In my 20 years of practice in the eating disorder field, one of the most common challenges clinicians face is helping clients with body image concerns. I often hear (and have said myself):

“I’ve tried cognitive strategies with my clients, but they’re not working.”
“My clients say they know their body is okay, but they don’t feel it.”
“I don’t know how to help my clients really feel different about their body.”

These struggles often stem from how we conceptualise body image and therefore, where we focus our treatment efforts.

Traditional approaches view negative body image thoughts and behaviours as the problem. So, we work on reframing beliefs, reducing comparison, and promoting body acceptance or neutrality. While these strategies can help at a cognitive level, they often miss the deeper emotional experiences that shape body image in the first place.

Take Claire, for example. She was teased repeatedly at school about her weight, developing beliefs such as:

  • “I am not acceptable as I am.”
  • “I am too fat to be loved.”

Even after treatment for her eating disorder helped her restore weight, eat regularly, and challenge her beliefs, she still felt unlovable.

Claire’s story highlights why traditional strategies sometimes fall short. They may change thoughts, but they do not reach the emotional learnings connected to the past experiences that formed those thoughts in the first place.

Why Reframing Our Understanding of Body Image Matters

Negative body image is not simply about thinking, “I’m fat” or worrying about how others see us. It often reflects emotional learning from earlier experiences, which may or may not relate directly to appearance.

For Claire, repeated teasing taught her, “I’m not good enough.” Her body became the target for fixing these painful beliefs. Hating her body became a way to make sense of her trauma and changing the body through dieting a way to control her pain, a coping mechanism that met an emotional need.

This helps explain why some clients resist improving their body image because, unconsciously, hating their body and seeing their body as the problem has been helping them survive.

When we reframe body image this way, our interventions shift too. Rather than jumping straight to fixing thoughts or behaviours, we can lead with curiosity before change, seeing them as a portal into unresolved pain.

We might ask:

  • What experiences shaped my client’s view of their body?
  • How has body dissatisfaction helped them cope with deeper pain?
  • What does hating or trying to fix the body help them avoid?

When we view body image as both a coping strategy and a reflection of an emotional learning, we can support clients in making meaningful, lasting change by addressing the original wounds that gave rise to the need to hate and fix the body.

Final Thoughts

Reframing how we understand body image can transform our clinical work. Seeing it not just as a set of distorted thoughts, but as an expression of unhealed emotional pain, allows us to bridge the gap between knowing and feeling. From this lens, we can help clients move beyond intellectual insight toward genuine emotional healing and a more compassionate relationship with their body.