"You Don't Need to Be an Expert in Everything": Debbie Thomson on Working with Eating Distress

Debbie Thomson, Transactional Analysis (TA) Integrative Psychotherapist, UKCP Acc & Imago Relationship Therapist

Many therapists encounter clients whose relationship with food and their body sits quietly at the centre of their distress. Its not always named as an eating disorder, not always presenting in a way that fits a diagnostic category, but present nonetheless. And many of those therapists feel a particular kind of anxiety about it.

The risk feels higher. The territory feels more specialist. The question of where their role begins and ends can feel genuinely unclear.

Debbie Thomson has worked with eating distress for years, and she hears this anxiety from therapists regularly. Her response is characteristically direct:

"You're not alone. But you don't need to be an expert in everything. If you can stay grounded, relational and curious — and willing to stay in contact — you can work with this client group."

That combination of warmth and clinical steadiness runs through everything Debbie does. It is, in many ways, what drew her to this work in the first place.

A relationship with food, and what it can hold

Debbie came to psychotherapy through her own experience of it. She has been in therapy for many years. "The growth I experienced in those early years was life-changing," she says, "and is what inspired me to become a psychotherapist myself."

Her path towards eating distress specifically began much earlier, in something far more everyday. "I've always loved food. I learnt to cook when I was little, and very early on I realised that food and cooking were connected to love — being cared for, caring for others, and feeling a sense of belonging."

That early understanding made her curious about why those same relationships with food and body can sometimes become so painful. "After all," she points out, "we all have a relationship with food and our body. We can't exist without either."

What she has come to understand, over years of clinical work, is that a distressed relationship with food or body is rarely about food itself. "It's a symptom," she says. "A survival strategy that helps someone cope, communicate or manage overwhelming feelings. When we focus only on the behaviour, we miss the meaning — and the individual — underneath."

What gets lost when we focus on the label

One of the things Debbie feels most strongly about is the limits of diagnosis as a framework for understanding this client group. Her three-day course is called More Than a Diagnosis - a title that is both a clinical position and a quiet challenge to how eating distress is often treated.

"A diagnosis can help us organise risk," she acknowledges, "but it doesn't tell us why someone is using food or their body as a way to survive." The problem, she argues, is that people don't fit neatly into disorders. "When we focus only on the label, we lose sight of the person's story, their individuality, their context, and the function the behaviour serves."

She is also clear about the systemic consequences of over-relying on diagnosis. "Many people don't fit existing diagnostic criteria at all, which means they don't receive the support they need. Access to help can also depend on where you live - a postcode lottery that leaves many people without care."

This is why Debbie believes that therapists working relationally - not just those in specialist eating disorder services - have something vital to offer this client group. The relational and emotional work that she describes as so often missing from clinical services is precisely what a well-trained therapist is equipped to do.

The relational lens - and why TA fits working with eating distress

Debbie's approach to eating distress is grounded in relational and attachment-informed thinking, and she uses Transactional Analysis as a key framework throughout the course. For her, TA offers something particularly useful: "a clear, accessible language for understanding how early relational experiences shape internal dialogues, survival strategies and beliefs about the self and the world."

When we look at eating distress through this lens, she says, the behaviour often begins to make sense.

"We can see how someone's attachment wounds and experiences of misattunement shape the way they relate to food and their body. The patterns around eating often reflect long-standing strategies for safety, expression or regulation."

The implication for therapists is significant. If you already work with relational and attachment wounds — and most counsellors and psychotherapists do — you are not starting from scratch with this client group. You are applying a familiar lens to territory that may feel unfamiliar.

What therapists most need to hear

When Debbie thinks about what she most wants therapists to take from her course, she returns to a single idea: "Eating-body distress is often holding something important together. When we challenge the behaviours without understanding what they're protecting, the person can feel overwhelmed or exposed. Curiosity and meaning-making come first - they create the safety needed for behaviour change to emerge and sustain."

This is also her message to therapists who worry about the risk and complexity involved. Knowing your limits, she says, is not a failure of competence - it is part of working safely and ethically. "When someone is medically unstable or needs medical input, referring on is an ethical and protective step. It doesn't have to break the relationship - it can support it."

Her hope for therapists who engage with this way of thinking is straightforward: "I hope they will feel more grounded, less afraid, and more relationally curious."

Is this course for you?

More Than a Diagnosis: Eating, Identity and Therapeutic Support is a three-day online course for therapists and mental health professionals working with adults experiencing eating disorders and eating distress.

It covers DSM-5 diagnoses, body image and shame, medical risk, and therapeutic interventions through a relational and TA-informed lens.

Debbie puts it simply: "If you want to feel more confident, more grounded, and more able to work safely while honouring the person behind the presentation - this course is for you. It's designed for practitioners who care deeply, who want to reduce shame, and who want to understand how food-body distress makes sense in the context of someone's relational world."

You can find out more and book your place at northsidetraining.co.uk/courses/eating.

More events and workshops coming up can be found on our events Calendar.