The Nature of the Problem

The nature of the problem

• Are you often on a diet or being careful to eat very little?
• Do you overeat?
• Do you binge eat? What do you mean by a binge?

How much food would you eat in a binge?

How often does this happen - times per week, day, times per day?

How long does a binge last?

• Do you snack between meals?
• Do you think about food a lot even when you are not eating?

• Do you do anything to try to counteract the effects of eating or of binges? E.g:

Do you diet strictly?

Do you miss out meals?

Do you stick to a rigid meal plan?

Do you ever stop eating altogether for periods of time,?

Do you ever take measures to rid yourself of food you have already eaten, such as vomit, take laxatives, take diuretics

• Do you eat the same foods every day?

• Are there foods that you avoid eating or that you regard as 'forbidden' altogether?

• How much exercise do you take? (In an anorexic, how far does this appear to be excessive? In a bulimic or obese binge eater, does the person follow a regular exercise plan, or do they avoid exercise as far as possible?
• How long has the problem(s) been going on?

Situational factors

• Under what circumstances do you binge?
• Under what circumstances do you under-eat?
• Do you binge eat/under-eat in response to specific moods or thoughts? As a result of eating certain foods or classes of food? In response to eating food regarded as forbidden? At what time(s) of day?
• Is there anything that makes the problem worse/better?

• Has there ever been a time when the problem disappeared completely or was better, or was a great deal worse, if only temporarily?

• Are there situations you avoid, such as going out for a meal to a restaurant or to a friend’s house?

• Do you eat in public? If not, what is it that stops you?
• Is there a pattern? Does it vary?
• Is eating ritualised?

It is often useful to go over a typical day to establish the client’s current pattern of eating.

History of weight and dieting

• When did you first become concerned with such issues?
• Do you recognise any precipitating factors or triggers?
• Are you on a diet now?

• Have you dieted in the past?
• How did you go about dieting? i.e. count calories/count fat units/low fat/low carbohydrate/weighing out food according to some published diet plan/just eating less or trying to cut out meals. (It is important to establish just what is meant by dieting in order to gauge the person’s level of nutritional knowledge.)
• How does dieting affect your eating habits?
• Do you think about food more, or less, when on a diet?
• How successful are you at dieting?
• What is your lowest / highest ever adult weight?
• Have you had a stable weight as an adult?
• What led you to diet in the first place?
• What weight would you like to be?
• What is your eating behaviour when you are not on a diet? E.g. do you tend to eat three meals a day plus snacks, or eat little and often, or eat continuously throughout the day? (Many people with eating disorders can barely remember a time when they were not on some self-prescribed diet or what it was like to eat ‘normally’.)
• Is there a pattern of dieting, obesity in your family?

Attitudes to food and eating (and history of attitude)

• What were mealtimes like as a child? (For example, Was there anything significant about the ‘emotional climate’ of family mealtimes, for example were meals taken typically in silence, or amid seething rows, solo in front of the television, or with varying members of the family in an atmosphere of ordinariness?)

• What kinds of foods do you like? What did you like before you developed a problem?

Attitude to Weight and Shape

• Do you feel that you are too fat? Just right? Too thin? Would you like to be thinner? Fatter?

• Do you want to lose weight? (Or, in the case of someone who is already emaciated - do you want to lose more weight, and if so, how much?)
• What weight are you aiming for? (i.e. what is your target weight?) How realistic is the target weight?
• What would it mean to you to be fatter/thinner? What would being fatter/thinner say about you as a person? What does being fat/thin say to you about other people you meet?

• What do you think will be the effect on you of losing weight? (i.e. will the client look better, feel better about herself, be meeting expectations of family/significant people in her life? In particular, the counsellor should look for unrealistic expectations of the way in which life will change if the weight is lost, e.g. ‘Everything will be OK if only I could lose weight.’ ‘I can only be happy if I know that I can get into a size 10.’)

• How would it affect your life if you knew that you could not achieve this weight?

• If you would like to be thinner, is there any part of your body that you are satisfied with? Is there any part/s of your body that you are dissatisfied with in particular?
• Is there anyone else who wants you to lose weight?

Attitude to dieting for overweight people

• How much weight do you expect to lose in a week?

• What will losing weight involve for you?

• Does the client expect to have to starve? Eat certain foods to the exclusion of others? Does she know which items in her diet will need to be reduced? Is she aware of the difference between sticking to a time-limited diet versus long-term healthy eating programme? What life-style changes will the person need to make in order to sustain any physical changes they might achieve?

• What difficulties will be involved in making these life-style changes? How will any attempt to change be affected by work and time pressures, or by financial pressures? How will it be affected by family pressures, such as demands made by family members or by the day to day problems involved in catering for a family (‘My family won’t eat vegetables/brown bread,’ etc.).

Effect on the client’s life

• How do the problems you have described affect your life in general?

• How do they affect your relationships with family, with friends, with colleagues?

• How do they affect your ability to do your work/study?

• Does the way you see the shape of your body negatively affect the way you behave in any way? (E.g. does it result in avoidance of certain activities such as swimming, eating in public, or have an effect on personal, physical or sexual relationships?)
• What have you told others about your eating disorder – if anything?

Previous attempts to change

• If the client has tried dieting, did he or she get their ideas or advice about what to do from friends, a group, a club, magazines, doctors?
• Has there been any previous attempt at therapy of a psychological nature? If so, what was the nature of the therapy approach taken? How did the client respond to the therapy?
• What if anything did he or she learn from the therapy - about the eating disorder, and about him/herself?
• What did he or she like best about the therapy? What did he or she like least about the therapy?

• Has the client ever seen a dietician? What kind of information or advice did the dietician give?

• How did any previous therapy or advice consultations end? Was this by mutual agreement, or did the client ‘drop out’, and if so, why was this?

• Most importantly, what are the client’s current expectations of counselling? What would he or she like to achieve through counselling?