In Relationship With Eating Distress: A Dialogical Approach

ABSTRACT

Eating distress is often approached as an individualised pathology, addressed through behavioural, cognitive and medical interventions. Family therapy offers important relational alternatives, particularly in child and youth mental health settings; however, contemporary practice is increasingly shaped by institutional priorities of risk management, symptom reduction and behavioural compliance. Although these priorities can play a role in safeguarding health and safety, they may also narrow opportunities to attend to relational meaning‐making and to the experiences of those within the broader relational network. Drawing on systemic and dialogical traditions, this paper proposes a dialogical reorientation in which eating distress is understood as meaningfully organised within relational, sociocultural and political contexts. A dialogical approach invites attention to the relational effects of eating distress, including its participation in processes of communication, regulation, connection and selfhood. It also extends enquiry beyond the immediate family or care network to the broader sociocultural and political conditions in which eating distress is lived and understood. Within this orientation, therapists shift from a position of expert towards participant in shared enquiry, allowing ethical practice to emerge within the therapeutic encounter. The paper explores implications for clinical practice, particularly in working with families and navigating tensions between care, control and responsibility. Practice vignettes illustrate how a dialogical orientation may take shape in family conversations. In doing so, the paper articulates a relational and dialogical approach that seeks to sustain therapeutic openness while meeting the demands of risk management and contemporary service contexts.