Digital guided self-help for binge eating disorder: a paper worth getting INTERBED with?


Family therapy for anorexia: can it create closeness and containment in parent-adolescent relationships?



Anorexia nervosa: relapse, recovery and remssion

Anorexia nervosa: relapse, remission and recovery



It’s been a while, apologies! I have a new post on the Mental Elf on eating disorders:

CBT for eating disorders: what impact on quality of life?



New articles on The Mental Elf:

I’ve been writing on mindfulness:

Mindfulness for young people: to meta-analyse or not to meta-analyse?

And on eating disorders:

Prevention of eating disorders: where do we start?



What good ever came from self-loathing?

Regardless of what model of therapy you are using or considering, self-loathing never turns out to do you any favours. If you are using CBT, you will know all the automatic thoughts and the negative behaviours and feelings that follow on from the core belief that you are unloveable or faulty in some regard. If you are using CAT, you will know about the trap holding a self-loathing position creates. And in Transactional Analysis, which I am working with a lot at the moment, you get to think about your internalised parent voice, if it is critical, can speak far too loudly and far too often to tell you you are not good enough or trying hard enough, to the point where you genuinely feel badly towards yourself.

Moving out of these feelings is no short journey, whatever your mode of therapy, but it can help to recognise at the start of the journey what benefits and what costs have come to you from regarding yourself with loathing. I am going to guess that the costs significantly outweigh the benefits, and that self-loathing has probably not led to self-improvement. If that critical parent really wanted you to do better, surely they would offer you more than continuous criticism? And in a CBT model, if negative thinking towards yourself just leads to self-defeat, then you know that that core belief has to be modified.

Making the changes is hard, but this first exercise can serve as a useful anchor and prompt to help keep you on your way.



I have another post up on The Mental Elf website, addressing eating disorders. The link is here:

Help-seeking for eating disorders: barriers and facilitators


I have just had a review posted on the mental health blog site The Mental Elf. The link is here:

Third wave psychotherapies for depression and anxiety in older people


As someone who practises in Mindfulness-Based Cognitive Therapy, it is important to me to keep up to date with how this line of therapy is advancing, and what the research evidence tells us about where, how and for whom it is effective. The aim of the blog is to help to convey research information to a wider audience in a concise fashion and to encourage people to discuss what is being found and how research is being done. If you are interested in the research side of therapy, it’s a good place to get informed and read some interesting views.


a little thought: wondering whether you are happy is a great shortcut to being depressed.

Something for the overthinkers amongst us!

Pura Vida!


Over the next two weeks I will be journeying to some really unusual places and I’m pretty nervous! The typical phrase to describe this would be ‘getting out of my comfort zone’. To an extent this is apt, but I’ve recently been challenged on the use of this phrase, and encouraged to find a different expression. The phrase often implies that there is something wrong with being in one’s comfort zone, or that being comfortable has some bad connotations. Actually, comfort is essential for us all, as anyone working with trauma will tell you. For those that feel they are living without comfort, practically or psychologically, would surely feel strongly about the dismissal of comfort.

i’m going with ‘expanding’ instead, hopefully keeping my comfort zone but growing myself; that’s the plan anyway! Thinking in this way helps me to think positively about some things that feel scary and uncertain, and they stop me from feeling like I have failed if things don’t work out. It probably means I’ll find more fun and enjoyment on the way – I’ll let you know how I get on!


What does it mean if your sense of worth comes from praise?

Praise is powerful. It is motivating and validating. It makes us realise that other people are noticing what we are doing, and, more importantly, that they notice what we are doing well. But praise is not unproblematic.

Some people are really good at self-praise in a realistic way, feeling a sense of warmth and satisfaction without tending to arrogance or self-dismissal. They are often the same people who can acknowledge but not depend on external praise. They like it, but they don’t need it, and they can be happy with their self-praise when no external praise is forthcoming.

Those who tend more to arrogance and those who tend more to self-dismissal tend to find themselves highly reliant on external validation. The more extreme this need, the more it leads a person to behave in ways that can make other people feel uncomfortable. It can also lead a person to start doing things that they think will lead to praise, regardless of whether they have a genuine interest in doing these things themselves.

I was thinking about this this morning with regards to the opportunity to do a 10k run in a few months’ time. I realised that the only motivation for doing it was that I could talk about it in conversation and (truth be told) be admired for doing it or receive praise for it. But actually, for me, running 10k is not particularly meaningful. So, I wondered, does it really make sense to enter this race? And perhaps it does – it’s for charity, it will be fun – but it did give me a moment to assess my own relationship with praise and external validation.



I thought I would share a nugget of wisdom I’ve acquired over the past twenty four hours.

As an extension to the idea that you cannot help anyone else until you can help yourself, you cannot love anyone else until you can love yourself. This is a much deeper observation than the idea of helping yourself before helping others, and it’s possibly more truthful, as we can all offer help when we are not particularly internally well or helpful to ourselves – it’s just that the help we offer can fail to meet what we promise because we are not well enough. Love, however, cannot be faked (mostly), and this applies both to the love we show to others and the love we show to ourselves.

Loving yourself is a way bigger battle than helping yourself, and helping yourself can be a massive struggle anyway. Someone might be able to give us advice as to how to help ourselves, but learning how to love yourself is a completely different kind of learning process. It is possible for everyone to make that learning journey, but hanging in there when it feels too challenging or just impossible requires support and that element of ‘right place, right time’.

When I heard the person who said about loving yourself coming before loving anyone else, I initially took a face value shrug at the comment. It has only been with a little time and reflection that I’ve noticed how true and profound it is, and how much it underpins therapeutic work, which is why I felt it was worth sharing.


I am horrible with injections and blood tests. A serial fainter, sometimes a double fainter, I am very conscious of letting whichever poor nurse or doctor due to operate a syringe in my vicinity know that I am likely to need three times as long as the average punter and that I will probably be sprawled on the floor if I don’t get a good twenty minutes of horizontal time on a bed. It’s a psychological thing, and I have no qualms in being honest and upfront about it.

Why, then, is it so different for things like telling your colleagues you’ll need more time and space at the work meal you want to go to, because of eating disorder related thoughts?

Or that you will struggle to meet in a certain restaurant because you don’t find it the most clean, and your thoughts about germs will be running rampant all evening?

In other words, why are some psychological issues perhaps more socially acceptable than others? And is this true, or are my thoughts on the matter unusual? Some people might not feel comfortable being open about their needle phobia. Some people might be open about all their psychological difficulties.

Just some thoughts to share, with no judgment on any ‘right’ way to be with disclosing one’s inner processes. May you have a lovely weekend – take care of yourself.


I have recently become a member of the Health At Every Size community, and have become more active in seeing what support is available for people with eating disorders in the podcast world. The brilliant thing about podcasts is that they are size neutral; you can’t see anyone! As with all media, you have to be careful, but there are some genuinely reflective and supportive podcasts out there. I recommend Meret Boxler’s Life. Unrestricted. and Christy Harrison’s Food Psych podcasts. Putting aside individual preferences and so forth, these podcasts, which both involve lengthy interviews with dieticians (usually), are sensible, open and unafraid to challenge the dominant diet beliefs in our society. Things like the belief that we should lose weight, or that eating is something to feel ashamed of, or that we should all do more and more exercise. It’s helpful too to hear from dieticians, most of whom got into their line of work because of their own eating issues, to talk from a size neutral position.

Sarah McDonald, Clinical Psychologist

DClinPsy MPH MA(Psychology)
Fully insured with PPS
Registered with the Health Care Professionals Council (PYL17796)

Book a consultation with me

Email: sarah@mcdonaldpsychology.co.uk