Actually, the title of this post is misleading. Hope is critically important in counseling, PERIOD. However, since this is a blog about redemption from eating disorders, for my purposes that is what we're considering.
In the biblical counseling course I am currently taking, the point is made that counselees will often say that they have prayed about the problem (read: sin), but that is all they have done. Their general hopelessness comes from the fact that nothing in their situation has changed; they are still enslaved; from all appearances, God has not moved. Does He not see or care? From their vantage point, prayer must be ineffectual. This often leads to hopelessness.
The problem with this common scenario, of course, is not prayer. Of course we should be praying (about everything), but that is only the first step. We should not stop there. The Bible gives decisive instructions on what we are to do in order to address our predicament the way God intends. Explicit, biblical instruction from the counselor, along with specific homework assignments, are often the first pro-active thing a Christian addict may have been given. This kindles hope that, indeed, change is possible.
It is a given that the goal of biblical counseling is always change - for the counselee to become progressively more conformed to the image of Christ. The Scriptural call to change is one that few anorexics or bulimics actually believe they are capable of anymore (especially if they have been steeped in the empty philosophy of "self-help" groups, which are usually nothing more than pity parties). Often, I hear from bulimic ladies, "I can't stop. I've been this way for too long. It's part of who I am. I can't change." The correct (read: biblical) response to this mindset is, of course, "God has commanded you to stop; therefore you can change (Phil. 4:13); in His strength, by His power and with His wisdom." Then I might point out specific passages that speak of "putting off" lust, pride, gluttony, drunkenness, etc.
Speaking about a problem from God's Word makes you solution oriented; not problem oriented. That is why I do not discuss food at length or ask my counselees to keep food journals. Such practices put the focus on the problem, not where it belongs (on Christ, and learning to obey Him in all areas). God has solutions to all problems. That fact alone should give all believers in the pit of an eating disorder great hope.
As Jay Adams put it succinctly, "A counselee needs to hear you talk the language of hope from the Bible". Amen to that.