Avoidant/Restrictive Food Intake Disorder (ARFID) is a lesser-known eating disorder. It can impact every part of life, from physical health to social interactions and self-esteem. In this blog, I’m sharing a bit about what ARFID is, my own lived experience, and some reflections from my practice as an eating disorder therapist.

Struggling with negative thoughts about your body? You’re not alone - there is support available.

I’m an Integrative therapist and I work online with a range of body image and eating problems. I’ve spent many years working in eating disorder services and learning about body image, partly due to my own lived experience in the past. I’m passionate about helping others tackle their body image concerns, so I work online offering body image therapy for anyone in the UK.

​This post will explain what body image therapy is, what it can involve, and how it can help you feel more at ease in your own skin.

This is a personal piece about how I went from being someone with very low self-esteem and self-worth, to a counsellor specialising in body image and eating disorders. I hope it may help others who may want to train to be counsellors, or for those struggling with self-esteem and body image problems, or for anyone who might just be interested in reading the journey.
 
I grew up in the Midlands in the Eighties and Nineties, what I would think of now as working class but I never considered that back then. From as young as I can remember, I didn’t like myself very much. I hated my body, and I knew I had to try and make myself thin to be loveable. I was a very quiet, shy child who found it difficult to speak up. A lot of people were very mean to me, both other kids and adults. I didn’t think I was particularly good at anything and didn’t think I was worthy of love.

As an Integrative counsellor based in the UK, I was keen to watch the BBC series, Change Your Mind, Change Your Life, hosted by Matt and Emma Willis. The show aims to shed light on the therapy process by following individuals through their therapeutic journeys. The series brings therapy into the public domain, but often it’s confusing for potential clients (and for those thinking of training to be counsellors/therapists) to understand different job titles, roles and modalities/approaches.

So, who are the therapists in Change Your Mind, Change Your Life? What’s the difference between a psychotherapist and a psychiatrist? What are all these different confusing modalities? And is Change Your Mind, Change Your Life a realistic portrayal of therapy?
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If you haven’t seen the show but are still interested in understanding more about therapeutic modalities and how to find a therapist/train to be a therapist, then do also keep reading!

Let’s talk about Irvin Yalom’s “Fat Lady” chapter from Love’s Executioner. I was given this chapter to read as “homework” during my first year of counselling training. Well… I wasn’t expecting it to pack such a punch.

The way Yalom talked about his client, Betty, was shocking; “I have always been repelled by fat women. I find them disgusting.”

His evocative words to describe her seemed purposely cruel, clearly chosen to make the reader uncomfortable. As a writer, I partly admired being able to evoke such strong reactions, and I’ll admit I read the whole thing captivated but astounded. I went back to my course the following week itching to talk about it, but there wasn’t space or time for discussion. So I bought it up in “open group” (like PD group) and shared my concerns about reading the “Fat Lady” chapter without any time for critical reflection. Most people said they were just blown away by Yalom’s honesty, and that was it.
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Back then I didn’t have the knowledge, language or confidence to challenge this further, but I certainly do now! For context, I work in private practice, predominantly with people with disordered eating and body image problems, and I work with many clients who have experienced weight stigma and anti-fat biases. I train counsellors on these topics and have read and written about this extensively. It’s safe to say this blog has been a long time in the making and I hope it’s a helpful deep dive.

Following the recent Supreme Court ruling that “the legal definition of a woman is based on biological sex”, I want to show my support for people trans, non-binary and gender queer people. As a counsellor with a strong ethical stance in social justice, I’m keen to make it clear that I stand with the trans community (which I’m using as an umbrella term), particularly trans women at this difficult time. Trans people are loved and supported, this week and forever. 

The term "incel" has become a focal point of media attention lately, since the release of Adolescence on Netflix, and due to violent incidents in recent years such as the Plymouth shooting in the UK, and the Toronto van attack in 2018. The term "incel" stands for “involuntary celibate”; a label adopted by people, predominantly men, who feel unable to form romantic or sexual relationships despite wanting to, and often blame others for this. What started as an online support group (ironically, set up by a queer woman) in the 1990s grew into an ideology rooted in anger, resentment, and misogyny.

Contains Adolescence spoilers and discussion of violence/abuse.
I also have a video covering this on YouTube if you prefer to watch/listen.
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Adolescence (Netflix) has sparked a lot of important conversations about social media, masculinity, the manosphere, and more. As someone who has long been concerned about the rise of misogyny and the manosphere, I’m glad this show exists. It’s also rare to see a show that focuses on the perpetrator’s family and the abuse and stigma they experience. I’ve always been fascinated by what leads people to cause harm. I’m a counsellor in private practice and I used to work for a domestic abuse charity with perpetrators doing group and 1:1 work with predominantly men (you can read more about my experiences here). In this blog, I’m doing a deep dive into Netflix drama “Adolescence”, exploring the influence of the manosphere, power dynamics, gender roles, shame and trauma. These are just my theories/opinions and may differ from others, and also keep in mind that counsellors and psychologists are trained very differently.

Writing can be a powerful tool for exploring and processing emotions. As a writer and counsellor, I have experienced for myself how writing can be deeply therapeutic. We pour parts of ourselves into our words, even sometimes without realising it. Looking back, I can see that my early fiction writing was a way of processing my feelings and experiences, as well as my journalling. Writing blogs helped (and continues to help) explore themes like trauma, social inequalities, eating disorders, and body acceptance, which are central to my work.

Below are some suggested writing exercises that may help build self-compassion and improve body image. Some of these exercises are more structured than others, so do whichever ones feel right for you. The key is to write in a way that feels good or helpful, without any writing rules or pressures.

People struggle with eating in many different ways, so there is no one-size-fits-all approach to recovery and healing. I'd like to offer some insights into what healing your relationship with food might look like, based on my experience as an eating disorder counsellor but also from my own lived experience. This is just my perspective and some common themes I’ve noticed in practice. The most important thing is that you find the right path to explore these issues in a way that feels right for you, at your own pace.
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With all the buzz about weight loss injections recently, I’ve been hearing the term “food noise” a lot. As an eating disorder counsellor, I often work with people who experience some kind of food noise – incessant thoughts about food, cravings, anxieties about eating, food rules, and more. Many people discuss taking weight loss injections, such as Ozempic, Wegovy, and Mounjaro, to help reduce food noise. But is this the best approach to tackling food noise, and at what risk?

I appreciate that many people feel they need weight loss drugs desperately, and they have every right to take them. The problem is that many people don’t qualify for weight loss injections through the NHS and seek them elsewhere. This can lead to numerous problems and risks, which I discussed in a previous blog post.

I stand against harmful diet culture and the idealisation of thinness in our society but I do not judge people who choose to take weight loss drugs or pursue other weight loss interventions, given the cultural pressures we face. As a counsellor, my main mission is to help people improve their relationships with food and their bodies and to build self-acceptance.
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As an eating disorder therapist, I hear a lot of people say they feel like they can’t stop eating. They say they’re out of control, that food has a hold on them, and they just can’t resist certain things (normally the food deemed "bad"). For many, it can feel like inner conflict, like an angel and a devil on their shoulders shouting at them.

Food can certainly feel like an addiction for many people, with powerful thoughts and feelings commanding them to eat. It can feel like a yearning need, with real distress at the thought of not getting what they want. This is not simply just about willpower or weakness, this is a distressing battle of the mind. It can have such a huge impact on daily life and mental health. This distress can be indicative of disordered eating or an eating disorder, for which people deserve tailored help/therapy.

There can be similarities in how addictions and eating disorders develop and are maintained, but there are important differences when it comes to treatment/ therapy.

It’s that time of year again - the endless barrage of adverts: diet products, gym memberships, expensive supplements, weight loss drugs and injectables and more. And let’s not forget the “psychological approaches” to weight loss - the ones that say “we’re-definitely-not-a-diet” when they most definitely are! The New Year comes loaded with expectations: to be better, fitter, healthier, more successful… and, of course, to BUY MORE STUFF. Businesses selling diet culture don’t care about your health, they care about making money.

So here’s your friendly reminder: you don’t have to listen to any rules, “shoulds” or “musts” about your body in the New Year. Sometimes, the stress of trying to “improve” does more harm than good. Perhaps the aim can just be to show ourselves a little more kindness and compassion this year.

Did you know that many people with eating disorders are not underweight?

It's common for many people to think of thin young girls with anorexia when talking about eating disorders but realistically it's a lot broader, with disordered eating affecting people of all different shapes and sizes.

One study reported that only 6% of adolescents with an eating disorder are classified as underweight.

This is hugely important for the way we view, and help, people with eating disorders. It’s the reason why I’m so passionate about the connection between weight stigma and disordered eating, and about my therapeutic work with people experiencing eating distress and body image issues.

So I wanted to talk about “Atypical Anorexia” in this blog as this is an aspect of disordered eating impacting people who are not underweight, and this is heavily influenced by weight stigma.

I recently saw “Your Fat Friend”, a documentary about Aubrey Gordon made by Jeanie Finlay. I’m a big fan of Aubrey’s work, her books, blogs and podcast - Maintenance Phase. She’s been a huge influence on me both personally and professionally. I'm a counsellor and I work with people struggling with eating, body image and the impact of weight stigma. I’m passionate about highlighting the importance of helping those in larger bodies with eating disorders, and training other counsellors in understanding disordered eating and weight stigma. This film just lit even more of a fire in me.

Spoilers! Everything Now is a coming-of-age drama comedy on Netflix, with a protagonist in eating disorder recovery. If you haven’t seen it, maybe go and watch it and come back, or if you’re not fussed about spoilers or have no intention of watching it and want to keep reading, then crack on! I’m a counsellor and I work with people with eating disorders, disordered eating and body image problems. I’ve worked for eating disorder charities for many years, but these are just my opinions on the show and how they dealt with the topic.
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I had the pleasure of facilitating some writing workshops, in conjunction with Arkbound, at a drop-in café in Bristol called The Wild Goose/InHope for people affected by homelessness or adversity. There were 8 weekly drop-in sessions, alternating with another facilitator each week, and we were flexible and adaptable with the content to suit attendees' needs. This meant having plenty of writing exercises up our sleeves, some of which I’d like to share with you here. It was an honour to be part of the workshops and meet some amazing people and hear some great stories.
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Writing can be so helpful for mental health and wellbeing - it has certainly helped me! It provides an outlet, can aid reflection, and in a group it can build connection and help feelings of isolation and loneliness. For me, performing my work to an audience at storytelling events (such as the one I co-run with my writing group - Talking Tales) helped me build confidence and feel part of a community.

What do domestic abuse and disordered eating have in common? How do they intersect and interplay? In this blog post, both my working worlds come together in a discussion and reflection on similarities and intersections I see between disordered eating and domestic abuse, for both victim/survivors and perpetrators.

A note on language: I use the term “victim/survivors” as different people prefer different terms. I may speak about perpetrators as male, though I’m aware other genders can be perpetrators too, but I predominantly work with men. I also am speaking in binary terms in this post, but would like to highlight how trans and non-binary people are particularly vulnerable to abuse and disordered eating.

Disordered eating

Let’s start with what disordered eating actually means… well, different people define it in different ways, but for me, I like to use it as an inclusive term for eating disorders and any distress around food or exercise, irrelevant of diagnosis. Sadly, many people find it difficult to get a diagnosis of an eating disorder, and many struggle to access any help due to cultural or societal barriers. I’ve heard the “not thin enough” rhetoric too many times now from people who have been turned away from NHS treatment.  BMI (body mass index) is often still used to gatekeep services, even though the NICE guidelines say otherwise, but NHS services are overstretched as it is.

Despite what many people think, most people with disordered eating are at higher weights (Duncan et al. 2017)
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A study by Hay et. al. (2017) showed that anorexia nervosa was only 8% of all eating disorder cases, which may come as a surprise to many. The most prevalent is "other specified feeding or eating disorder" (OSFED), because unsurprisingly, eating disorders do not fit the tick boxes easily, and most people are not thin. The stereotype of the thin white teenage girl with anorexia is overused, however, access to treatment requires a level of privilege, so treatment and research is often based on this limited demographic.

I created this image, which I use in my workshops, to show how I view disordered eating and how diagnosed eating disorders are just the tip of the iceberg.
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Eating disorder treatment can largely be focussed on anorexia nervosa because it does have the highest mortality rate, and people are often very unwell by the time they access NHS treatment. The idea of being “not thin enough” for treatment means that people are losing even more weight, exacerbating the eating disorder. The system is very much “firefighting” we might say, with people only getting the help they need when they are at crisis point. I liken this to domestic abuse services… there for when people are in crisis and are trying to flee an abusive relationship. For eating disorder recovery, the goal is often a “healthy” weight on the BMI chart, in domestic abuse it’s often to get out of the relationship. Neither of these solutions fully help the issues, it’s just dragging people out of the situation that they will enviably end up back in again because the deeper-rooted patterns and issues are not being addressed.
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My view of both takes a “zoomed out” approach, considering the bigger picture of societal and cultural issues we need to tackle to help prevention. Both disordered eating and domestic abuse sit within a context of patriarchal rules and gender expectations, systems of oppression around race, body ability and size, gender, sexuality etc. Poverty and food insecurity plays a huge role in relationships with food and is a contributing factor to disordered eating. Striving for weight loss is often at the root of why disordered eating develops in the first place (though not for everyone), because of our social and cultural reliance on thinking that thinner is better. There are many different influencing factors, which is why eating disorders are so complex and need to be viewed through an intersectional lens.

Domestic abuse

I work with perpetrators of abuse, which is my way of trying to go upstream. Helping people leave abusive relationships is so important of course, but we need to go to the root of the problem, which in many cases… is men (#notallmen etc etc). YES, I KNOW OTHER PEOPLE CAN BE PERPETRATORS, but my work is mainly with men because they are more likely to be perpetrators of abuse. I’ve written another blog about my work with perpetrators, which you can read here.

I am not here to blame or point fingers at men but rather help the ones that want to be helped. Not all of them want to be helped of course, but many do want help to manage their anger and change their behaviours. This is how we break the cycle, so people don’t end up in other abusive relationships, and so that kids don’t grow up to normalise abuse. Victim/survivors and children are always at the heart of perpetrator work.

What do both domestic abuse and disordered eating have in common? Control.

Disordered eating and body image problems can be a form of coping, to try and regain control when other aspects of life feel out of control, or when things from the past have created a need to feel safe. Domestic abuse is about control, a fear of feeling out of control and sometimes a deep fear of abandonment. Many victim/survivors, and perpetrators, have experienced trauma or difficulties in childhood, which can contribute to needing to feel in control to feel safe. For male perpetrators, masculinity expectations in our society (e.g. strength and dominance) and the impact of living in a patriarchal society, and power and privilege, can all contribute to an abusive relationship.

Domestic abuse takes many forms, coercive control being a more subtle, manipulative way of controlling and silencing victims. A person’s body and appearance can be a target for a perpetrator who may want to isolate their partner. They may make subtle comments about what they’re wearing or about their weight to fuel the victim’s body image concerns, which in turn can discourage them from going out. For a victim/survivor of domestic abuse, weight and appearance might be one thing that they feel they can control. They may need to be fixated on weight loss to meet a standard their partner expects, or it may be to avoid weight-shaming comments from them. They may experience this like gaslighting, it’s their own fault they’re fat (which they may feel means “unlovable”). They may be judged for what they eat by partners, or if money is tight they may be made to feel guilty about eating. They may prioritise feeding their kids, they may have to rely on food banks and feel ashamed. Kids can sometimes refuse food as it’s their only way to communicate that something is wrong when they don’t have the language that adults do. These are just some examples, there are many ways that food and appearance can intersect with domestic abuse, both as a coping mechanism for victim/survivors, and as a method of control used by perpetrators.

Exercise and steroid abuse

Although men obviously do struggle with eating disorders too, men may find themselves leaning to exercise and “bulking up”, which we could speculate as being a quest to feel more masculine perhaps or a way to feel stronger and in control when they feel emotional and vulnerable. “Muscle dysmorphia” can lead to over-exercising and the use of diet/protein products to build muscle, and there is a risk of steroid misuse.

Anabolic steroids are legal for personal use, but it is illegal to supply or sell them, though this does not stop people from buying them online or through gym contacts. This is particularly dangerous as there could be anything in them. Anabolic steroids can increase anger, anxiety, aggression and hostility (Oberlander and Henderson 2012) as well as having physical effects and the risk of becoming psychologically dependent. There is a documentary by Reggie Yates on YouTube called “Fatal Fitness: dying for a six pack” which highlights many of the issues with exercise and steroids affecting men.

The eating disorder voice

Many people in recovery from an eating disorder speak of the “anorexic voice” or “eating disorder voice” - the critical thoughts that shame them and tell them what to eat/what not to eat. This voice, many say, is like an abusive partner (or parent) in their heads. That part can’t just be switched off, they can’t escape it, because it’s deep-rooted… it’s similar to how a victim can’t easily leave a perpetrator.
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The cycle of abuse is decidedly similar to a binge and restrict cycle:

​Shame plays a big part in this. With perpetrators we talk about the “pit of shame” and how hard it can be to get out. They can feel ashamed of their behaviour but sometimes unable to break the cycle, falling back again, feeling out of control when they get angry. For victims, trying to leave isn't just about building resilience and strength, it’s literally about safety, as the risks can skyrocket when they separate. The risk of stalking harassment and even homicide increases after separation. In the same way that victims stay in relationships to try and keep themselves safe, people hold on to disordered eating for that same safety.
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There is a great story/metaphor by Dr Anita Johnston about clinging to a log in a fast-flowing river. Even when you reach calmer water, and there are people on the river bank who can help you get out, the log saved your life so it’s hard to let go (the video is at the end of this blog if you’d like to watch it in full). This is meant to demonstrate the power of disordered eating, but can equally demonstrate the difficulty of leaving an abusive relationship.

Both domestic abuse and disordered eating are about power and control ultimately. Both are linked to trauma, and cannot be separated from systemic issues and inequalities. However, it’s important to work in a case-by-case, client-centred way, honouring their unique experience and intersecting aspects of identity.

If you’re struggling with any of the issues discussed in this blog, I offer counselling sessions online – find out more here.

If you’re looking for more information and training on disordered eating, I’m offering a workshop through Online Events on 27th September. I also plan to run training elaborating on this blog, on domestic abuse and disordered eating, so if you want to be updated on this please sign up to my mailing list.

Resources

• FearLess -support for domestic abuse, sexual violence and stalking (and perpetrator programmes)
•  Freephone National Domestic Abuse Helpline, run by Refuge: 0808 2000 247 
• Men's Advice Line on 0808 8010 327 (Monday to Friday 10am to 8pm), or visit the webchat at Men's Advice Line (Wednesday 10am to 11.30am and 2.30pm to 4pm)
• ManKind on 0182 3334 244 (Monday to Friday, 10am to 4pm)
• LGBT+ - Galop on 0800 999 5428 
• Karma Nirvana on 0800 5999 247 (Monday to Friday 9am to 5pm) for forced marriage and honour crimes. You can also call 020 7008 0151 to speak to the GOV.UK Forced Marriage Unit

 
BEAT Helpline: 0808 801 0677 https://www.beateatingdisorders.org.uk/

First Steps ED: https://firststepsed.co.uk/services-and-support/ (counselling, befriending, groups, workshops and more)

Anita Johnston log video:

As a child in the early 1990s, I had free school dinners. As I clutched my special token, waiting for my slab of pizza and green custard for dessert, I knew for the first time that I was different. People thought I was poor, but – even worse – they thought I was fat.

I was told to ignore the people who bullied me (the old ‘sticks and stones will break my bones’ motto) but my worst fears were confirmed by the school nurse. I was not normal. The BMI (Body Mass Index) chart showed that I was too fat and I had to lose weight to get to the ‘normal’ category as soon as possible. The BMI chart, I was later surprised to find out, was designed in the 1830s by a mathematician and it wasn’t intended as a measure of health for individuals. It was also largely based on white, male, European body shapes, and made no provision for sex or cultural difference.1 It’s shaming and dangerous, according a recent report from the Government’s Women and Equalities Committee.2

The school nurse suggested I start exercising and try to eat healthily. She’d made a common assumption, based on the myth that fat people don’t eat well or exercise. I was doing dance classes twice a week, plus step aerobics and Mr Motivator (the coolest way to exercise in the 1990s).

Unfortunately, these assumptions about fat people didn’t stay in the 1990s. Today the same simplistic assumptions are made and many hold the view that fat people should simply eat less and take more exercise. This even includes our Government, whose ‘war on ob*sity’ campaigns are not only ineffective but potentially dangerous.
 
Fat equals stupid?

Ob*sity is a complex issue, influenced by many factors, including genetics, environment, culture and trauma, with poverty being a prominent predictor. I’ve noticed a wave of seemingly compassionate people making this connection and blaming cheap, processed food. This suggests that, if healthy food were cheaper, ob*sity would just disappear. The first problem with this approach is that it’s too simplistic – fruit and vegetables are already cheap from many greengrocers and it doesn’t make people want to munch on a carrot instead of a chocolate bar. Second, it’s based on the patronising belief that working-class people simply need educating, implying that we’re so stupid that we don’t know how to feed ourselves correctly.

As a child, I spent every weekend cooking with my Italian grandmother, mainly because I had no friends (because of being fat) but also because I loved food and cooking. Everything we ate was fresh from my grandfather’s garden – homemade, unprocessed, hearty goodness. Ironically, I was eating less healthily when I ate diet bars and shakes, which I thought I needed in an attempt to compensate for the large Italian meals. It took many years to recognise these as restrictive and compensatory behaviours, and to realise the amount of anxiety I felt around food. I was always either ravenously hungry to the point of feeling faint, or stuffed full to the brim with stomach cramps. I was in a binge and restrict cycle without even knowing it, starting from about six years old.

I thought all of this was completely normal. I also knew that being fat was the very worst thing I could be and that I’d need to do anything and everything to avoid it. I tried to override my hunger signals and told myself that I would be so ‘good’ and ‘strong’ if I hardly ate. Isn’t it strange that we don’t trust our bodies to tell us when we’re hungry? Yet we’d never ignore the signals that tell us we’re cold or that we need to go to the toilet. As babies, we cry, we get fed, then we stop crying when we’re full. Then, as we grow, we’re told to finish everything on our plate even if we’re full, and we’re introduced to ‘good’ and ‘bad’ foods. We’re taught to override our natural instincts. And then there are the beauty standards – women in the media, films and TV who are not too thin but not too curvy, sexy but still innocent, beautiful but unthreatening, confident but submissive.
 
Fixing the problem

The problem isn’t for fat people to fix – it’s much bigger than that. It’s about inequalities, austerity, discrimination, trauma and a hugely underfunded mental health system. It’s the family cycles of behaviour and trauma that can create difficult relationships with food. It’s the difficult home life and family experiences (such as domestic violence, addiction and abuse) that are more likely to affect the poorest children. It’s also a society that tells fat children that their bodies are wrong and that it’s their fault, or blames their parents, and encourages anything to get rid of the weight, however dangerous – diets, pills, barbaric bariatric surgery.

It’s about a society that would rather blame fat people than look at what is really going on. The food industry spends millions encouraging us to eat more processed food than ever, while the diet and fitness industry tells us to lose weight. This push/pull keeps many people stuck in cycles of guilt and shame, while their weight fluctuates, with the anxieties and health implications that may come with that.

Despite Government campaigns, ob*sity rates are not decreasing. The solutions so far have been short term, encouraging increased fear and anxiety around food and increasing stigma towards fat people. Shaming people into losing weight simply doesn’t work. In fact, it’s more likely to exacerbate difficult relationships with food as they search for further comfort, coping mechanisms and control. The recent report from the House of Commons Women and Equalities Committee concluded that the Government’s ob*sity strategy has failed to ‘promote healthy behaviours’ and could be ‘contributing to body image pressures’.2
It identified that the use of BMI as a measure of healthy weight has become a kind of proxy or justification for weight shaming, and called for the Government to immediately scrap its plans for calorie labels on food in restaurants, cafés, and takeaways, and to urgently commission an independent review of its Ob*sity Strategy and ensure its policies are evidence-based.
 
Fatphobia

In Love’s Executioner, Irvin Yalom is explicitly honest about his disgust at his fat client, Betty. I was both shocked and impressed by his honesty but ultimately was disappointed that the success of the client was measured by her weight loss. He recognises his weight bias but does nothing to challenge or change his own views – Betty loses weight and he puts his arms around her, seemingly delighted that his hands can reach. Even in Susie Orbach’s Fat is a Feminist Issue, fat is something that is pathologised – women especially are seen as psychologically unhealthy if they’re fat.

There are strong links between trauma and disordered eating, but working on the trauma does not guarantee a client will lose weight. When I started to explore my relationship with food and unpack my trauma, I became happier and healthier, but not thinner. I worked on finding acceptance for myself as a happy, healthy, fat person, which is still seen as a radical act in our society. My body image problems were just the surface level of my deep-rooted low self-worth.

My body image issues were part of a lifelong self-esteem deficit that affected my mental health, my relationships and my career choices. Growing up, I capped my ambitions to protect myself from more hurt, convinced that a short, fat girl from the Midlands couldn’t make anything of herself. That’s now incredibly sad to write. I just want to reach out and hug that young me who thought she was worthless.
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Weight stigma and fatphobia are prevalent in our culture and it’s arguably more harmful to health than actually being fat. If counsellors are compliant with the pursuit of happiness presented as thinness, we’re only reinforcing the myth that clients would feel better if they just lost a bit of weight. We need to delve into the unconscious biases we all hold towards fat people, question where they come from and then actively work to challenge them. Fat counsellors aren’t immune to this – in fact, internalised fatphobia might mean these biases are even stronger. If counsellors collude with the view that weight loss is always a virtuous pursuit, they’re complicit with a cycle of harm that keeps clients from finding their true self-worth beyond how they look.
 
References

1. Gordon A. The bizarre and racist history of the BMI. Medium 2019: 15 October. http://bit.ly/2ZhiroN
2. Women and Equalities Committee. Changing the perfect picture: an inquiry into body image. Sixth report of session 2019–21. London: House of Commons; 2021. https://publications.parliament.uk/pa/cm5801/cmselect/cmwomeq/274/274.pdf

Update - I no longer work on this programme as it ended due to funding limits. I wrote a follow-on blog here.

I’m a group facilitator on a Domestic Violence Perpetrator Programme, which, if I ever got invited to fancy dinner parties, would probably go down like a lead balloon, as the saying goes.

But really, people are usually intrigued, some are just less afraid than others to ask questions! This blog contains my honest reflections and experiences of being a group facilitator working with men who have used abusive behaviours. My workplace and the overarching research are mentioned, but these views are my own and are not of my employers, the researchers or the programme creators. Confidentiality is of the utmost importance here too, so I won’t be using any names or identifying factors for individuals, but will sometimes refer to “group members” generically as a collective when talking about patterns and themes.

The language is binary due to the nature of the programme I work on as it’s for cis-gendered heterosexual men only, but I just want to flag up the vulnerability of trans and non-binary people being abused by partners and family members, also male survivors of abuse. None of these things are talked about enough.
 
What is a perpetrator program?
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Programs and interventions vary in different areas, so my experience is only based on one; a 26-week intervention for men who have used abusive behaviours toward their partners or ex-partners.

The weekly group sessions are 2.5hrs (with a short break) and involve a check-in at the start, followed by a led session based on themes and content from the programme manual. The sessions focus on different aspects of abuse, ranging from what abuse is (which is very important due to the misconception that only physical abuse is “real” abuse), sexual respect, anger management, attachment theory, CBT (cognitive behaviour therapy), emotional regulation, and more. It’s not something the men can do as a quick tick-box exercise to appease social services, it’s a long intervention and it’s challenging. It takes commitment, bravery, responsibility and accountability, and it involves dealing with a lot of difficult emotions.

​There are very few perpetrator programmes in the UK (though areas differ) as proving that they work and getting funding is difficult (hence the reason for the research study). There’s no doubt that prioritising helping victims/survivors is crucial when it comes to funding domestic violence services, but this can lead to a lack of help for perpetrators who want to change their behaviour, which in turn helps keep their partners (and children) safe. Perpetrator work is crucial for long-term change in helping victims/survivors and their children, to avoid them going into other relationships with the same patterns of behaviour. The safety of partners, ex-partners, children and future partners is at the heart of the programme.
 
Why just men?

A question I’m asked a lot (and I initially wondered this too) is “what about women?” Well, studies show that men are far more likely to be perpetrators than women. I know that statement will make some people feel uncomfortable and may prompt the response “but women can be abusive too”. This is true, but this response steers the focus away from the central issue. It’s similar to saying “all lives matter” - it de-centres the current problem, making it harder to focus on areas for change. Other perpetrator interventions in other areas may accommodate women, but the particular model this programme is based on (the Duluth model) involves content specifically to unpack masculinity and issues of power and control in a patriarchal society. It’s sometimes called a “pro-feminist” model for that reason, though I personally would argue that working on the basis that patriarchy and inequalities exist isn’t inherently “feminist” but is rather just highlighting an issue that affects us all. Naming the patriarchal imbalances doesn’t have to be an attack on men (as is often assumed about feminism) as it can help men too; after all, the patriarchy is damaging for everyone and places various harmful expectations on men.

In a wider social context, it can be difficult to talk about male violence (especially on social media) without there being a lot of anger and defensiveness. We do still live in a society based on historical patriarchal values and that can make it difficult to have conversations about male violence as it can be met with de-railing and gaslighting tactics (albeit sometimes not conscious). Powerful people often fear losing their power and want to stay in control, so equality is risky for them. It’s the same with individuals who use abusive behaviour, it’s about power and control and the fear of not having it.
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We need to centre what’s important to be able to make a positive change in the world, and that means we need to put aside our discomfort with talking about male violence and abuse. This isn’t about pointing the finger or blaming men, but rather looking at how we can help. Patriarchal values can be harmful, with narratives about being a “real man” and expectations of being “the provider”. The messages about being strong and not showing emotion are prominent in the group, and we do work around “the man box” and masculinity expectations to unpack these. Many of the men on the programme have never been in spaces where they talk about emotions, and certainly never with other men. Many would say they’re not emotional people while forgetting that anger is an emotion too. We sometimes draw icebergs to demonstrate this, with anger at the top and all of the other emotions under the surface; anger being the emotion often seen as more “acceptable” for men to show.

As a facilitator it’s been amazing to see how powerful group work with these men can be. They share experiences, model new behaviours, and both challenge and support each other. The group allows a safe and boundaried space to start to process these difficult emotions without the judgement or stigma they may otherwise face for having the label of “an abuser”.

What got me into this work
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In about 2012, I got a job as a receptionist at a counselling organisation, and like many newbies was given tasks such as stuffing envelopes. We had a domestic abuse signposting pack, which contained flyers for a perpetrator programme, and it instantly struck me as such a crucially important thing. I would never have dreamed that ten years on I’d be working on one myself! I was just a self-conscious receptionist, I hated groups and I never thought I’d be able to become a group facilitator, or a counsellor too…but proving myself wrong has been pretty awesome I’ll admit!

When I was learning more about feminism and inequalities, I became quite fascinated by men’s rights activists, incels, pick-up artists and “men going their own way” (MGTOW), in the dark depths of the internet known as the “manosphere”. It was part horrifying, part ridiculous, and mostly infuriating. I was channelling my anger and processing some of my stuff no doubt, but I was also curious about where these kinds of views and such blatant misogyny stemmed from. Since then, I’ve trained as a counsellor and have benefited hugely from being able to look at both systemic and individual factors and issues which lead to abuse, both in my own time, my work and through studies.

Personal experiences in my own life have led me to have increased curiosity about perpetrators of abuse and sex offenders, and understanding these client groups has been helpful for my own healing too. I still had doubts about if I was being naïve, especially as most other counsellors (and trainee counsellors) I met did not want to work with these client groups. I wondered if I was kidding myself; wouldn’t I be terrified sitting in a room full of abusive men? Often I get the sense that certain client groups are seen as “too manipulative”, “untreatable” or “resistant” (interestingly, eating disorders are thrown into these categories too, which is my other line of work), but this has only sparked my interest and passion further. I wonder how much these labels were more about the practitioners and their views, judgements and societal stigma.  
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Born evil?
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Words like “perpetrator” and “sex offender” hold a lot of stigma and seem to spark instant fear, leading to them being quickly deemed as “monsters”. There’s a sense that they will never change, or can’t change, or even that they were “born that way”. This is absolutely not the case, even serial killers and “psychopaths” were not “born evil”, despite what the media would portray. It’s instead a complex mix of genetic and environmental factors which can create disruptions in early brain development. People are not “born evil”, this is a myth perpetuated by society, potentially as a way to focus on the ”baddies” and ignore systemic societal issues and trauma which influence this behaviour. It takes curiosity and compassion to look beyond the labels and stigma, and holding strong boundaries, and being self-aware and reflective, so supervision (group and one-to-one) is very important in this work.
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Perpetrators and offenders have often been hurt and traumatised themselves. This is not an excuse for their behaviours but it’s important we look at the potential causes and influences. Experiences are different for every individual, but themes can include violence or controlling behaviour in their home when they were growing up, substance abuse, poverty, trauma, mental health issues, and systemic inequalities and discrimination such as racism. The first few years of life is a vulnerable time and we know from various literature that not having your needs met and not having enough love in the early stages of life is detrimental for brain development. (I suggest reading Sue Gerhardt’s book “Why Love Matters” if you’re interested to learn more). This in conjunction with attachment theory (Bowlby), means that a child may grow up with an insecure attachment based on not forming secure relationships with caregivers when they were babies, which becomes a template for their relationships and their whole lives. Part of the benefit of group work is to form and grow relational bonds through relationships with the facilitators and the other group members.

My expectations when starting as a group facilitator

When you picture a perpetrator group, what do you see? Stella-swigging blokes in vests with tattoos on their necks? The men tell us they’re often surprised and relieved to find that it’s “normal guys” just like them. But sometimes, they may hope to find men “worse” than them, so they can position themselves as “not as bad as that guy”. This can happen with men who have not used physical abuse. They think they are not as bad as other guys because they’ve not been physical, but part of what we do on the programme is to go over all the other types of abuse and the impact – that emotional forms of abuse stick with women for years, if not their whole lives. There is no hierarchy of abuse in the group, they’re all there because their behaviour is impacting people negatively and they want to change that.

I’ll be honest, I was absolutely terrified when I sat in on my first group. How would I feel sitting with all these men that I knew had abused women? What if I freaked out? Cried? Got scared? I soon realised that many of these men were anxious and scared too, even more so than me. It can be terrifying for them, as they share the same fears around what to expect, but also there’s the worry of what we’re potentially going to put them through. It is a challenging programme! Some of our role plays are hard-hitting, and we run empathy exercises (for instance asking them to sit in the role of their children and answer questions about the dad) which can bring up a lot for them, but it’s within a safe, contained and boundaried space.

These men are dealing with a lot of shame, past trauma, attachment wounds, anxiety and many other factors, so safety and being “held” is vital. For me, being able to offer this “holding” and containment has been a real honour. I get to sit in a world that only a few see, and that feels like a real privilege and a gift. These men sit with really tough emotions and work really hard on their behaviour and self-development, and I find myself admiring and respecting them. This can create internal conflict in itself, forming relational bonds and feeling somewhat proud of the guys and the work they do, in the context of a society that says they’re “bad”. Many people have done bad things, but it doesn’t make them “bad” people. Underneath this behaviour there is often pain, shame and low self-esteem. The paradox for the men can be feeling as if they don’t deserve to improve their self-esteem, but this is needed in order to move out of the “pit of shame” as we call it (sometimes known fondly in our group as the “pit of sh*t”).
 
My reflections one year on

I started working on the Programme about a year ago (at the time of writing), which means I’ve done a full run of the programme (it’s continuous, so men join at different stages). The original members of the group who I started with have completed the programme, so there have been some heartfelt endings and it’s been lovely to hear the reflections from the men in their final group. I’m not involved in the research side of it, but if you ask me if perpetrator programmes work, then ABSOLUTELY. I have seen, felt and experienced it. Not everyone will be ready to change, but many are, and this can have an impact on their whole family.

It’s so important that we see beyond labels, judgements and stigma to see the human being behind the behaviour. I like to believe that nobody is “untreatable” or “too resistant” or not worthy of help. Working on a perpetrator program helps take a bigger picture approach to domestic violence and abuse, by moving beyond the reactionary system currently in place, which often just involves helping victims stay safe in a dangerous situation. This just means the perpetrator continues their behaviour, and even if the victim can leave, they both risk getting into other abusive relationships in the future, so this approach isn’t helping to break cycles in the long-term. Helping perpetrators reflect on and change their behaviour is a vital longer-term approach to help break cycles of abuse, ultimately helping the next generations to come.
 
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I've written a follow-up blog here - Reflections on Working with Perpetrators of Domestic Abuse