I remember the first time I brought the case of a client with an eating disorder to supervision. As I talked about my client and presented their case, I noticed anxiety in my supervisor. Anxiety is a frequent visitor for therapists working with disordered eating and eating disorders. There are many reasons for this. Working with eating disorders is challenging. We are often working with entrenched behaviours that may have been present for a long time. Safety and protection are paramount. It is therefore understandable that this work can create anxiety. However, I think there are a number of reasons why anxiety might arise in the therapeutic space.

The therapist's anxiety about safety and protection is one reason. Another may be the impact of the client's experience and therapeutic process on the therapist. Disordered eating and eating disorders can evoke difficult emotions for clients and therapists alike. As therapists, we may experience some of these feelings as intensely countertransference. Feelings such as shame, disgust, repulsion, or rage may arise in the therapeutic relationship. As a psychotherapist, I may experience these difficult feelings as part of my countertransference. Tolerating difficult countertransference can be challenging. This, in turn, can increase anxiety. Good supervision from an experienced psychotherapist who understands the Specialism of eating and weight is important

On many occasions, in a supervisory context, a therapist presents a client who is experiencing eating-related difficulties. I am often struck by how the focus is placed on the person's behaviour. Yet we would not usually approach other presenting issues in this way. We would look at what may underlie the behaviour. We would consider how psychotherapy might help address what underlies the behaviour and, where appropriate, support change. However, perhaps because of the countertransference and anxiety associated with eating-related difficulties that I am describing, the therapist focuses on behaviour. I see eating-related behaviour as a possible indication of a person's psychological struggle. It may communicate a struggle that feels difficult to express in other ways. Alongside practical and medical considerations, it is this psychological struggle that may need compassionate attention.

Alongside ongoing attention to safety and protection, we can be curious and look beyond the anxiety that arises. What meaning might this eating-related behaviour hold for this person? What may be contributing to their psychological distress?

There are multiple possible meanings of the anxiety that is stirred in the therapist within the therapeutic relationship. Reflectively exploring that anxiety for example in clinical supervision may help us make more meaning of the anxiety we present with as therapists and find a more appropriate approach to the therapeutic work and support the client's healing.

When we can be curious about our own anxiety, while remaining attentive to safety, we may be better able to meet the person in front of us with steadiness, compassion, and clinical care.