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A Therapist’s Guide to Treating Eating Disorders in a Social Media Age – Interview

Shauna Frisbie joined us for an interview on her book, A Therapist’s Guide to Treating Eating Disorders in a Social Media Age. What follows are our questions in italics, and her thoughtful responses.

In A Therapist’s Guide to Treating Eating Disorders in a Social Media Age, you remind us that eating disorders can “steal the authentic self” and seriously damage identity development. Please tell us more.

The authentic self can only be present when the true, genuine self is acknowledged by a person and expressed to others. Authenticity occurs when actions align with the whole of who one truly is across situations, rather than when a person expresses characteristics to gain approval from others. A false self may be created to gain approval from other people and from a society that dictates a narrow view of appearance and behavior. The very nature of the singular focus on meeting toxic cultural standards that occurs with an eating disorder directly opposes authentic wholeness.

Eating disorders steal the authentic self by shifting attention away from the true feelings, reactions, desires, interests, and values of a person. Eating disorders take over a person’s life by creating a narrow eating disorder identity with rigid rules that must be followed. An eating disorder can feel like an identity over which a person feels control, if only they can follow the rules exactly. This is an identity based on physical appearance and acting in ways that might gain approval from others, or even on an anorexic or bulimic identity. When the false identity is present, the individual will behave in ways that fit with or are congruent with the eating disorder identity. So rather than developing an authentic identity based on the true self, identity development is stunted when the eating disorder becomes the focus of identity. When all of a person’s time and energy is focused on maintaining the eating disorder identity, a full, authentic identity is not possible.

What are some of the identity challenges people diagnosed with an eating disorder face while immersed within our social media saturated world?

Social media has changed how and where we interact with one another. Because identity is shaped by social interactions and feedback from others, social media is now another means through which identity is formed. Social media posts are a very public forum to try out one’s identity for those whose opinions and acceptance are believed to matter.

One of the most challenging aspects of social media use for those with eating disorders is the emphasis on physical appearance that is inherent in the photo-based content of social media. Unrealistic societal standards or cultural expectations for the thin ideal are rampant in these images, which makes it highly likely that individuals with eating disorders will compare themselves to images viewed on social media in much the same way that in-person comparisons occur for these individuals. Comparisons that occur on social media have been shown to be more damaging to body image than in-person comparisons, so the frequency of social media use and the availability of unhealthy images is extremely damaging. Social media is rife with diet, weight loss, and other misinformation about the need to reshape the body. Social media also offers the opportunity for those with eating disorders to post selfies to seek affirmation of physical appearance in the form of likes or comments. These types of social media interactions heighten body dissatisfaction and promote beliefs that physical appearance can be reshaped to adhere to culturally sanctioned ideals.

In my book, I talk about the difficulties that people experience in response to photographic images. Because visual and emotional processing systems in the brain are extensively connected, images are processed quickly and often out of a person’s awareness. Unconscious emotional reactions impair the ability respond rationally to images that trigger strong feelings, and it is clear that images depicting cultural standards for physical appearance have the power to override logical thought. Even those who utilize editing apps in their own social media posts have difficulty acknowledging that photos they view may also be edited. Those with eating disorders have more difficulty with social media content because they are already focused on physical appearance and the desire for approval from others, and they often have difficulty with emotion recognition and expression. They seek out social media content related to body and weight, yet do not have the emotional skills to deal with their own responses to these images.

Please describe photo therapy.

Photo therapy is a collaborative therapeutic approach that engages the client and therapist to uncover the client’s internal reactions to a photograph. Although photo therapy techniques were developed well before the advent of social media, in the social media age it is more important than ever for clients to be able to determine how they are impacted by the images they view. Photo therapy techniques guide the client to look beneath the external characteristics of a photograph to reflect on the feelings, thoughts, memories and meanings that are stimulated by viewing the image. The therapist’s task is to aid clients to unravel how the personal, social, and cultural messages in the images they mindlessly post or view on social media reflect and impact their identity.

Photo therapy techniques can facilitate emotional awareness and processing of responses to various types of images including selfies and other types of photos taken by the client, family photographs and other images of the client taken by others, as well as any images the clients views on social media. Clients always have phones with them in session, making content readily available for processing; however, the therapist can also assign photo-related tasks such as photo narratives or selfies of the day for specific therapeutic goals. Photo therapy relies on open ended questions that are carefully chosen to move the client toward exploration of emotional responses to images and how these inform one’s sense of who they are. Importantly, therapists don’t need artistic or photographic skills to use photo therapy techniques, so photo therapy can be used by and trained to therapists who are open to learning about specific activities and the types of questions that aid clients to explore what the images mean for them.

How can one discern the “truth” in social media images?

The truth in social media images is subjective to each individual client. Therefore, the truth is based on the client’s openness to exploring how they react to and are impacted by images. The task for the therapist is to aid the client to look beneath the ‘what’ of an image —the cliched poses that advertise success or perfection— to the ‘how’ and ‘why’ of the image — how taking or viewing the images makes one feel or the desires that are expressed in the image.

In order to gain this skill, clients need a basic understanding of how their emotional reactions to photographs can impair what they believe to be real or accurate. Social media is a fantasy world inhabited by seemingly perfect specimens of humanity, and it contains only highlight reels of perfect lives. If an individual chooses to enter this world, exposure to toxic messages that place an overvaluation on weight and shape is a given. To prevent harmful responses to social media, the individual must continually practice self-awareness of the meaning they are making when they view images. This search for the truth is the basis of photo therapy work.

What can selfies tell us when used in a therapeutic context?

Selfies can provide a wealth of information from the client’s perspective. When guided to explore what is beneath the surface of a selfie, clients often express intense emotions and confusing thoughts that were previously out of awareness, increasing insight into the self. When we ask clients open-ended questions about what the selfie is trying to say or how they want others to react to it, we help clients gain self-awareness about their desire for positive self-presentation and affirmation. Therapists learn about clients’ internal dialogue and their sense of who they are through these interactions; however, the power of this work lies in clients’ growing ability to self-explore and learn about themselves­­.

When used in a therapeutic context, selfies allow a person to see themself from an external perspective and to speak about themself indirectly from a third-person perspective. Clients can interact with the images at their own pace and over time may be able to speak of their feelings more directly from a more personal first-person perspective as they are ready. Across time, selfies can be a reminder of progress in developing an authentic identity. They represent the client’s life story, which is a foundational component of identity.

Please speak to the power and influence of group membership in our social media age.

Group membership has become more complicated in the social media age. It is no longer based on proximity to others; a person can hang out, interact with others, and gain a sense of belonging through social media. Individuals today have larger social networks than in previous generations, but there are challenges inherent in these complex group memberships that occur primarily on social media. Because people are on social media around the clock, many feel pressure to constantly be on their phones. They know what their friends are doing at any given moment, and they see photos and messages of activities in which they’re not included. They are fearful of not constantly monitoring social media, fearing they will miss out on what is going on or even be forgotten by others if they are not constantly present.

Images and posts on social media demonstrate in a very public way who holds membership in a group, and as in previous generations, group membership is highly influential to identity formation. Social media is both a very public forum and a context in which personal relationships are navigated. Rules for group membership are often unspoken, social blunders are witnessed by many, and comparison is rampant. Many individuals in this age obsess over their social media posts, only to feel lonely and to long for face-to-face interaction. There is great concern that group interactions on social medial do not meet the need for connection in the same way as being with others in person does. Holding membership in groups that now meet primarily through social media may not give one the sense of belonging or the social experiences that are crucial for well-being.

In terms of recovery, reducing risk of relapse, and reducing the risk of developing an eating disorder, what are some steps an individual can take to improve their social media literacy?

This is an excellent question because we can be certain that social media will not magically disappear. Social media literacy is increased when individuals follow some basic strategies.

  1. Understand how social media is designed to promote excessive use and dependence through likes and comments, rather than true connection.
  2. Recognize the power that visual images have to influence feelings, thoughts, and identity.
  3. Develop skills that enable decoding of the underlying meaning of social media content by gaining knowledge about toxic social and cultural messages that are represented in social media images.
  4. Assess social media use for habits that negatively impact mood and beliefs about the self.
  5. Choose to only engage in social media in ways that enhance authentic identity and resist toxic cultural messages.
  6. Cultivate face-to-face relationship skills and connections to supplement social media relationships. Humans are wired for a deeper means of connection than social media can provide.

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About the author:

Shauna Frisbie, Ed.D, is a certified eating disorders specialist who integrates cognitive behavioral, interpersonal, and mindfulness-based approaches in her clinical work. She is a professor in the graduate psychology and counseling department of Lubbock Christian University and lives in Lubbock, Texas.


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