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.

This chapter presents a guide for assessing comorbid eating disorders (EDs) and trauma in a way that shapes and directs treatment. It draws together a combination of assessment tools and principles from the fields of EDs, trauma, and generic mental health, as there is limited literature available on this specific area of assessment. The chapter summarizes various aspects of assessment into distinct sets of guidelines, to help steer the clinician and client through a vast maze of information toward a meaningful formulation and treatment plan. It provides a road map to facilitate comprehensive assessments that lead to the construction of insightful formulations and the delivery of engaging treatment plans. The authors believe that trauma-informed ED assessment guides safe and effective treatment, shining a beacon of light on the road toward transformation and healing.

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 offers ways to be an effective therapist for clients who suffer from both an eating disorder and trauma (ED&T). It describes the importance of therapeutic presence and how to facilitate safety and healing through the therapeutic relationship. The information provided is equally applicable to all phases of treatment. Therapy for ED&T clients involves providing safety, education, insight, and a corrective emotional experience, thereby allowing the client to rectify faulty thought, emotional, and behavioral patterns. Therapists need to use their training and the therapeutic relationship for this to happen. The author’s experience treating ED&T clients corroborates the need for therapy training programs to increase their focus on training therapists how to achieve therapeutic presence, establish a positive alliance, and use the relationship to put the client’s symptoms out of a job.

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.

Dance and movement therapist and psychologist Ann Krantz believes that “the symptoms of eating disorders (EDs) serve to disconnect affect from the body, particularly as sexuality, trauma, and cultural influences contribute to conflicts in the woman’s [individual’s] developmental struggle toward self-identity”. Individuals suffering from both trauma and EDs have difficulty making their “house” a “home”. They often run away from “home” in an attempt to feel safer, centering their lives on using emotionally driven behaviors as a way of attempting to alleviate the often horrific anxiety they might otherwise experience. Dance and movement therapists weave together nonverbal dialogues that transform everyday movements into expressive communication. The cognitive markers can be used by therapists and patients alike to decode, track, and understand the experiences that fit into the bigger picture of their lives.

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 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.