The tree's unseen roots reach farther than its branches. Depth versus surface steadies the tree. Us too.
Depth Oriented Recovery Work: A Psychotherapist’s Reflection
Summary
Many modern treatment programs promise eating disorder recovery through rapid symptom control, cognitive techniques, or medication. But beneath the visible patterns of restriction, bingeing, and purging lie psychic wounds that cannot be managed into healing. This essay explores why depth-oriented recovery work remains essential—and how genuine transformation arises not from control, but from contact with the self that the disorder once protected.
Main Article (1,650 words)
The Age of Quick Fixes
After forty years of sitting with people who struggle to make peace with their bodies and their hungers, I find myself both grateful for modern progress and uneasy with its direction. The eating disorder field now emphasizes techniques—CBT worksheets, exposure hierarchies, and medical management—designed to regulate behavior and thought. Insurance companies, research protocols, and even the language of recovery have followed suit.
A woman may learn to eat three balanced meals and two snacks, replace “distorted cognitions,” and identify her triggers. She may even achieve some symptom remission. But often she remains at war with herself in subtler ways—haunted by shame, restlessness, a desire to participate in mild to severe self-harm activities, and a persistent fear of being seen. These inner fractures, once the source of her eating disorder symptoms, now live silently beneath her new routines. When they emerge and she binges, restricts, or vomits, she holds on to the diagnosis that this behavior is not serious if it happens only once or twice a month. She experiences a kind of cognitive distortion and a sense of lying to herself because she knows those behaviors are not correct, are not recovery, and are always lurking, ready to emerge when her pressures or triggers are too intense for her to bear.
Depth work begins where the manualized approaches end.
When Treatment Forgets the Soul: the need for depth oriented recovery work
The shift toward evidence-based therapy has helped thousands stabilize, but it has also quietly exiled the psyche. In most treatment centers, a woman’s dreams, memories, and symbolic inner life are often viewed as distractions from measurable outcomes. Her eating disorder is framed as a problem to be managed, not a language to be understood.
This neglect is not malicious—it is cultural. We live in an era where recovery is often equated with productivity. The goal is to return quickly to function, to “move on,” to perform wellness. But psychic healing unfolds differently. It is cyclical, imaginal, and mysterious. It requires time, solitude, and a willingness to engage with what has been hidden.
Depth psychotherapy invites the woman not to suppress her symptom but to ask what it expresses and what it accomplishes. Yes, it has negative consequences, but it also relieves her of anxiety and gives her a sense of control and peace, if only for a short time. Bingeing may have once been her body’s protest or solace during emotional starvation. Restriction may have been an act of control when life felt formless or unsafe. These gestures carry meaning; they are not merely mistakes or behavioral malfunctions.
The Protective Genius of the Disorder
When we label bulimia or anorexia purely as pathology, we miss the intelligence that created them. The disorder is often a psychic compromise—a survival adaptation to trauma, neglect, or unbearable longing. In neurological terms, the brain attempts to regulate overwhelming emotion through ritualized behavior. In psychological terms, it is the ego’s defense against the terror of annihilation.
But when the symptom is stripped away without addressing the terror it concealed, the woman may feel more fragile than before. The behaviors vanish, yet the raw pain beneath remains unintegrated. She may relapse or transfer the compulsion to another domain: perfectionism, work, relationships, or even spiritual striving. She may isolate herself and exercise extreme control over who can enter her life. She may act out her feelings sexually, by becoming sexually anorexic or sexually bulimic, i.e., having no sex or excessive sex or alternating between bingeing on sex and then restricting her sexual activities.
The deeper task, addressed by depth oriented recovery work, is not simply to stop the behavior but to meet the self that the behavior defended. The goal is to find, develop, and strengthen the self’s ability to care for itself sturdily and healthily.
The Slow Return to Inner Authority
Depth oriented psychotherapy asks something radical of both therapist and patient: patience. In the beginning, nothing changes. But beneath the surface, a new internal relationship begins to form—between the frightened parts of the self and the witnessing consciousness that can hold them.
Gradually, the woman learns to inhabit her own interior space without dissociating or numbing. She relies on the presence and sensed experience of her therapist to risk knowing more about her own inner life. She begins to sense the origins of her hunger—not just for food, but for safety, recognition, and truth. What once seemed dangerous to feel becomes tolerable. Over time, this reclaims what neuroscience calls neural integration—and what the psyche calls wholeness.
Recovery then becomes more than the absence of symptoms. It becomes the presence of self.
The Cultural Displacement of Depth
Why has depth recovery work fallen so far from favor? Because it cannot be mass-produced. It requires devotion, mystery, and language that resists quantification. It values metaphor over metric. It asks questions that disrupt the very systems eager to declare a cure.
Insurance plans will not reimburse a conversation about a dream of a locked door, nor will a randomized controlled trial easily capture the slow emergence of courage in a woman who finally speaks what was once unspeakable. Yet this is where transformation lives—in what cannot be counted.
The modern world prefers measurable wellness to soulful integration. But the women who come to therapy after exhausting all other routes already know: symptom management does not touch the deepest wound.
The Return of Meaning
What does it mean to heal from an eating disorder at depth? It means that hunger becomes human again. Food loses its moral charge. The woman no longer measures her worth in control or purity. She begins to feel curiosity toward her inner life, her body, and her relationships. She develops a tolerance for uncertainty, and with it, the freedom to live authentically.
In this sense, recovery is not an end state but a return to participation with life. It is not compliance with a program but reconciliation with one’s own being.
A Therapist’s Weariness, and Hope
After decades of writing and speaking about eating disorders, I, too, have felt weary of repeating what feels self-evident, of witnessing new generations suffer the same distortions in a culture that glorifies control. I become disheartened when a woman has spent years bingeing and purging or compulsively overeating and still thinks her problem is with food. She may call because she is terrified that her life is in danger. She’s had stents implanted and knees replaced, yet she still talks about diets, exercise, and failures at following behavioral protocols.
Yet my weariness and heartache, when I examine myself and my work, are also a call. It reminds me that the conversation must move deeper still, to the level of meaning and psyche.
The next step in our understanding of recovery must not be faster cognitive restructuring or new medications. It must be the restoration of the human spirit to the center of treatment.
Toward the Unfinished Work
In the companion essay to this essay, The Unfinished Work Beneath Symptom Relief, I’ll explore what happens when depth healing begins—the encounter with trauma memory, the symbolic language of the body, and the slow, courageous reconstruction of self-trust. For now, it is enough to remember that eating disorders are not solved through willpower or techniques. They are invitations to know the self that has lived unseen.
FAQ
Q: What’s the difference between modern evidence-based treatment and depth psychotherapy?
A: Evidence-based treatments target behaviors and thoughts, while depth psychotherapy addresses the unconscious meanings, trauma patterns, and relational wounds beneath those symptoms.
Q: Are CBT and medication wrong for treating eating disorders?
A: Not at all. They can stabilize acute distress. But without addressing the underlying psychic injuries, recovery often remains incomplete or fragile.
Q: Why do some women relapse even after years of apparent recovery?
A: When the inner causes of the disorder—shame, deprivation, fear of visibility—remain unintegrated, the psyche seeks other ways to express them. Deep work brings those causes into consciousness.
Resources
- Keaton, D. Then Again. Random House, 2011.
- Poppink, J. Healing Your Hungry Heart: Recovering from Your Eating Disorder. Conari Press, 2011.
- Woodman, M. The Pregnant Virgin: A Process of Psychological Transformation. Inner City Books, 1985.
- Kalsched, D. The Inner World of Trauma. Routledge, 1996.
- van der Kolk, B. The Body Keeps the Score. Viking, 2014.
- Diane Keaton Suffered From Bulimia
Signature
Joanna Poppink, MFT, is a depth-oriented psychotherapist specializing in midlife women’s development through life transitions, trauma integration, and deep eating disorder recovery. She offers virtual psychotherapy in California, Arizona, Florida, and Oregon.
For a free 20 minute consultation, e-mail
