A Chat with Ilene Fishman Part 2: Thoughts on the Therapeutic Process

Recently we sat with Ilene V. Fishman, LCSW, ACSW, FAED (Fellow of the Academy of Eating Disorders). In part, we wanted to discuss her book The Deeper Fix: For your Growth and Empowerment, but we also wanted to catch up with a dear friend of and provider of clinical supervision for Galen Hope. We are excited that Ilene has agreed to share some of her wisdom with us and allowed us to share it with you.

In this segment, we talked with Ilene about her perspectives on therapy, and on the relationship between client and therapist.

Good Therapy Vs. Bad Therapy

One of the many points at which Ilene’s philosophies and Galen Hope’s intersect is that we mutually believe that there were, and ARE, substantial gaps in the mental healthcare system. Galen Hope, as we’ve discussed in our blog, was founded because far too often, patients are stepped down before they are truly ready—while the physical recovery has begun, the journey of healing the underlying psychology behind their disorder has only barely started. On this idea, Ilene says:

“So many people are failed in our mental health system. So many families, so many individuals, and partners, so much suffering and that’s one of the pet peeves of mine.

Which is part of why I wrote the book that I did. Called The Deeper Fix. When people come to me and they’ve spent years in therapy and not gotten well. I’m not saying that the therapy wasn’t helpful in any way, that they spent years doing, but it wasn’t helpful enough.

And, you know, therapists can be really, really nice, and caring, and have the right intentions, but it doesn’t mean that it’s good therapy.

Therapy takes time, (I’m thinking about eating disorders, but it depends on what someone is trying to accomplish in therapy, whether it’s if they’re there because of an eating disorder or they’re there because of another issue), but if we think about eating disorders, it takes time. 

And we don’t expect that people are going to get better right away. But one of the most important parts about good therapy, I think, has to do with people should know what they’re working on. 

People need to know in therapy, what are the goals? What are we trying to accomplish and why?

Very often people will say to me, I’ll be talking about what’s going on in the therapy, and people will be like “when are we going to start doing that” and I’ll say we already are starting that.

You can’t fix something unless you know what needs to be fixed, so identifying where are the problem areas, what’s wrong, how is this eating disorder impacting one’s life? Or how are the unhealthy relationships, or whatever it might be, how is it impacting your life? Where are the problem areas? What are we trying to accomplish together? And I think that needs to be clear in the in the therapy relationship, and it has to keep being revisited, so that we make sure that the therapy stays on track.

Another thing that’s important, I think, about how I work is that I really value the therapy relationship. But my goal is not the therapy relationship, it’s the person’s relationship with themselves. 

And I come in as the authority, in that yes, I’m the therapist and you’re paying me. I know a lot, but I want you to know a lot. I want you to become the expert about yourself. I want you to not remain dependent on me. I want you to be dependent on me as long as you need to be in order to become whole and independent. 

And I think very often, look, we all get gratified from our patients. I love my patients. I love this work, but my goal is that people can be whole and do well without me. That’s the goal of therapy. It’s not to continue to need me. 

It’s not that we don’t have an important relationship. The therapy relationship is this unique relationship. And I also encourage people to be completely honest, the good and the bad. Because I think there’s empowerment in communication and learning to communicate. So, people know what I’m thinking. They don’t have to guess or wonder; they know what I’m thinking and I want to empower them.”

Ilene also had very poignant thoughts on what makes for “bad” therapy:

“You have to like your therapist, but you have to make sure that your therapy really is on track.

I think a lot of therapy is sort of mediocre at best. It’s well-intentioned, and people get a little better. I’m also a big proponent of the concept of undertow, and I think relapse is a misnomer.

I think the only reason people relapse is that they were never really better in the first place.

Because once you’re really better, you can’t go back to mistreating yourself that way. It becomes ego dystonic. When I start out with patients, they say eating disorder behavior is ego syntonic. People are comfortable with their eating disorders. I mean, they’re not because they’re in therapy, but they’re basically comfortable with their eating disorders because it’s serving an important function.

And as long as someone needs their eating disorder, they’re going to keep holding onto or going back to their eating disorder. But what we want, what I want to see, is that somebody can still be very, very symptomatic, but I know they’re really getting better because their relationship with themselves is changing.

Somebody else could be the opposite symptomatically. They’re looking so much better, but I know they’re not really getting better. So that undertow, you need to fix that. You need to fix the internal experience, and you need to fix the relationship with self. And I would say that’s true, probably, not just with eating disorders but in general with therapy, when whatever people are struggling with. It has to do with how they treat themselves, how they feel about themselves, how they are with themselves, and then of course how they are with all the other relationships in their lives.

But it stems from how we are inside of ourselves.”

Society and Therapy

We asked Ilene how a discussion of the broader social implications of ED show up in a therapeutic relationship with her clients. Specifically, we were interested in the ideas of social shame and a cultural narrative of control (which we discuss in our previous segment with Ilene).

“Well, I identify again how it works, how it’s the lived experience. What people are doing with themselves, and then I put that in the therapy context, in the psychological context. Also, I’m able to put it in the sociological societal context. 

It’s interesting, I was a psych and women studies double major in college, and so in a way, I have that feminist background. That really helped me in terms of my own personal recovery, and I think it’s always there for me. 

I see patients through the lens of societal impact on people and how people feel, and certainly for women being oppressed and how society oppresses us. And how diet culture oppresses us. And who’s getting wealthy? Off of our fitting into certain sized clothing and buying their diets and their diet food?  I educate people and I think that we have to educate. Any good therapy is also educational, because that’s how we try to empower people so that they can be empowered in healthy ways, rather than with their disordered eating or exercise.”


Built on the principles of assertive community treatment, Galen Hope is an eating disorder and mental health treatment center offering individualized treatment options that include Intensive Outpatient (IOP), supported housing, and Partial Hospitalization Programs (PHP). As a “Community of Integrated Wellness,” we pride ourselves in fostering a thoughtful and meaningful care experience that can guide our clients on their road to recovery and increased quality of life, regardless of diagnosis. Galen Hope currently offers separate, age-specific programming for adolescents ages 12-17 and adults 18 and up of all genders.

To learn more, or to join our community for integrated wellness, please contact us today.

Belong. Heal. Grow.

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