Contributed Article by Susan Kleinman, MA, BC-DMT, NCC CEDS
“Body image is the picture in our mind’s eye of how we look to ourselves. It reflects our beliefs about how we think others perceive us and captures how we experience the feeling of “living” in our bodies.” ~ Adrienne Ressler, MA, LMSW, CEDS
Everyone has a body-image. Beginning at birth, body image develops as we experience life, incorporating the messages of our personal and more global culture into the picture that forms in our mind’s eye. Although we may hope to form an inner image that is more positive than negative, we are all susceptible to finding fault with who we are. By feeding ourselves a steady diet of self-criticism we pave the way for a deprecating self to take control. Sticking to us like glue, these critical thoughts become central to our actions and decision-making – causing us to express ourself from a distorted perspective. This imbalance has the power to paralyze us and will, when we let it roam freely in our minds. According to Oliver Wendell Holmes, “The greatest thing in this world is not so much where we are standing, as in what direction we are moving”. Consequently, when low self-esteem or insecurities promote negative perceptions, they must be challenged in order to regain a more balanced perspective.
Individuals with eating disorders, as well as survivors of trauma, tend to fix their attention on their distorted perception of themselves. In an attempt to avoid bodily felt connections they may numb feelings and sensations to quell overwhelming emotions, and engage in punitive and negative thoughts and self talk regarding their perceptions of themselves ( Kleinman, 2009).
Because our thoughts attitudes and feelings are influenced by the rhythm and movements of the body, likewise, body movements are influenced by our thoughts, attitudes and feelings. Therefore, body and mind cannot be treated independently of one another (Ressler & Kleinman, 2012).
Expanding the ability to resolve body-image issues must include examining what underlies the negative perceptions and feelings. Exploring the impact of one’s perception of self on one’s life must also include an emphasis on living “in” rather then controlling the body.
Megan, a patient at The Renfrew Center in Florida described the struggle between her positive and negative body image this way:
“Over the years, I have grown to see myself the way I believe other see me, as a failure, a disappointment, and a burden. These messages feel like a knot in my stomach that keeps tightening and never loosens. They are like a voice in my head that keeps repeating that I’m no good and nobody wants me around. They cause me to feel heavy and weighed down. I have become a very sad, introverted woman, afraid I will be rejected if I speak out. I hurt myself by not eating, overeating or purging. I make sure I never feel satisfied, and I make myself believe that my accomplishments are not real.
There is a small part of me, however, that does believe that I am a strong, independent, lovable human being, capable of experiencing emotions and trusting myself. ”
In order to develop a healthier body image, Megan will need to build on her strengths and re-balance her body image so that her negative thoughts are no longer dominant. In short, she will need to:
- Learn about how her perception of self takes form and lives in her body
- Explore how she expresses herself through her body language
- Identify how she sees herself and perceives how others see her
- Examine how her image of herself impacts on her life
- Explore and develop strategies to expand her ability to resolve her body-image issues
While in treatment, Megan, participated in a special group, called Body Image Experiential ( Kleinman, 2001). This format was developed in order to provide an opportunity for our residential patients to explore their body image issues from the inside out. Since our body image programming centered mainly around the media’s impact on a person’s body image, it was believed that a format that focused also on the person’s relationship with their body stemming from their internal perceptions of themselves, would be helpful.
The Body Image Experiential format embraces a psychoeducational, experiential and psychodynamic format, lending itself to:
- Helping participants explore and begin to understand what is driving their body image perceptions
- Acknowledging when they are turning toward disordered patterns as a way of coping with feeling overwhelmed
- Challenging them to use their distortions as signals that might help them recognize when they are having conflicts.
- Trusting that if they are able to recognize what is not feeling ok, they can take action in healthier more effective ways, rather then automatically resort to eating disordered behaviors
First, patients are engaged in a discussion focused on a meaningful quote related to body-image, such as “There is truth in every body” (Residents at The Renfrew Center of Philadelphia, 2002) or “It is not uncommon to hear someone with an eating disorder describe her relationship with her body as that of one with a stranger or even an enemy”, ( Kleinman & Hall, 2006). Then, expressive movement techniques are developed by the therapist to embody understanding of emerging issues. The movement work is processed on a body level as well as a cognitive level. This is followed by each patient journaling on a worksheet developed specifically to contain body image notes called a BIN (Kleinman, 2002). Use of the BIN provides the patient with a means of externalizing insights as well as documenting them as a resource. Finally, mini goals are developed for homework to help patients create action plans on body image issues. Before the next group, the therapist reviews and writes feedback on each patient’s BIN. Patients acknowledge that the feedback provides them further direction, and support in working on issues identified in the group (Ressler & Kleinman, 2006). The written feedback also provides a cognitive framework of guidelines to assist continued exploration of issues.
In Megan’s case, the therapist told her that since she’d been able to recognize a positive message, she could use that small part of herself that she’d identified as “strong, independent and articulate” as her foundation for growth. She could develop strategies to transform the negative attributes she’d identified into positive ones. The therapist reinforced her suggestion by identifying each negative attribute Megan had identified and showing what she meant by adding, “For example, you said you are scared of rejection and afraid to speak-out. Two of your mini goals this week can be to take a risk to speak-out and assert yourself, as well as to connect with peers. ”
The second week, Megan wrote on her BIN: “I am a little more optimistic and I feel empowered, but I am afraid and because of this, I still withdraw and feel meek. The good thing is that I am starting to respect myself, and in turn, treat my body with more respect by nourishing it and not feeling guilty. ”
Wanting to encourage Megan to continue to move in this direction, the therapist wrote back,
“ Megan, you have identified and articulated what you need to do. Now you need to try to fear yourself less and trust yourself more. I’ll be glad to help. ”
The third week, Megan wrote on her BIN, “ I use my eating disorder to make me feel less scared – more in control of my life. It moves the focus away from the things that I think I cannot accomplish so that I do not have to feel negatively towards myself for failing. I then focus on my eating disordered behaviors like counting calories, or distracting myself by keeping busy. My eating disorder helps me run away and be ok about it. I pull away from the people in my life and I don’t ask for help. When I run as fast as I can, I switch my focus immediately to something else, instead of facing what lies ahead. I never give myself the opportunity to learn from my mistakes. I feel the need to be successful at everything I face and as a result, I work myself sick. I am hard on me at all times. I am not sensitive to my feelings, I numb myself and this makes me tense and anxious. ”
The therapist wrote back to Megan, “Although you may not be aware of this, once again, you have identified a great next step. If you reverse the last statement you made, I am hard on me at all times. ( I am not sensitive to my feelings, I numb myself and this makes me tense and anxious), you will be able to work to transform problems you’ve identified into strengths that can work for you. Specifically, you will need to transform being hard on yourself into being kinder to yourself, like you would be with a friend; insensitivity toward your feelings into acceptance of all your feelings and subsequent needs, and numbing yourself into experiencing and expressing feelings so that you can be in charge of, rather than attempt to control what you feel. ” Megan approached the therapist following this group, asking for further help in implementing strategies and they decided to begin working together individually using dance/movement therapy to delve further into these issues (Kleinman, 2002)
By using the patients’ strengths to explore issues they identify, it becomes more possible for them to feel empowered to consider removing their masks, to explore what lies behind them, and then to develop new ways to cope with their discoveries. Key to the success of this format is the dance/movement therapy component that builds on the notion that experiential understanding begets cognitive understanding (Kleinman & Hall, 2006). Adolescent girls and women with alexithymia find this format particularly helpful because communication continues to be available when words are not possible. Once engaged in interactions that focus on expressive movement, insights spring to the surface because of the visual and experiential clarity inherent in the movement metaphors.
Kleinman, S. (2002). Challenging body image distortions through the eyes of the body. Proceedings of The American Dance Therapy Association, 37th Annual Conference. Columbia, Maryland: American Dance Therapy Association
Kleinman, S. (2009). Becoming whole again: Dance/Movement therapy for those who Suffer from eating disorders. In S. Chaiklin & H. Wengrower (Eds.), The art and science of dance/movement therapy: Life is dance (pp. 125-144). New York, NY. and Hove E. Sussex: Routledge. ( Revisions in Press)
Kleinman, S. & Hall, T. (2006). Dance/Movement therapy: A method for embodying emotions. In Davis, W & Kleinman S (ED) The Renfrew Center Foundation Healing Through Relationship Series: Contributions to Eating Disorder Theory and Treatment Volume 1: Fostering Body-Mind Integration. Philadelphia, PA (pp 2-19).
Kleinman, S. (2001). Body Image Notes (BINs)
Ressler, A. and Kleinman, S. (2006). Reframing Body-Image Identity in the Treatment of Eating Disorders. In W. Davis & S. Kleinman ( Eds). The RenfrewCenter Foundation Healing Through Relationship Series: Contributions to Eating Disorder Theory and Treatment Volume 1: Fostering Body-Mind Integration. Philadelphia, PA,
Ressler, A. and Kleinman, S. Experiential and Somatopsychic Approaches to Body Image Change. In: Thomas F Cash, editor. Encyclopedia of Body Image and Human Appearance, Vol 1. San Diego: Academic Press; 2012. p. p. 418-424.
Susan Kleinman, BC-DMT, NCC, CEDS, dance/movement therapist at The Renfrew Center of Florida, is a trustee of the Marian Chace Foundation, past president of the American Dance Therapy Association and past chair of The National Coalition for Creative Arts Therapies. She is co-editor of The Renfrew Center Foundation’s Healing through Relationship CD, co-author of chapters on body/mind methods in the textbook Bridging the Research-Practice Gap in the Treatment of Eating Disorders and the first Encyclopedia of Body Image and Human Appearance. She has also contributed several chapters for textbooks used in the education and training of dance/movement therapists, has earned international recognition for her expertise in using dance/movement therapy as a treatment method for women with eating disorders and is a recipient of the American Dance Therapy Association’s 2009 Outstanding Achievement award. Her work is featured in the documentary on eating disorders entitled Expressing Disorder: Journey to Recovery.
Updated and Published Date: June 1, 2013
Last Reviewed By: Jacquelyn Ekern, MS, LPC on June 1, 2013
Page last updated: June 1, 2013
Published on EatingDisorderHope. com, Help for Eating Disorders