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.
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- Go to chapter: Trauma-Informed Approaches to Body Image Disturbance: A Historical Review for a Holistic Future
The chapter analyzes the gestaltists view, psychoanalytic view, feminist and sociocultural views, and tries to come to some understanding of where one might be going in promoting change from body image disturbance (BID) to positive experience. The gestaltists sought to recognize the incredible power of the mind to organize information, so that one can effortlessly make sense of all we take in via one’s senses. The psychoanalytic view greatly helped our understanding of BID in various forms of psychopathology. However, the denial of the traumatizing effect of sexual abuse, it also greatly limited the potential for care. For many disorders, treatment models followed the historical sequence from psychoanalysis to behavioral to cognitive behavioral. The treatment of BID in eating disorder drew in one more viewpoint in1970s, that of the feminist view. Finally, the cognitivists sought to explore the internal processing that links cultural influence and learning history to psychopathology.
This chapter provides an overview of recovery and beyond: dealing with triggers and setbacks. Recovery means holding tight to foundational ways of living that were learned in treatment and generalized into daily life during the healing process. Recovery can be inconsistent and unpredictable at times, demanding strength and courage to continuously redefine ne one’s self-story and live from one’s authentic self. Negative life events, whether they are large or small traumas, can act as powerful triggers, leading to the return of the eating disorders (ED). Stressful life events and daily life stressors can easily disturb unprocessed traumatic material, activating memory networks and causing pain and suffering, along with adding new traumatic material to the brain and body system. In the end, the therapist supports and celebrates the unique image of recovery that is self-defied, value-based, inclusive of fractures and imperfections, and created by the client.
This chapter explores parts or ego states somewhere in the middle of the two that are invested in one or the other form of eating disorder (ED). “Ego state” and “part” are used interchangeably in this chapter. The chapter provides a short neurological explanation of ego states, their purpose, and the difference between dysfunctional and dissociated ego states. It provides an overview of various traditions of parts, which, although not exhaustive, can uncover the common and universal characteristics of ego state work. EDs are very difficult to treat in that they demand attention on so many levels: psychological, emotional, physical, behavioral. The authors believe that it is the reality of dissociation that makes this work all the more difficult, a reality that demands an invitation to all parts of our client to come together and collaborate in the service of healing.
This chapter provides a brief description on trauma-focused cognitive behavior therapy (CBT) and eating disorders (EDs). CBT has proven to be the most well-supported approach for EDs in the empirical research. It is considered the first-line “treatment of choice” for individuals diagnosed with bulimia nervosa and recommended for the treatment of anorexia nervosa (AN), atypical EDs, and binge eating disorders (BED). Furthermore, multiple studies have demonstrated the efficacy of using CBT for post-traumatic stress disorder and trauma symptoms. CBT for EDs is approximately 20 sessions for treating bulimia nervosa or BED, whereas treatment for anorexia nervosa can require a much longer treatment, typically lasting 1 to 2 years. Addressing trauma work will add to the number of sessions. CBT for EDs and for trauma can be done concurrently or sequenially. Deciding on the format can be done on the basis of clinical presentation and in collaboration with the client.
Hypnosis relates to when a person’s behavior shows he or she is in a trance like frame of mind, dissociated from his or her usual conscious awareness. Hypnosis challenges the polarization between the different aims of behavioral and analytical therapy. The reports of many of the patient shows the real source of their distress, and sometimes seem to make the problem worse. This has been eloquently expressed by a young doctor, a survivor of childhood anorexia. “When you live with anorexia, you fight your own thoughts and fears, your own self, every second of every minute of the day. Recognizing this spontaneous hypnosis or trance state as a clinical sign involves a different level of listening skills, a modified approach to history taking and to all the advice given. The focus of therapy is turned from the past to the future from regression to progression.
This chapter provides a brief description on eating disorders and the case for emotions. Throughout this chapter, the author have used the terms “emotion” and “feeling” interchangeably, although neurologically they can be understood as different stages of the emotional experience. Much of this chapter is how the author teach clients emotional courage and competence, but it has also helped many clinicians in their own journeys. Change is what we most often fear, even if it means shaking off toxic residue and stepping into the unknown of a different and healthier identity. So-called “good” feelings often end up scaring us as much as the “bad” ones, because they, too, invite change. Feeling requires courage. The emotion knocking on your door is letting you know that you have reason to be excited or fearful and that your aliveness is calling you to a larger version of yourself.
This chapter discusses art therapy: images of recovery. Art therapy is a mental health profession that provides an alternative means of communication and often can be the treatment of choice for clients processing recovery from traumatic events, as well as eating disorders (EDs). Through the art making process, a visual dialogue between the client and the art images is created. The client’s self-talk and internal messages can be documented in an imagistic form. Art therapists are extensively trained to assist the client in creative expression and in facilitation of the client’s self-exploration. Using art therapy with EDs is a unique therapeutic approach that exposes conflicts, problems, thoughts, and behaviors that are not simply about food or a number on the scale. ED patients have extreme fear of being negatively evaluated. The art therapist works toward eliminating those fears by giving the clients creative control over their selfexpression.
Trauma is unrelenting and pervasive; it bleeds into the present moments of daily life, often stealing joy, muting a person’s ability to fully connect and accomplish tasks of daily living. Starting with an overview of the internal family systems (IFS) model, this chapter discusses how IFS conceptualizes eating disorders (EDs) and approaches trauma treatment. IFS differs from other approaches to trauma treatment in several ways that we elaborate, especially eschewing the idea that stabilization and explicit skills training are necessary prerequisites for processing traumatic memories. Instead, IFS asserts that clients can learn to interact with the different parts of themselves without getting overwhelmed or needing the therapist to actively manage the process. The chapter uses case vignettes to illustrate how IFS achieves the goals of phase-oriented trauma treatment to heal EDs in a nonlinear, relational way.