Do I need an eating disorder diagnosis to start therapy?

No. You do not need a diagnosis to begin eating disorder therapy. Many people seek support for disordered eating, body image distress, or food-related anxiety without a formal label. Therapy focuses on your lived experience and what you want support with.

Will an eating disorder therapist tell me what to eat?

In a trauma-informed first eating disorder therapy session, you will not be told what or how to eat. The early focus is on understanding your relationship with food and building safety and support. Any changes happen collaboratively and at a pace that feels manageable.

What should I talk about in my first eating disorder therapy appointment?

You can talk about whatever feels most important or safe to begin with. Many people start by sharing what’s been coming up around food, body image, stress, or emotions. It’s also okay to say you don’t know where to start—your therapist can help guide the conversation gently.

What questions are asked in the first eating disorder therapy session?

You may be asked about your relationship with food and your body, when certain patterns began, how stress affects eating, and what support you’ve had before. These questions are not tests. You can pause, decline a question, or slow things down at any time.

What if I’m not ready for eating disorder recovery yet?

You don’t have to feel fully ready for recovery to begin eating disorder therapy. Ambivalence is common and understandable. Therapy can be a place to explore what feels protective about current patterns and build safety before making changes.

How might I feel after my first eating disorder therapy session?

There’s no right way to feel after a first session. Some people feel relieved or lighter, while others feel tired, emotional, or thoughtful. Starting therapy often brings awareness to what you’ve been carrying, and all of these responses can be normal.

Is the first eating disorder therapy session an intake appointment?

Often, yes. The first eating disorder therapy session may include intake-style questions to understand your history and current concerns. A trauma-informed intake should still feel collaborative, paced, and respectful of your boundaries.

What to Expect in Your First Eating Disorder Therapy Session

Jan 4

Written By Abby Behar

Starting eating disorder therapy can bring up a lot at once.

You might feel hopeful and nervous. Relieved and unsure. Curious, but also hesitant. You might worry about saying the “right” things, being judged, or being pushed to change before you feel ready.

If you’re preparing for your first eating disorder therapy session, here’s the most important thing to know:

You don’t need to perform, prove anything, or be ready for everything to change.

The first session isn’t about fixing you.
It’s about creating a space that feels safe to begin.

You Don’t Need to Know Exactly What to Say

Many people come into their first eating disorder therapy session worried they won’t know how to explain what’s going on.

You don’t need perfect language.
You don’t need a diagnosis.
You don’t need a clear plan.

It’s okay to say:

“I don’t really know where to start.”
“I’m not sure if this is bad enough.”
“Part of me wants help, and part of me doesn’t.”

Ambivalence is not a problem here. It’s common and it makes sense.

What Happens in a First Eating Disorder Therapy Session

The first eating disorder therapy session is usually focused on understanding, not changing behavior.

We spend time getting oriented to:

what you’ve been experiencing
how food, eating, and body thoughts show up in your life
what has helped you cope so far
what feels overwhelming, stuck, or confusing

Eating disorder behaviors often develop for a reason. Therapy begins by understanding why they’ve been there, not taking them away.

Will I Be Told What or How to Eat?

This is one of the most common fears about starting eating disorder therapy.

In a trauma-informed first session:

You will not be forced to eat certain foods
You will not be given a meal plan (I am not a dietician!)
You will not be pressured to change behaviors immediately

Food may come up as part of understanding your experience, but the focus is on safety, context, and support, not control.

You Are in Control of the Pace

If you’re worried about losing control in therapy, that concern is important.

In your first eating disorder therapy session:

You decide what you share
You can say “I’m not ready to talk about that”
You can ask questions or slow things down
Nothing is forced

Support comes before change. Therapy works best when your nervous system feels respected, not rushed.

Questions You Might Be Asked

Every therapist works a little differently, but you may be asked about:

your relationship with food and your body
when certain patterns began
how stress or emotions affect eating
any previous therapy or support
what led you to reach out now

These questions aren’t tests. They’re simply ways of understanding your experience.
You’re always allowed to pause, redirect, or say you’d rather not answer something yet.

What the First Eating Disorder Therapy Session Is Not

Especially in a trauma-informed space, the first session will not involve:

shaming or confrontation
being told you’re doing things “wrong”
forced eating

You are not being corrected or controlled. You are being listened to.

How You Might Feel After the First Session

There’s no right way to feel afterward.

Some people leave feeling lighter or relieved.
Others feel tired, emotional, thoughtful, or unsure.

All of these responses are normal. Beginning therapy often means slowing down enough to notice what you’ve been carrying and that can take energy.

What If I’m Not Ready for Recovery Yet?

You don’t have to be fully ready for recovery to start eating disorder therapy.

Therapy can be a place to:

explore ambivalence without judgment
understand what current patterns are protecting you from
build safety before making decisions
move toward more space in your life, gradually

You are allowed to take this one step at a time.

A Next Step

If you’re considering eating disorder therapy in Seattle, WA, or via telehealth in Washington or Massachusetts, you’re welcome to reach out.

A consultation is simply a conversation—a chance to see if the space feels steady and supportive. There’s no obligation to move forward.

You don’t have to know exactly where this will lead.
You only need to start where you are.

Support comes before change.

Learn more

Abby Behar