Trauma-Informed Approaches to Eating Disorders is clearly a much needed and long overdue book about treatment, written by a diverse group of clinicians and carefully edited to focus on the needs and strengths of clinicians. The complexities and challenges that undergird, surround, and even haunt the nature, diagnosis, treatment, management, and understanding of eating disorders (EDs)-in-relation-to-trauma are so great, even for veteran clinicians, that they can leave practitioners at any level of experience feeling helpless and exhausted. This book, in a way that would be appreciated by practitioners of acceptance and commitment therapy, accepts the reality of those feelings and is committed to improving treatment, understanding, and compassion. The book is designed to foster respect for complexity and link it to humility in the presence of tragedy, tribulations, and suffering, framed all too often by our own shortcomings as healers. EDs are dangerous, ubiquitous, usually chronic in nature, and difficult to treat. Anorexia nervosa (AN) has the highest fatality rate (4%) of any mental illness. Bulimia nervosa reveals a fatality rate of 3.9%. EDs offer an enormous challenge to therapists because of their complexity, which includes severe medical risk, co-occurring anxiety, depression and personality disorders, an addiction component, and body image distortion—all of this within a mediadriven culture of thinness in which starving and purging can for some become lifestyle choices. This complexity is further exacerbated by the presence of painful life experiences or trauma. The book elucidates the connection between trauma and EDs by offering a trauma-informed phase model, as well as chapters describing the ways in which various therapeutic models address each of those phases. It offers an in-depth exposition of a fourphase model of trauma treatment.
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- Go to chapter: Boats and Sharks: A Sensorimotor Psychotherapy Approach to the Treatment of Eating Disorders and Trauma
Boats and Sharks: A Sensorimotor Psychotherapy Approach to the Treatment of Eating Disorders and Trauma
This chapter presents a case study of a sensorimotor psychotherapy (SP) approach to eating disorder (ED) treatment. In contrast to traditional psychotherapeutic approaches, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT), that lean heavily on the impact of thoughts on emotional experiences and somatic patterns, also known as top-down processing, SP also uses bottom-up processing, the effect that one’s somatic organization has on affect and affect regulation, cognitive functioning and specific beliefs about self and other. The very core of SP is four foundational principles that cultivate therapeutic presence and guide both content and quality of interventions: organicity, nonviolence, unity, body/mind/spirit holism. SP understands human experience through the lens of five core organizers: thoughts, emotions, and three somatic organizers. SP explores actions as a cycle with four stages: clarity, effectiveness, satisfaction, and relaxation.
This chapter conceptualizes the preparation phase in three parts for teaching and learning purposes. The preparation phase of the four-phase model is not a one-and-done event. It is visited and revisited often during the therapeutic journey. The first part of preparation is stabilization, sometimes referred to as case management. It is the sine qua non for the remaining parts. The goal here is to make sure that the client is externally safe, as well as internally stable. A second part of the preparation phase is developing skills and resources. Among these are skills that involve changing internal states (self-soothing) and containment of disturbing affect. The third aspect of the preparation phase focuses on short-term successes in which the client gains mastery and confidence in dealing with changeable life circumstances, something of a personal trainer approach.
This chapter focuses on an interpersonal/relational psychodynamic approach to working with eating disorders (EDs), which illuminates the links between symptom and meaning, action and words, isolation and relatedness. The work of any treatment of EDs is an ongoing, complicated mixture of direct intervention with the symptom and exploration of what the intervention means to the patient, including the role the symptom plays in the patient’s intrapsychic and interpersonal world. Understanding this as it unfolds relationally allows the intersubjective experience of both patient and therapist to collide, mingle, and ultimately coexist. Thinking about working with patients with EDs from this vantage point means that the experience of conflict is a therapeutic gain, not obstacle. Multiplicity and the capacity for dissociation are seen as part of the manifestations of what happens with patients with EDs.
This chapter deals with structural dissociation in the treatment of trauma and eating disorders. Dissociation is the inability to stay present when intolerable feelings and mental contents are activated. It is a way of making the overwhelming less overwhelming. A dissociative process is an unconscious attempt to sequester the intolerable away into the recesses of the mind, never to be contacted again. The chapter uses structural dissociation theory of the personality. Structural dissociation theory distinguishes two action systems that govern human behavior. The first action system is daily life and second action system is defense. The theory defines three levels of dissociation, primary dissociation, secondary dissociation, tertiary dissociation. Treating dissociation is a phase-oriented approach. The first phase is stabilization and preparation for trauma reprocessing. This is where the dissociation is treated. The second phase is reprocessing the painful memories. The third phase is full consolidation and integration.
The earliest American death workers had been members of other trades or occupational groups, and “undertaking” was largely a part-time job. In colonial America, most of the activities following a death were carried out by family members or friends. Funeral customs in the early years of the 20th century were tinged with Victorian era and post-Civil War practices. Infant, child, adolescent, and younger adult mortality was common and especially powerful influences on the emerging practices of that era. Funeral directors have been held to higher professional standards and have striven for more professionalism within the industry. An increasing number of professionals in the field are going on to graduate work or training in fields such as aftercare specialists, bereavement counselors, and as funeral celebrants. Many baby boomers may want a unique funeral experience. As they grew older, baby boomers increasingly questioned the traditional funeral.
This chapter sketches out the brief rich history of modern “hospice” and “hospices”, concentrating on developments in the United States and the United Kingdom, and highlights the spread of influence and the adaptation of ideas in other cultures and jurisdictions. Hospice is both a service and a set of ideals; a way of doing and a way of thinking. Financial considerations remain central to thinking about the provision of hospice and palliative care in the United States. Skilled nurses, social workers, chaplains, and volunteers provide the kind of holistic care that is increasingly valued by older people. The paradox for the health care system is that the patient must be dying in order to get it. Medicare pays hospice a fixed daily rate. Hospice has a key role to play in current debates about care at the end of life.
While the home is generally reported to be the preferred setting to receive end-of-life care, and despite it being the wish of a majority of patients to die at home, hospitals are the place where most people die. A chain of events triggered by a panel discussion on death and dying in February 1973 at a local church led to Dr. Mount’s development of a palliative care service pilot project at the Royal Victoria Hospital, a McGill University-affiliated institution. The conclusions of this project were clear: the medical, emotional and spiritual needs of the terminally ill and their families were generally neglected in the delivery of health care. In many countries, the development of hospital-based palliative care services has been largely influenced by the fee-for-service system, a system that very often fails to provide support for the interdisciplinary team beyond physician reimbursement.
Modern hospice and palliative care is approaching a significant anniversary: In 2017 it will be 50 years since the founding of St Christopher’s Hospice. The hospice movement grew very slowly in its early decades, whereas during the last 20 years it has gained acceptance and is now viewed as an essential part of any complete health care system. The most common need for palliative care is cardiovascular diseases followed by cancer, respiratory disease, and a long list of other noncommunicable diseases. This chapter focuses on the global need for hospice and palliative care and the growing efforts to address the economic, political, and cultural challenges of bringing effective end-of-life care to the millions in need around the world. The National Hospice and Palliative Care Organization (NHPCO) is the largest membership organization for hospice and palliative care providers in the United States.
- Go to chapter: When Trauma and Loss Collide: The Evolution of Intervention for Traumatic Bereavement
This chapter explores the evolution of intervention for traumatic bereavement. Following some definitions and conceptual clarifications, it briefly sketches a noncomprehensive timeline of that evolutionary process. Traumatic stress refers to distress that is caused by a person’s experience of psychological trauma, in particular dying and death of the loved one. Traumatic stress can occur during and/or after the dying and death. The traumatic deaths as giving rise to traumatic bereavement go beyond the traditional ones from accident and disaster, suicide, and homicide. A relation between traumatology and thanatology may seem so obvious as to be a tautology, for almost all traumatic stressors encompass death or the threat of death. Up until 2000, there are six major concepts that seem especially noteworthy, foundational, and never to be forgotten by anyone practicing with traumatized. The chapter discusses these concepts briefly.