasn’t quite working and the ways that the eating disorder sort of helped stabilize the relationship in certain ways. I was curious if in what ways you’ve seen partners become closer.

Ashley M.: Yeah, I think that does happen. I’ve also seen the reverse too. So I’ll speak to the happy ending before the other. But I definitely see that when the eating disorder is able to be pulled out, that there are a lot of opportunities to reconnect with parts of your partner that you didn’t even potentially know were there or were missing. I also think that there’s something really healing about being able to be seen and heard by someone that you felt like you weren’t for quite some time. So there is a lot of a lot of benefit that can come from that. And I think there’s this misconception, you know, that we have to handle things on our own or that our partner isn’t going to be there for us. And some of that is definitely a side effect of the eating disorder, right? The more isolated we are, the more we think we need to stay isolated in our emotional experiences. And so I think there is something about giving our partners the benefit of the doubt and the opportunity to see if they could show up for us. Because maybe, maybe they can. Or maybe with some therapeutic support, they’re able to. And so I think learning to trust someone else is scary and hard. But to have that be met by the person that you’re in a relationship with can be really, really healing. And that goes way back to like childhood attachment wounds, I’m sure too. So we can be doing some like really really amazing, sustainable work by doing that relationally. And on the flip side though, I will say I’ve seen some relationships that the eating disorder is such a functional part of that system that by moving it out, the relationship itself may not be repairable. And sometimes that can be a maintaining factor for those who are in relationships where maybe they feel like they aren’t necessarily the most healthy relationships, or maybe there’s a lot of unmet needs and maybe some things that can’t and won’t be resolved, because unfortunately, right, that happens. Sometimes it feels like I either have to choose recovery and choose to leave my partner and embark on into the world alone and go through all of these changes, or I need to choose the eating disorder to stay in the relationship. And I will say, I hear that a lot, that this is a relationship that the eating disorder is needed in order to stay in, and there may be a lot of barriers to leaving and the thought of, I don’t know, recovery versus the eating disorder versus the relationship is very, very dicey and tricky and has real, real significant consequences. So I guess I want to also kind of play that piece as well. Well, you know, moving through eating disorder recovery can allow you to deepen relationships. It can also make you aware of relationships that may not be sustainable or survivable and then what?

Sam: Well, right, the eating disorder can in so many situations, relationships included can sort of be a distraction. And then when you’re in recovery, you’re able to face some of the realities of a relationship or a job or, you know, some people realize they’re in school and they don’t even want to go to school for what they’re going to school for, you know, and it’s in a way recovery can help you get in touch with who you really are and maybe the relationships that you actually want, like it can help give you clarity. And there might be some people out there listening, terrified of losing their partner if they choose recovery. And in the same, there’s another way to think about it. It can be like becoming more in touch with the authentic you.

Ashley V.: Yeah.

Ashley M.: Agreed.

Ashley V.: Ashley, I’m curious, I kind of want to switch gears for a second and talk a little bit about body image and maybe body dissatisfaction. So we know that people with eating disorders, most people might experience some level of body dissatisfaction. So how do concerns about weight and shape impact these relationships? And how do you help couples navigate this issue?

Ashely M.: Yeah, kind of like what I said at the top. I mean, sometimes it can feel like concerns about body image can really deeply influence whether we’re going to be accepted, loved, chosen. And like we said, that can happen from, you know, early stages of obtaining a relationship or, you know, through later stages of commitment and committed relationships. I think when it comes to body image, I think it’s really important to remember that our bodies tend to be the place where a lot of our ambiguous, difficult emotional experiences land. And I think sometimes it feels like I have to heal my relationship with my body or I have to heal my body image distress before I’m going to be able to be in a relationship, before I’m going to be able to be physical with another person because if I can’t love how I look and how I feel, how can I ever imagine that somebody else? Well, and I think it’s really important to have very open conversations about that, not just with our clients, but with our clients and their partners and their relationships, because I think there is so much more to emotional intimacy, physical intimacy, and being chosen and staying in committed relationships that has very little to do with body shape and size. And I think we have to remember that. And I think we have to get reconnected to that. Again, we have a lot of, you know, mainstream messaging and influences out there that really emphasize the physical as the be all and end all of relationships. But at the end of the day, what is really beneficial is to kind of go back to why we choose the partners that we choose and how much that may have somewhat to do with physical attractiveness and chemistry and things along those lines, but how much sustainable relationships stay sustainable because of factors that are so much more value-based, right? We align, we can communicate, we problem solve, we want the same things. We are healing from similar generational traumas that we’ve kind of come from. Like there’s so many other reasons that we choose and stay in relationships beyond the physical. And I think it’s very important to remind ourselves of that, not just even within our own individual selves, but also in our relationships. I’m choosing you because I feel seen with you. I’m choosing you because I can problem solve with you. I’m choosing you because at the end of the day, you still ask me how my day was. And that stuff is so much more significantly powerful in creating long lasting relationships than trying to chase you know, youth and thinness, beauty and sexual attractiveness.

Ashley V.: Which is bringing up for me, like the thought of weight stigma and internalized weight stigma and just maybe how that has shaped so many of our messages, not only we give ourselves, but may even project into the world because of our culture.

Ashley M.: I think it’s a, it’s a huge barrier. to relationships in some ways, right? I think there’s so much belief that our value and our worth is tied up in our physical bodies. And I think because of that, there’s so many people who feel like they have to change and alter who they are in order to be lovable, in order to have the relationships and the life that they want. And yeah, I think that weight stigma is a huge, huge influencing factor when it comes to relationships. And I think we should talk about it all the time, which I’m really glad we’re doing today because I don’t know that we even recognize it sometimes. I think it’s so tongue in cheek and just assumed. And there’s so many messages out there that really do perpetuate that belief. And so I think the more we can offer counter messages, the better.

Sam: Absolutely. I wanted to spend a little time talking about some of the interventions you actually use in session. Like what would happen if I went to couples therapy? What actually happens in the room? And so when you’re helping partners deepen their emotional intimacy, helping them get reconnected, what are some of the things that you might actually do with them in a session?

Ashley M.: A lot of things. But my favorites are my top few. I think one of the things that I use a lot actually is very similar, if not almost, you know, just taken out of some of the UT work that we do at Renfrew, but has been sort of picked up and applied into relationships. One of the things that I really enjoy doing is having couples talk about their automatic appraisals, their automatic knee jerk interpretations, because there is so much that happens in relationships that is not said. There’s what we say and there is what everything else. Right. And so there are so many opportunities for us to fill in the blank with what we think is going on. And nine out of 10 times that is influenced by our belief systems, our lived experiences, internalized weight stigma, etc., and so before we know it, we’re not actually engaged with our partner, we’re engaged with our interpretation of our partner. And a lot of the time they’re engaging with us, not through the lens that’s actually us, but their automatic interpretations as well. So I really like to have you know, couples be able to identify some repeated conflict, right? Cause we all have them. What’s the conflict that you have the most? And then I, instead of really trying to resolve the conflict, cause that’s not really the point. And a lot of the research says that there’s some like, you just can’t resolve some conflict. Some conflict is just always going to be there. So we’re not trying to solve the conflict with them. We’re trying to identify the automatic patterns of thinking that they have and their interpretations of their partner. Most of the time those are influenced by our stuff. Whether it’s parents, whether it’s lived experiences, it’s bullying, you know, you fill in the blank. We are interpreting their interactions, their desires, their needs, their wants through our lives. And so I think it’s really important for couples to be able to sit down and see those in front of the other person so that they can be like, as a matter of fact, that’s not what I was thinking. As a matter of fact, that’s not what I feel. To be able to offer some disconfirming information that our knee-jerk automatic appraisal of our partner, their thoughts, their intentions might not actually be what we think it is, but it might actually be this. And there’s no one better to get that information from than straight from the horse’s mouth, which is the other partner. And so I really like doing that. And another piece that I add in is actually taken from parenting. So Dr. Becky Kennedy, she talks about the most generous interpretation and applying that in parent-child dynamics, but I think it’s a game changer for all relationships. The idea is, is that we all have these kind of knee-jerk automatic interpretations. And instead of getting so caught up in assuming the worst in our partners, how can we give them the most generous interpretation of their behavior? So just like we would look at a child and we would say, they’re not giving you a hard time, they’re having a hard time. How can we take that and apply it to our partners too? Because most of the time, I’m not giving my husband a hard time, purposefully, but I might be having a hard time. And so if we can both have that understanding that if something’s coming up in our relationship and our partner is showing up in a way that’s kind of undesirable or something that doesn’t exactly pull us in and makes us kind of want to step back, there’s probably a need there. And it’s not because they’re trying to give you a hard time, they’re trying to fight with you, they’re always like this, it’s because they need something. And how can we, if we give them a generous interpretation, we’re more likely to lean in and connect to that person then to push back and say, here they go again. It’s always like this. No matter what I do, it’s not good enough, so I’m not even going to try. So that’s a huge, and you can see that there could be millions of sessions that we have about all of that stuff.

Sam: Oh, yeah. Well, it’s so powerful. When you can change the way you’re interpreting something, there’s a chain effect where it will change your response to the situation. And if your response changes, then your partner’s response will change also most likely. And I mean, it can go on and on and completely change the relationship dynamic entirely. And I love that you’re talking about cognitive flexibility which is a skill we talk about all the time in eating disorder recovery. I think we talk about it a lot in individual sessions but how thinking more flexibly. Not getting so caught up in the story that you keep telling yourself over and over again. How cognitive flexibility can actually improve your relationship and your connection to your partner. It’s amazing.

Ashley M.: Absolutely, absolutely. And I think some people struggle because they’re like, well, if I can’t give them the most generous interpretation because they’ve done X, Y, and Z, or they’ve let me down, or they’ve disappointed me, or it’s not about accountability. It’s really about exactly what you said, Sam, which is this idea that if we can have flexibility in our interpretation, it has a complete and utter domino effect on our emotional experience and the emotional experience of our partner. And so we can still have accountability. You can give your partner the most generous interpretation, even knowing that they are a flawed person and maybe have done some hurtful, painful things in the past. It doesn’t mean that you have to only see them through the lens of the hurt and the pain. You can still give them the benefit of the doubt and also know that you’re capable of holding accountable for you know, things that require accountability.

Sam: Well, I think that’s so important. It doesn’t mean that you are not going to set a boundary or you’re not going to take care of yourself or do what you need to do to keep yourself safe. That’s different. This is more about thinking flexibly so that you can respond in a way that’s best for you and for the relationship, whatever that means.

Ashley M.: Exactly. Exactly, because they talk a lot in, I think, It’s Gottman that talks a lot about the difference between like, you know, harsh startups and more gentle startups. And so I just think if I’m, if I have a most generous interpretation of my partner and said it, when I do go to speak with them or I do go to share how I’m feeling, or I do go asking for clarification about something that happened, if I’m thinking through the lens of the most generous interpretation, I’m going to have a more gentle startup. I’m going to have a more soft startup. That’s going to be inviting to the conversation versus that harsh startup that’s going to be more likely to lead in disconnection, conflict, lashing out, eating disorder behaviors, etc.

Sam: Absolutely. So I think it is important to include in this episode some concrete guidance for folks who might be listening and maybe they love someone who is relapsing or they love someone and they’re noticing eating disorder symptoms maybe for the first time, maybe the onset of an eating disorder. What do you suggest? How can someone support the person that they love, the person they’re in a relationship with? How do they approach them about what they’re noticing?

Ashley M.: Oh, it’s tough, right? It’s tough to be equally scared and concerned and not know what to do. Those are, it’s a really difficult combo for the partner. And I think it contributes to why sometimes we need a conversation about the how to, because it can sometimes fall flat. It’s a very scary experience. And I think sometimes there’s a lot of fear at what the response will be. So I guess I just want to have a lot of, a lot of empathy for partners who are wanting to broach this conversation because it’s scary and hard. I think where I want to continue to kind of put the emphasis when it comes to partners is, you know, your job isn’t to manage and monitor symptom use. Your job isn’t to be a symptom use detective and police officer and, you know, warden, I guess, for a lack of better term. It needs to be continuing to be about that emotional connection. How do I stay present and emotionally connected to my partner while also expressing concern? So I think there’s less about what you say and how you say it. And I think it’s about continuing to stay focused on what you’re seeing and what you’re feeling. And so, you know, we talk a lot about emotion coaching and, um, family treatment and treatment with any sort of, you know, relational support system. And I think emotion coaching is, really applicable in this situation, which is basically giving a support person, giving a loved one the skillset to say, I’m noticing that you’re struggling and I’m here. So basically, if you notice that your partner’s having a tough moment, whether it’s around food or maybe it’s not around food, it could be around just about anything. Instead of being uncomfortable, worried about being awkward, worried about saying the wrong thing and distracting, disconnecting or avoiding, notice it. It seems like you’re having a rough day. Seems like things are really hard right now. Noticing it, very, very important versus ignoring it because of your own discomfort or because of your own being unsure as to what to do. The next piece of that is to really kind of bring in some validation. It makes sense. This has been a tough week. I know you’ve had a lot going on and I’m here for you. And so these conversations really need to happen where we’re sitting alongside our partner, right? Like body language matters. We need to be sitting next to them. If there’s physical touch is something that can be used and accepted and it’s tolerable, having that be a part of, I’m here for you. I’m physically here for you. And I think laying that foundation of, I’m noticing things are hard and I get it. And I’m here. I want to put that first before this is what you say. Here’s the script and here are the do’s, here are the don’ts. I want you to connect. I want you to notice the hard first before you come in and say, I’m noticing the hard and here’s a list of resources and I would have an appointment for you on Friday. I mean, that may be necessary based on the level of intensity and maybe this isn’t the first time you’re having this conversation. But if it does happen to be the first time you’re having the conversation, I think focusing on connection, I’m noticing it’s hard, it makes sense to me and I’m here for you. That has to come first before we then offer anything else.

Sam: Yes, leading with empathy, compassion, validation before everything.

Ashley V.: That makes me think I worked a lot with children in the first part of my career. And there was the idea of connection over correction. And so right, aligning with and being there and simply like, being there, you know, sometimes I need that connection with my husband. I’m like, I ask him to just stare in my eyes for six seconds. Like, we just need to stare. I just need a moment of connection to kind of settle and soothe my nervous system, you know? And I’m just thinking how helpful that could be really for anybody kind of embarking on this process for the first time or embarking on it again, you know? So Ashley, we are running out of time. We always we always feel like this goes too fast. So before we close, I was just curious, do you have any resources or for folks that are like hearing about this for the first time or for folks that are hearing about this for the seventh time? What are some resources? Where can you point us to get more support?

Ashley M.: There is so much to be said and so much to be talked about when it comes to this intersection of eating disorders and romantic relationships that I don’t have a plethora of resources to be able to offer that really highlights that intersection really well. But I will say there’s a lot of great resources out there that really can support the focus on increasing connection, especially if you are in a romantic relationship and that desire for connection is there. And I truly feel that if we heal the partnership, we feel connection in relationship, it will have it will have a direct correlation on eating disorder symptoms. So if we’re looking for that type of resource, I would say I really love Gottman, like Gottman Method. There’s so much good, good information there. Esther Perel is amazing. I mean, there’s a lot of really great amazing names in couples therapy right now. Use those resources. There’s weekly newsletters that go out and there’s actual tips for doing things like you said, like looking in each other’s eyes for six seconds and things along those lines that you can bring into your relationship at any point. Because I think that connection is so important, but I also think it can be worked on no matter where you are in your relational journey, especially if there is an eating disorder history present or concern for some re-experiencing connection, focusing on resources that can help you find ways to do that. Because if I’m completely honest, I don’t know that I would know any of this had I not gone to school to be a licensed marriage and family therapist. There’s no schooling that is supportive of how to form and maintain healthy relationships. I bet that will continue to evolve. I’m hopeful of in our education systems, but a lot of the skills that we’re talking about, you know, validation and connection and automatic appraisals and a lot of us are just out here just winging it, trying to do our best. And so I think any information and education we can get on relationships is very, very beneficial no matter where you are in the process. And of course, all of the eating disorder resources that you guys mentioned all the time are still there and still applicable and still are very much relationally focused. And again, if we can put connection infused with the eating disorder skill set, I it’s just the perfect combo.

Ashley V.: Awesome. Ashley, thank you so much for being here. I think that this was an incredible conversation and one that we’ve needed to have actually for a while. So, so glad that you’ve been here with us and thank you all for joining us for another episode. We’ll see you soon.

Ashley V.: Thank you for listening with us today on All Bodies, All Foods, presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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