By Jennifer Rollin, MSW, LCSW-C, Therapist & Founder of

The Eating Disorder Center

If you’re reading this as a therapist, there’s a good chance you’ve worked with clients who feel completely stuck in unhelpful thoughts and patterns around food or body image. You may have seen clients who understand, on an intellectual level, that their eating disorder thoughts are distorted, yet still feel unable to disengage from them or behave differently in the moment.

In my work treating eating disorders, two clinical patterns show up again and again.

First, clients are often highly fused with eating disorder thoughts. These thoughts are not experienced as “mental events,” but as facts or rules that must be obeyed. Many clients do not initially recognize these as thoughts at all. Instead, the eating disorder voice feels authoritative.

Second, eating disorder behaviors often function as subconscious coping strategies. Restriction, bingeing, purging, or compulsive exercise are frequently attempts to manage overwhelming emotions, trauma responses, anxiety, shame, experiences of oppression, or attachment and relational wounds. This is important to name clearly for clients: eating disorders are not choices or a result of being ‘vain.’ They are serious mental illnesses that often develop as attempts to survive unbearable internal experiences.

Acceptance and Commitment Therapy (ACT) is one of the modalities used by myself and members of my team at The Eating Disorder Center. ACT can be particularly effective for eating disorder treatment because it shifts the therapeutic focus away from eliminating thoughts and emotions and toward changing a client’s relationship with their internal experience.

One ACT process that is especially useful in eating disorder recovery is cognitive defusion.

Thought Defusion in Eating Disorder Treatment

Defusion refers to a set of skills designed to help clients create distance from their thoughts, rather than automatically believing or obeying them. In the context of eating disorders, defusion allows clients to notice eating disorder thoughts without acting on them, so they can move toward behaviors that align with recovery and with their deeper values.

Importantly, ACT does not ask clients to determine whether a thought is “true” or “false.” Instead, we help clients assess whether a thought is helpful or unhelpful in moving them toward the life they want.

Below are several defusion strategies that can be particularly effective when working with eating disorder thoughts.

1. “I Am Having the Thought That…”

One of the simplest and most accessible defusion techniques is linguistic distancing.

When a client notices an eating disorder thought, invite them to add the phrase:
“I am having the thought that…”

For example:
“I am having the thought that I cannot eat carbohydrates.”

An additional layer is:
“I am noticing that I’m having the thought that…”

This subtle shift can be powerful. It helps clients begin to experience thoughts as events occurring in the mind, rather than truths that require immediate action. Over time, this practice can loosen the grip of rigid eating disorder rules and create space for choice.

2. Labeling Repetitive Eating Disorder Stories

Many eating disorder thoughts show up in predictable, repetitive narratives. Helping clients identify and label these patterns can reduce their intensity and authority.

For example, a client might label a recurring thought pattern as:
“This is the ‘If I recover, I won’t be able to cope’ story.”

Or:
“This is the ‘I can’t trust my body’ story.”

By externalizing and naming these stories, clients can learn to recognize them more quickly and respond with greater flexibility, rather than being pulled into automatic behavioral responses.

3. Using Metaphor and Analogy

ACT metaphors can be especially effective with eating disorder clients, as they bypass debate and engage experiential understanding.

One analogy I frequently use is to compare eating disorder thoughts to unhelpful TikTok videos. Clients can click on them, engage, and watch them all the way through. Or they can notice the thought and swipe past it. With enough swiping, the algorithm begins to change.

Other clients resonate more with the idea of eating disorder thoughts as spam emails or scam texts. They may still arrive, but clients do not need to open them, analyze them, or respond.

Metaphors like these help normalize the presence of eating disorder thoughts in recovery while reducing the urgency to act on them.

4. Singing the Thought

This technique does not resonate with everyone, but for some clients it can be surprisingly effective.

Inviting a client to sing an eating disorder thought to the tune of a familiar song can strip the thought of its seriousness and perceived authority. The goal is not to mock the client’s experience, but to highlight that thoughts are sounds and words produced by the mind, not commands that must be followed.

Bringing It All Together Clinically

When using ACT with eating disorder clients, the broader therapeutic goal is to help clients learn how to:

• Notice and defuse from unhelpful thoughts
• Allow uncomfortable emotions without using eating disorder behaviors to escape them
• Clarify personal values around recovery, relationships, health, freedom, and meaning
• Take committed action in alignment with those values, even in the presence of discomfort

For therapists who do not specialize in eating disorders, it’s crucial to refer out or seek consultation. Eating disorders are treatable, yet complex illnesses and are the second deadliest mental illness. With treatment and support, full recovery is possible.

About The Eating Disorder Center

The Eating Disorder Center is a premier outpatient eating disorder therapy practice founded by Jennifer Rollin, MSW, LCSW-C. We specialize in treating teens andadults with anorexia, bulimia, binge eating disorder, OSFED, and body image concerns.

We offer eating disorder therapy in Rockville, Maryland, serving individuals in Potomac, North Potomac, Bethesda, Olney, Silver Spring, Germantown, and Washington, D.C. We also provide virtual eating disorder therapy in Maryland, Virginia, Washington, D.C., Florida, Pennsylvania, and California.

As most CSWA members know, the Association of Social Work Boards (ASWB), which oversees the licensure examinations for social workers, has been working for the past three years to eliminate the disparities in pass rates to the exam (see ASWB Report, 2022). CSWA has been having quarterly meetings with ASWB leaders to share updates in the field, as well as to discuss the problems we have seen in the clinical examination.

ASWB has just released the first of several changes which will be made to improve the exams as follows:

Association of Social Work Boards Examination Changes

The exam will shift from four content areas to three to better reflect real-world social work practice.

The total number of questions will be reduced (specifically from 150 scored + 20 pretest to 110 scored + 12 pretest) while maintaining the 4-hour exam time.

There will be a stronger emphasis on problem-solving, reasoning, and application - not just recall.

The updated exam will feature a higher proportion of 3-option multiple-choice items to improve clarity and focus.

These changes are set to go live in August 2026. ASWB hopes these changes will lead to a more streamlined, relevant exam; content that mirrors current professional practice; and a greater emphasis on real-world skills. The other changes which CSWA hopes will be addressed will be the pass disparities which have been identified. ASWB’s information on the topic can be found at https://www.aswb.org/upcoming-changes-to-the-social-work-licensing-exams/.

Contact: Laura Groshong, LICSW, CSWA Director of Policy and Practice, lwgroshong@clinicalsocialworkassociation.org 

Here are a list of resources that are available for those who will need assistance due to the shutdown.

RESOURCES:

Bank of America: announced assistance available to furloughed Federal employees. Call the priority assistance line [844.219.0690](tel:844.219.0690).

Chase Bank: Chase today announced efforts to help its customers who are U.S. government employees affected by the U.S. government shutdown. Here’s the special line they set up [1-888-356-0023](tel:1-888-356-0023).

Congressional Federal Credit Union: For more information on our Relief Line of Credit or any of our assistance programs, contact our Member Service Representatives at [800-491-2328](tel:800-491-2328) or stop by one of our branch locations.

Fed Choice: They’re offering quite a few different options to assist – for existing and new members.

Interior Federal Credit Union: They’re offering a special loan for both member and non-member furloughed Federal workers. Net paycheck up to $15,000, interest free up to 30 days. Members may apply for a limit up to the equivalent of 2 net paychecks. More offers are available on the site or call [800-914-8619](tel:800-914-8619)

Navy Federal Credit Union: These guys are offering a special loan program. Read the FAQs PDF from this link to see if you qualify or call [1-888-842-6328](tel:1-888-842-6328)

PayPal: PayPal has made a very generous offer. They’ve allocated $25 million to fund interest-free cash advances to our furloughed Federal workers that need assistance right now. This is for both new and existing PayPal Credit customers. Minimum loan is $250 with a maximum cash advance of $500. Your account does need to be in good standing if you’re an existing PayPal Credit customer. Existing customers call [1-877-689-1975](tel:1-877-689-1975). For new accounts, apply here first, then after approval call [1-877-689-1975](tel:1-877-689-1975).

U.S. Bank: Will waive all late fees if you miss a mortgage payment due to the shutdown. Also mentioned they will defer first payment dates for new mortgages.

U.S. Employees Credit Union: USECU is also offering shutdown loans, but only until Tuesday, January 15th. Call [(312) 922.5310](tel:(312) 922.5310) to get help.

SunTrust: SunTrust didn’t make a specific offer, but they did make a public announcement that they have programs in place to help clients affected by the shutdown.

Synchrony Bank: These guys handle store cards for Amazon, Lowes, Walmart, JCPenney, Chevron/Texaco, and many other large nationwide companies that you might do business with on a day-to-day basis. They are allowing affected customers to defer payments until after the shutdown. Contact them for more information.

Union Plus: For union members, there are a great number of options available if you’re with Union Plus. Call them at [800-472-2005](tel:800-472-2005) to ask about these offers: $300 Furlough Grant for eligible Union Plus credit card holders, Mortgage Assistance Loan & $300 Grant: payment grace period for your Union Plus Life and Accident Insurance, payment grace period for Union Plus Auto Insurance, and payment grace period for Union Plus Life and Accident Insurance.

Wells Fargo: They’ve got a few different options to help depending on the services clients have with their bank.

Furlough Grants

FEEA-NARFE: This is an awesome offer that every furloughed Federal worker needs to take advantage of. FEEA-NARFE fund is offering $100 grants to active federal employee members who are not receiving a paycheck during the current shutdown due to being furloughed or working in excepted status. To apply, visit the FEEA website.

Thrift Savings Plan

TSP Plan News and Announcements: TSP allows for the suspension of loan payments when you go into non-pay status. They do not require documentation about your furlough currently. Missing one or two payments will not cause your loan to go into default. Log in to your account to check your status or simply call the Thrift Line at [1-877-968-3778](tel:1-877-968-3778).

Toyota Financial Services & Lexus Financial Services: Affected lease and finance customers in good standing with their accounts may be eligible to take advantage of up to two months of finance contract payment extensions or lease deferred payments. Toyota Financial Services call [800-874-8822](tel:800-874-8822) and Lexus Financial Services call [800-874-7050](tel:800-874-7050).

Hyundai Capital: Hyundai will extend all Hyundai Capital auto loans and lease payments for 30 days for current Hyundai owners who are federal government employees furloughed during the shutdown. Impacted consumers should contact Hyundai Motor Finance at [1-800-523-4030](tel:1-800-523-4030) to take advantage of this offer.

Kia Motors Finance: Kia has announced they’re offering deferred payments of 30 days. If you’ve been affected by the current Government Shutdown and need assistance from Kia Finance, please contact us at [1-866-331-5632](tel:1-866-331-5632).

Ford Credit, GM Financial, & Mercedes-Benz Financial Services: It has been reported that these companies are among those providing qualified customers options such as payment deferrals, late fee waivers and special care lines to address their individual problems, though official announcements from these companies have not been released online.

Mobile Telephone Service Providers

AT&T: Will assist with adjusting late fees, providing extensions, and revising payment schedules.

Sprint: Will provide short-term payment solutions. Call [1-888-211-4747](tel:1-888-211-4747)

T-Mobile: Offering short-term assistance and can spread out service payments over time. Call [1-877-746-0909](tel:1-877-746-0909) or 611 from a T-Mobile device.

Verizon: Offering flexible payment options and has a Promise to Pay program to set payments for a future date. Call [1-866-266-1445](tel:1-866-266-1445).

Rental Home Assistance

National Rental Home Council: Represents many of the nation’s largest operators of single-family rental homes. They’re offering deferred rent payment options with no late fees to any renter who has been furloughed.

OPM Sample Letters for Creditors and Mortgage Companies: OPM created these sample letters for Federal workers to contact their landlords, mortgage lenders, and utilities, to request help during the shutdown.

National Food Resources & Advice

Feeding America: These guys have a nationwide network of 200 food banks. From those food banks, they have 60,000 partner pantries from which they can serve every community across the United States. This is an awesome resource, and they have already begun serving Federal employees affected by the government shutdown.

Your School District: To save on food and ensure your kid eats breakfast and/or lunch free (less stress and worry for you), notify the district of your furlough. No income is an emergency and normally qualifies you for the free meal program.

Home, Auto & Life Insurance Relief

MetLife: For those not receiving a paycheck from the federal government because of the current shutdown, MetLife Auto & Home may grant a one-time, 30-day grace period on your payment of premium on a MetLife Auto & Home policy. Members must request this one-time allowance by calling [1-800-GET-MET8](tel:1-800-GET-MET8). Certain restrictions apply, and premium remains due after delay expires.

Fidelity & Guaranty Life Insurance Company: To help the nearly 27,000 AFGE members who currently have a policy with the company during this government shutdown, the company “will keep the policy-in-force by waving the cost of insurance charges for the next 30 days.”. Policies beginning with the letter "Y" call: [844-800-9146](tel:844-800-9146), all other policies call: [888-513-8797](tel:888-513-8797)

Other Notable Mentions for Relief & Assistance.

Rent-A-Center (Benefits Plus Membership): If your account was up to date at the time of furlough and you are a part of benefits plus you may be eligible for a payment waiver based on your state: “Involuntary Unemployment Payment Waiver: Losing a job is hard and making payments while unemployed is even harder. Fortunately, your Membership waives your payments when you are involuntarily unemployed. Whether you were fired, laid off, suspended, or are out of work due to a labor dispute or strike, your payments are covered for up to four (4) months, up to $1,000, or when you’re able to return to work.”

National Freebie Offers

U.S. Office of Personnel Management: Their fact sheet states that federal employees may be eligible for unemployment compensation administered by state unemployment insurance agencies. So, eligibility is determined by state law, not on the Federal level, which may work in your favor.

USAA Are offering deferments for all loans and credit card payments.

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IN PERSON CE Event!

CLICK HERE FOR MORE INFORMATION AND ONLINE REGISTRATION: https://gwscsw.org/event-6215332

Regulating Racial Reactivity and Defensiveness in Work with Youth and Families

Mark your calendars for the GWSCSW event listed below. Register today and save your spot!

Catholic University

Presenter: Kenneth V. Hardy, PhD  
Saturday, October 25, 2025 | 10:00 AM-12:00 PM
Cost: $45 Retiree/Graduate/Student | $75 Member | $120 Nonmember (Please make sure you are logged in to get the correct member pricing)

After you Register Online for GWSCSW Events -- you will have the option of paying by credit card or sending in a check. If you send a check your profile will be updated when the check is received. All checks can be mailed to: PO Box 711 | Garrisonville, VA 22463

NOTE: GWSCSW has applied with the National Board for Certified Counselors to be an authorized sponsor of Continuing Education for licensed counselors.

.  Register today and save your spot! https://www.gwscsw.org/event-6225280

Legislative Town Hall-Connecting Clinical Practice with Recent Legislation
Online ZOOM
Sunday, June 29, 2025 | 11:00 AM-12:00 PM 
Cost:  EVENT IS FREE FOR MEMBERS - COST FOR CEUs IS $15 (Please make sure you are logged in to get the correct member pricing)

After you Register Online for GWSCSW Events -- you will have the option of paying by credit card or sending in a check.  If you send a check your profile will be updated when the check is received.  All checks can be mailed to:  PO Box 711 | Garrisonville, VA  22463

Category 1 - 1 CEU

Please join our fabulous lobbyists-Christine Krone, Mark Smith and Guy Rohling-for an hour long update on June 29^th at 11 am. We will hear what has been going on for the past 6 months regarding social work with the legislatures from DC, Maryland and Virginia. Laura Groshong from the Clinical Social Work Association (CSWA) will also join to give us an update on national issues, including the Interstate Compact. There will also be time for your questions!

This event is free to membership, but you must register to join. I look forward to seeing you there!

Judy Gallant, LCSW-C  
Director, GWSCSW Legislation and Advocacy

 

https://www.gwscsw.org/event-6153739

https://www.gwscsw.org/Behavior-and-Conduct-Guidelines

All GWSCSW CEU events are designed to be professional, ethical, safe spaces to further learning, skill-building and discussion about topics of interest within the field of clinical social work. To that end, we request that both participants and presenters take responsibility to cultivate an environment where optimal learning takes place, by:

1. Encouraging ethical, diverse, and inclusive conversation that represents the culture of clinical social work.
2. Embracing differences, promoting honest and curious discussions, responding with questions rather than ultimatums and keeping a collegial and open mind to further understanding.  
3. Behaving with respect: Not using disparaging terms, verbal insults, bullying statements, offensive racist, hateful, homophobic or sexist language, or any forms of harassment.   

5 Social Work Trends for 2025: What They Mean for the Profession

https://online.marymount.edu/blog/5-social-work-trends-2025

https://djph.org/wp-content/uploads/2024/03/djph-101-05.pdf

Social Work Compact implementation timeline

SW-Commission-Timeline.pdf