ClinicNotes: August 2025
welcome to ClinicNotes - a newsletter designed for practitioners working with relationship with food & eating behaviour. This is my public journal, where I share the latest research, tools, training, and anything else useful to practitioners working with eating difficulties and behaviour change.
building psychological flexibility in a client who binge eats
A lovely client (30, restrict-binge cycles) has been struggling with body image worries and body checking several times a day. Although there are various methods to address this, a valuable, evidence-based and longer-term approach with wider benefits can be building psychological flexibility.
How are we achieving this?
We have spent several sessions (and homeworks) uncovering what really matters to this client. We have explored her values and started to explore how body-checking behaviours often pull her away from these.
So far, this involved:
Identifying her values using the values checklist. You can find an example of this resource here. Her values are connection, adventure and freedom.
Assessing her values against body checking. As a homework, this client has journalled about each value and whether body checking is aligned with this value or not. We then discussed the summary of this in a session.
She said that body checking was blocking her value of connection:
“When I spend lots of time, several times a day checking my stomach, my skin (for ageing) and my legs in the mirror and in photos, it means I am distracted and caught up in worries and thoughts about my body. I then find it hard to be present and connected to other people because I’m ‘in my head’.”
Next steps:
We are going to work on defusion techniques to help her manage the urge to body check, and identifying specific, values-aligned actions that can serve as more meaningful alternatives. I’ll keep you updated on her progress in future newsletters!
🧭 What this can teach us: Body image distress isn’t really about appearance. It’s often about disconnection from meaning, presence, and relationships. By helping clients notice the function of their behaviours, connect them to their values, and move towards more flexible, purpose-led actions, we shift the focus from fixing the body to restoring a meaningful life.
👉 interested in psychological flexibility? check out my blog here.
a simple approach to assessing client readiness
This month we’re spotlighting a deceptively simple but powerful tool: the Readiness Ruler, a staple of motivational interviewing and a fantastic addition to your clinical toolkit.
I often use it in discovery calls and initial sessions to explore a client’s readiness to change, but I also use it to deepen the conversation, encourage self-reflection and ‘change talk.’ Although it is an assessment approach, it might also be considered an intervention tool.
Here’s how to use it in practice:
Step 1. Explore importance
Ask the client to rate (0–10):
“How important is it to you to make change to you right now?”
Then explore:
What makes it important right now?
What would happen if nothing changed?
What are you most worried about in terms of changing?
Step 2. Explore confidence
Ask the client to rate (0–10):
“How confident are you in your ability to making this change?”
Then explore:
What makes you that confident already?
What would help you feel one point more confident?
What skills do you have to make this change?
Key Insight: Importance vs Confidence
For me, importance matters more than confidence. If someone values change (and deems it important) but feels unsure how to get there, that’s a workable place. Confidence can be built. Skills can be taught. But if the commitment to change is low, it’s harder to create momentum.
📎 Want to try it? Grab the tool here.
having an eating disorder is like…riding a bike up a mountain
Anyone who knows me will tell you I LOVE METAPHORS and ANALOGUES. I share these with my clients on a very regular basis - and to be totally honest, some of them hit the mark and some of them crash and burn!
Here is one that is pretty universally liked:
Having an eating disorder is like riding a bike up a mountain. Sometimes the terrain is easy going and you feel like you're smashing it! And then sometimes, things feel so steep its impossible to make much progress despite putting in loads of sweat, tears and effort!
And sometimes you might even fall off the bike - crashing because of a rock on the path or from a branch smacking you in the face.
Now, all-or-nothing thinking might make a client feel like they've “blown it” or “what is the point.” But the important thing to share is that crashing the bike does not mean they've rolled back to the start of the mountain! And instead, the ‘crash’ gives them and us valuable insight and learnings into what they can do differently next time.
Remember, when clients struggle with progress, that's when it's great that they have you as their practitioner!
👉 what do you make of this metaphor? Pop me a message on Insta and let me know!
New training alert!
ACT for working with eating disorders and obesity
For any of you who have trained with me or I have supervised or worked with, you’ll know I LOVE Acceptance and Commitment Therapy (ACT). As an approach, the evidence and support is gathering for its utility in eating disorder recovery.
SDS seminars (a psychological skills training provider) are offering a 6-hour masterclass exploring ACT in eating disorders and obesity. Live online sessions are running on 17th and 24th October (mornings).
How to practice intuitive exercise - an article by Jessica Francis
An interesting article on intuitive exercise that also includes four useful questions you could ask yourself/clients about their movement.
Nothing About Us Without Us: The Overlap of ADHD, Autism, and Eating Disorders by Bernie Wright
Covers the importance of honouring neurodiversity in eating disorder care.
Risk factors for eating disorder symptoms at 15 years of age: a 9-year longitudinal cohort study - Hanson et al., 2025
An interesting longitudinal study outlining the risk factors of eating disorder symptoms at age 15 years, suggesting different pathways for girls and for boys.