There’s no one-size-fits-all approach to treating body image concerns in therapy. How body image work looks depends a lot on what’s contributing to someone’s distress and how those struggles are showing up in their life.
For some people, body image issues are closely tied to anxiety, perfectionism, trauma, disordered eating, chronic dieting, or experiences of weight stigma and oppression. For others, they show up through constant comparison, body checking, avoidance, shame, or feeling disconnected from their body.
There are many ways therapists can approach body image work. Here are some of my go-to approaches.
One of the biggest themes I see in body image work is the deeply internalized belief that body size and shape are directly under our control - and that our weight reflects our eating habits, exercise routines, discipline, responsibility, or moral character.
When someone believes their body is entirely controllable, body dissatisfaction often becomes much more than “I don’t like how I look.” It can become: My body is evidence that I’m lazy, irresponsible, unhealthy, or failing.
The problem is that this narrative isn’t accurate. Body weight is influenced by genetics, biology, environment, medications, stress, health conditions, access to resources, and many other complex factors. It is not simply a reflection of willpower or behavior.
In therapy, part of the work can involve exploring and unlearning inaccurate and harmful beliefs about weight, fatness, food, and health that contribute to body shame. Shifting these beliefs can sometimes shift how we relate to our bodies, too.
This may sound surprising, but I often think about body image distress through the lens of grief.
We live in a culture that strongly teaches us that thinness is both attainable for everyone and deeply valuable - and that if we work hard enough, we can (and should) achieve it. Given those messages, it makes a lot of sense that there can be grief around not conforming to the thin ideal, letting go of certain hopes about our bodies, or accepting that pursuing weight loss may come with significant costs.
In therapy, we might explore body image using different models of grief. What stages of grief seem relevant here? What are you mourning? Are there rituals, practices, or forms of meaning-making that might apply?
Having grief about your body is valid. And importantly, acknowledging that grief doesn’t mean the solution is shrinking your body.
Many people assume that the goal of body image work is to love your appearance all the time.
That’s not necessarily my goal.
Bodies change throughout life. Appearance changes with age, illness, disability, pregnancy, stress, hormones, and countless other factors. If our body image depends on always feeling positive about how we look, we may set ourselves up for repeated distress whenever our bodies inevitably change.
Instead, I often work from frameworks like body neutrality and body liberation.
Body neutrality is less about loving your appearance and more about acknowledging that you have a body - and that it deserves care, nourishment, rest, and respect regardless of how you feel about how it looks. I want clients to be able to focus more on their internal experience than on other people’s external perception of their body.
Body liberation goes a step further. It’s about working toward collective freedom from systems that devalue and marginalize certain bodies. When you nourish yourself, rest, care for your body, and meet your needs regardless of body size or negative body image, you are not only supporting yourself - you also help create permission for others to do the same.
Body image distress isn’t just about thoughts and feelings. It’s often maintained by behaviors.
In therapy, we may look at patterns that both stem from and reinforce negative body image, such as:
These behaviors can provide temporary relief from anxiety or uncertainty - but they also tend to strengthen the brain’s focus on appearance and reinforce body preoccupation over time.
Therapy can involve identifying what leads up to these behaviors, building alternative coping skills, and making environmental changes that make body-checking or avoidance less automatic.
Another theme that often shows up in body image work is body–mind dualism: the idea that the body is separate from the “real” self or separate from the mind.
This can reinforce viewing the body as an object - something to manage, optimize, discipline, or turn into a project.
My therapeutic approach tends to view the body differently: not as separate from who we are, but as a fundamental part of our experience.
Being nourished, rested, and allowing our bodies to exist at the size they need to be - rather than constantly suppressing or fighting them - can make it easier to be present for the parts of life we actually care about.
In therapy, we can explore how your body is not just something you have but something deeply woven into how you experience relationships, joy, values, creativity, spirituality, work, rest, and daily life. The body is not a side project that can be endlessly managed without cost.
Body image work in therapy is not about convincing yourself you’re beautiful or forcing yourself to love your body every moment of every day.
It’s often deeper than that.
It can involve grief, unlearning harmful cultural messages, reducing behaviors that keep you stuck, reconnecting with your body as part of your lived experience, and building a relationship with yourself that is grounded more in care and values than in appearance.
And importantly, you don’t have to wait until you “feel good” about your body to begin caring for it.
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