Harm Reduction, Healing Centered Engagement and Eating Disorders: Dismantle The System To Help Client Heal

Harm Reduction has long been a buzzword in substance abuse treatment. Many treatment centers and practitioners tote the badge of honor that is “harm reduction” much like those of us the eating disorder field will tote if badge of “HAES” and “intuitive eating” but saying words and doing the work behind them is so utterly different.

First, we must realize that many movements such as HAES and IE are often used by thin, white, heteronormative femme presenting providers to disarm Fat, Queer, BIPOC, AAPI, Disabled clients into believe they have our best interest at heart (I say ours because I fit under a few of those labels). Any framework used without a harm

reduction and a healing center engaged lenses is frankly a failure.

Harm reduction when used as a means to honor a person experience should:

1. Accept that people are human and will do behaviors of some kind regardless of our interventions, that part of being human is we all do something.

2. Being human is complex and demanding abstinence from most behaviors and substances doesn’t work for everyone.

3. Increasing quality of life and community connection is more important and is often a more successful experience when we expand the criteria for “wellness”.

4. Reducing harm through a non-judgmental and non-coercive lens is key as it honors the reality of being human.

5. Include the people struggling in conversations about the issue be it substances or eating disorders.

6. Allow clients to be the agents of change within the harm reduction and allow them to guide you in ways that feel good for them.

7. Recognize that intersecting identities increases vulnerability within society and therefore the ability to heal.

8. And finally, equally do not minimize

Taking this into consideration we must then wonder what other frameworks are getting wrong when a harm reduction lens isn’t applied?

Harm reduction is a part of what we consider a trauma informed approach however I feel this actually challenges trauma informed framework and asks us to elevate it to something more. This is where healing centered engagement comes into play. This is a framework that looks at trauma informed and said, “nice try, hold my bag.” It was designed around the theory that the more marginalized someone is the more trauma they experience. And it moves up from what is wrong with you, to what happened to you, to finally what is right with you. This is a framework that feels the most authentic to who I am and the one that follows most closely the professional ethics I hold so dear:

1. Being culturally grounded and that healing is a collective experience that considers all of the persons intersections.

2. Focusing on what the persons assets are rather than a focus on deficits.

3. Using trauma sensitive language that mirrors a person’s language.

4. Utilize empathy as the base of everything we do and in ever interaction.

5. Acknowledge harm done both individually and collectively.

6. Support a person’s dreaming and imagination as they can grow beyond their trauma.

In my work I bring together harm reduction and healing centered engagement as a way to not just “support recovery” but to instead offer something better, more authentic and more sustainable. To be completely honest I think the idea of recovery is unattainable. Not because I have no hope but because the etymology of the word recovery means “restoration” and to “get back”. An eating disorder changes a person and their lives forever. This is why an abstinence model in eating disorders feels like a set up. We can’t move back, we can only move forward and we often find we still have thoughts, feelings, or behaviors we need to regularly manage rather than just ignore or make go away forever, that’s just not how this happens.

I once joking said to a colleague that we don’t just DBT eating disorders out of existence. Instead it becomes a chronic condition that one maintains and heals overtime in whatever way that means for the individual, for many it will be no longer calorie counting, or re-learning to enjoy movement, for some it’ll be no longer abusing laxatives or incorporating that scary food back into their daily eating. And for many it is also purging on occasion, still feeling shame around eating, struggling with fatphobia and the idea of a perfect weight. This is the painful nature of this beast.

Notice how Health at Every Size hasn’t shown up to play yet? Frankly we’re learning more and more where this framework no longer fits into a harm reduction or healing center engaged lens. This statement isn’t to be subversive it’s just the framework still has cracks that have become more evident and honestly it never sought to fit in with the other models I’m discussing. It feels important to note that I was once a massive HAES advocate and since have moved away from this and instead tell people I use a weight neutral approach as part of a harm reduction & healing centered engagement model.

Here’s why: we need more than weight neutral approaches, joyful movement, gentle nutrition and educated providers. We need more than this when disabled people move and eat differently, when cultural food is not centered in eating disorder treatment, when not all bodies move in the ways we imagine or can, and when often the most educated and empathetic providers are inaccessible and the marginalized are lefts with the dregs of interns and student medical providers instead of long-term, quality, consistent care. None of this ever touches the fact that this, white, cis-heteronormative folx are often the ones that can afford and access higher education so they can become providers in the first place. The inequities of our system end up playing out just as they intended. With people becoming rich off social justice frameworks when there are actually frameworks that are better suited, more inclusive and don’t require often hefty certification costs to use.

Harm reduction and healing centered engagement don’t just offer better eating disorder and substance use treatment, they offer better, more ethical, more empathetic and more intersectional medical and mental health care. In those spaces we have the power to transform the systems we are in to reflect the people actually in it rather than what the systems of oppression would prefer.