Trauma-Informed Approaches to Eating Disorders Interview

Andrew Seubert and Pam Virdi editors of Trauma-Informed Approaches to Eating Disorders joined us for an interview on their book. What follows are our questions in italics, and their thoughtful responses.

You gathered the work of some great minds in our field to develop Trauma-Informed Approached to Eating Disorders. How did this effort get started?

We met in Hamburg, Germany, at an EMDR conference several years ago, both of us presenting on various aspects of eating disorders (EDs) and EMDR. Pam was approached to write a “protocol” for EMDR and EDs and asked Andrew to collaborate, but both didn’t think that the topic could be captured in a “protocol.” Andrew’s thought was to create a book that would both introduce readers to a trauma-informed approach to EDs that would be inclusive of various theoretical models. He presented the idea to Sheri Sussman of Springer Publishers and the rest is history. The various authors were tracked down via a great deal of legwork and with the help of generous colleagues in the ED community.

Each chapter is richly informed from research. For example, Chapter 4 focuses on the significance of the therapeutic presence and safety. Please share some of the concepts presented here.

The basic concept derives from the attachment field. Clients with EDs can be quite guarded and mistrustful of anyone trying to take away their ED, which has helped them survive, albeit in a dysfunctional way. Likewise, they have often experienced attachment injury and absence, as well as trauma (big “T”s) and painful life experiences (small “t”s), all of which easily leads to a sense of chaos and lack of control.  A strong therapeutic dyad must be a primary goal for the therapist as a way of creating attunement and healthy attachment. It is only within this relational context that the client will feel safe enough to venture into the landscape of emotional vulnerability, challenging the fears, anxiety and shame that are part and parcel of EDs.

Andrew, one of your chapters is entitled, “The Courage to Feel: Eating Disorders and the Case for Emotions.” Can you elaborate on your statement, “Pain is not necessarily a bad thing”?

There is pain when we inadvertently place our hand over a fire. The pain is a message to pull our hand back. This is what I would refer to as pain with a purpose. There is, however, pain that repeats, that spins repeatedly in a circle, but goes nowhere. An example of this would be ignored sadness, which carries the message that we have lost someone or something. If we ignore or bury the feeling, the “pain” of loss simply continues and even worsens, at times, in the direction of a depressive state. This is pain without a purpose, what I would refer to as suffering. As someone once said, “Pain is necessary; suffering is optional.” Yes, there are emotions that are painful, as is the pain of a hand in the fire, but if the pain has a purpose and a message, it is a “guest at our door”, as Rumi put it, bringing us a needed message. Despite the pain, there are really no “bad” feelings or even “good” feelings. There are either warning or well-being feelings, both bringing us information for our benefit. The suffering arises when we ignore, bury, avoid and deny the emotional guest.

Recognizing that clinicians rely on different theoretical models, you offer a section focused on selected models. You then charged each author to include what each stresses when preparing their client for trauma processing. Can you please briefly summarize one author’s response to this concern?

In the chapter describing EMDR, DaLene Forester maps out an 8-phase approach, the second of which is the preparation phase. In her own words, “A major component of preparing a client to do EMDR therapy involves stabilization and affect tolerance skills, as well as resources to support the client’s ability to process earlier life events that may have contributed to the development of the ED. A list of client strengths can form the basis for creating such resources.” Although several of the theoretical models do not seem to include such preparation, both Pam and Andrew subscribe to the need for this phase of the trauma-informed model. DBT skills, breathwork, internal state change via “safe place” imagery are all examples of strengthening the client for trauma processing. Of utmost importance is the attention that Ms. Forester gives to the presence of dissociation in clients with EDs. We believe that dissociation to some degree is inevitably present in EDs and that screening for and educating the client about dissociative strategies is necessary if the actual trauma processing is not to be derailed.

The case examples provided accurately illustrate the complexities of traumatic experiences. Where do you feel the field of eating disorders is in regard to trauma-informed therapeutic approaches?

Without any hard data to substantiate our point of view, we would guesstimate that the ED field is decades behind trauma awareness and trauma treatment. There are many reasons for this. To begin, trauma and dissociation have, in the past, rarely been included in the training of psychiatrists, psychologists and therapists. When there has been training, it is often CBT dominated. Changing thoughts and beliefs is, of course, a necessary part of the treatment, but if we’re not willing as therapists to get “messy” by involving somatic and affective experience in the treatment, then we are bypassing the core of stored traumatic experience. And the operative word here is “experience.” This is why we felt it necessary to include chapters, for example, about Somatic Experiencing,  Sensorimotor Psychotherapy and Accelerated Experiential Dynamic Psychotherapy.  Brain studies have clearly shown us that the emotional and somatic material of a painful event is stored in a part of the brain that is, as Bessel Van der Kolk describes it, “mute,” meaning that it doesn’t relate to or work in language. Therapy, therefore, must find ways, often non-verbally, to  access and move that emotional and embodied material to a part of the brain that can truly consolidate it into a “memory.” In other words, a trauma-informed approach doesn’t restrict itself to PTSD, which are symptoms, but goes more deeply to the roots of the symptoms. Is it always about trauma? Perhaps not, but if one broadens the definition of trauma to include “Big T” and “Small t” events, then there are very few clients whose ED was not either caused by or, at least  exacerbated by, painful experience.

The final chapter addresses “Finding Self Again …” The authors include the value in reclaiming and developing a mature spiritual identity. What can this add to an individual’s recovery and life experience?

The key word here is “identity.” A mature spiritual identity, regardless of religious tradition, brings one to a larger sense of Self that is beyond problems and diagnoses. As a client achieves freedom from the false, shame-based story that arises from painful experience and hurtful relationships, s/he steps into a transpersonal identity, if you will, that allows us to let go of the fallout of trauma. Call it “Self”, or “Higher Self” or “Soul”, but whatever language we use to point towards this reality, it is hope-generating. It gives us vision and is our true Home. We then realize that we are not what happens to us, nor are we  the eating disorder that imprisons us. Who we most truly Be is greater than all of that. As Sartre wrote, “Freedom is what we do with what’s been done to us.”

Please share your recommendations for therapists who work with individuals with eating disorders and have also experienced trauma.

Get trauma-informed training and continued consultation that includes the experience of the body and emotions. It’s difficult when we’ve been trained otherwise, particularly if we’re already a seasoned clinician, but often, if we are to be the best therapists we can be, we must change and expand, and step beyond our training and orientation with the humility of the beginner’s mind. There are wonderful approaches now in existence, many of which are covered in our book. Learn about trauma and dissociation, about the body and emotions, and serve all, not just part, of your client: mind, body, emotion and spirit.

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About the editors:

Andrew Seubert, LMHC, NCC, is the co-founder of ClearPath Healing Arts Center in Corning and Burdett, N.Y. A licensed psychotherapist for 35 years, he has an extensive background in Existential-Gestalt psychotherapy and in music therapy, and provides EMDR consultation and training for other clinicians. Andrew specializes in working with trauma, posttraumatic stress, eating disorders, and the integration of spirituality and psychotherapy. A passionate and engaging international presenter and workshop facilitator, Andrew and his wife, Barbara have co-parented a blended family of five and now reside on Seneca Lake, N.Y. His first book, The Courage to Feel: A practical guide to the power and freedom of emotional honesty, was published by Infinity Publishing in 2008. He has authored a chapter in EMDR Solutions on the use of EMDR with clients with intellectual disability and co-authored an article on the same topic in the fall of 2011 for the Journal of EMDR Practice and Research. He has written two chapters on eating disorders for EMDR  Solutions II and has completed How Simon Left His Shell, a fable and User’s Guide based on The Courage to Feel, to teach children and adolescents emotional honesty. His most recent publication is Trauma-informed Approaches to Eating Disorders, which he co-edited with Pam Virdi of the United Kingdom.

Pam Virdi is an accredited EMDR Consultant, Integrative Psychotherapist, Lecturer and Supervisor who now works full time in private practice with adults, couples and young people. She specialises in the treatment of eating disorders but also has extensive experience of working successfully with a broad range of other clinical difficulties including complex trauma and PTSD. She is an accredited member of The British Association for Counselling and Psychotherapy and EMDR Europe. She started her career in mental health 36 years ago when she completed her core training as a psychiatric nurse. The last 24 years of her career in the National Health Service (UK) were spent working as a specialist psychotherapist and trainer in an Eating Disorder Service in Birmingham. As a lecturer, she has experience of developing, co-ordinating and delivering programmes of study up to Masters level and ran a year-long Eating Disorder Pathway (part of a BSc Mental Health Studies degree) at Birmingham City University. This scheme of study ran successfully for 8 years and made a valuable national contribution in training professionals of all disciplines to work in this highly specialist and challenging area of work.  She has served as a member on the Editorial Board of the European Eating Disorder Review Journal (1998 – 2008) and has set up and chaired national special interest groups for eating disorders both generally and EMDR specific. She has experience of working with the media to promote a better understanding of eating disorders and has given newspaper and radio interviews and regularly presents at national and international conferences. She is associate editor for a book called Trauma-Informed Approaches To Eating Disorders which was published in August 2018 by Springer Publishers.

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