How do I tell my therapist I need more support?
Telling your therapist you need more support is not a criticism of them, and good therapists know it. You can say something as simple as: I think my eating disorder needs more than weekly sessions right now, and I want to talk about a higher level of care. Most therapists will respond with relief, not offense, because they often see the need before clients name it. Stepping up to an IOP is usually a temporary intensification, done in collaboration with your therapist, not a replacement for them.
Why this conversation feels so hard
People put off this conversation for reasons that make emotional sense: fear of hurting the therapist's feelings, fear of being seen as a failure, fear that naming the severity makes it real, or worry that the therapist will overreact and everything will change at once. Underneath all of that is often loyalty. You have built a relationship with this person, and asking for more can feel like saying they were not enough.
Here is the clinical reality: needing a higher level of care is about the illness, not the therapist and not you. Eating disorders often need more contact hours, meal support, and team care than any weekly session can provide, no matter how skilled the therapist. Our page on when weekly therapy is not enough lays out the signs.
What to actually say
You do not need a polished speech. Any of these openers work. I have been more honest in my head than in this room, and I think things are worse than I have let on. The food stuff is not getting better between sessions, and I think I need more structure. I read about IOP and I want your take on whether I need it. Can we talk about levels of care?
If saying it out loud feels impossible, write it down and hand it over, or email it before the session. Therapists receive these messages regularly. What matters is that the truth gets into the room, not how gracefully it arrives. If you want to walk in with information, our levels of care page and the levels of care guide give you concrete language to point to.
How therapists usually respond
In our experience, the most common response is some version of: thank you for telling me, and I agree it is worth exploring. Many therapists have been gently raising the possibility already, or waiting for an opening. Some will want to consult with an eating disorder specialist or program, which is appropriate. A good therapist treats this as collaboration, not competition.
If your therapist dismisses your concern outright, especially if behaviors are escalating, you are allowed to seek an independent assessment anyway. You are an adult, and second opinions are a normal part of healthcare. The National Eating Disorders Association offers general guidance on seeking care at nationaleatingdisorders.org.
IOP works with your therapist, not against them
Stepping up to IOP usually does not mean leaving your therapist. With your written permission, we coordinate with outside providers so that care is continuous: they know what we are working on, we know your history, and when you step back down, the transition is smooth because the relationship never broke. Many clients return to their original therapist after IOP with a stronger foundation than before.
If you want to explore what that would look like, see what we offer, or call us at (512) 882-4599. We are happy to talk with you first, or with you and your therapist together.
Related questions
Will I have to stop seeing my therapist during IOP?
Usually not. Arrangements vary by situation, and we will discuss what makes clinical sense, but coordination with existing outpatient providers is standard practice, and returning to your therapist afterward is a common plan.
What if I have been hiding how bad it is from my therapist?
That is extremely common with eating disorders, and therapists know it happens. Coming clean is not a betrayal to apologize for. It is the moment treatment starts working with accurate information.
Can my therapist refer me to Empowered Treatment directly?
Yes. Providers can contact us on your behalf with your permission, or you can reach out yourself through our contact page and sign a release so we can coordinate. Either path works.
Where to go from here
Your situation deserves a real plan. Let's build it.
Call or text and tell us what's happening. Confidential, judgment-free, and specific to you.