Family Trauma and Eating Disorders

Written by Tammy Holcomb, LPC, CEDS, Executive Director at Carolina House, NC

I’m writing this article in honor of all of those who have struggled with working on both eating disorder and family trauma issues at the same time. This is such a difficult task due to the challenge of sitting with powerful emotions without turning to the eating disorder for relief.

This challenge is hard both for the client going through the emotions as well as for the therapist who is trying to decide when to push further and when to pull back. This battle is not for the faint of heart. It requires courage and trust for both the client and the therapist.

I’ve seen this battle successfully fought and won many times. So, I know it is worth the time. Yet, that is one of the key elements needed. It takes time. It takes time for client and therapist to build a relationship. It takes time to learn self-care practices, support systems and emotion regulation skills and to develop reliable crisis plans.

Finding the Time to Heal

Often, both client and therapist feel the pressures of time for different reasons. People want to find the perfect time to do this work. So, they wait until they have a school break or until works slows down enough so that they can breathe.

Then, they come into a therapy appointment, roll up their sleeves and say, “I am ready. Let’s do this.” Often, the thinking is that what they must do is to tell the story of what happened and that will pave the way to recovery.

Yet, most people don’t have just one story when there is family trauma involved, and as these stories unfold, they are often painful enough to make the client want to run immediately back to Eating Disorder behaviors. These behaviors may be dangerous, but they feel more familiar and safer than traveling back to a painful past.

Making the Journey to Recovery Easier

So, there are things that clients and therapists can do to make this battle easier on them both. First, the client-therapist relationship needs to be the right match. Is the therapist qualified to work with both Eating Disorder behaviors as well as trauma?

I’ve seen people do this work with two therapists working as a team, but that is not always ideal and can open the door to complications.

• Is the therapist available at times that will work with your schedule?
• Is the therapist affordable to see on a regular basis?
• If needed, could you afford to see your therapist a couple of times a week during a hard spell?
• What rules does the therapist have about contact outside of therapy?

These are all important questions and things to think about up front. In addition, it is important to realize that while there can be pieces of work done over years with different therapists, it is very comforting and nice in the early stages to have someone that can commit to a period of time of working with you.

Knowing Your Boundaries

The rule here for therapists is to know your boundaries and not take on a client if you feel that you will not be able to meet their needs in regards to time, availability and commitment. Naturally, we cannot always know these things in advance, but it is something to consider before beginning the relationship.

I know one of the hardest things I ever have had to do was say goodbye to clients when I chose to close my private practice.

Utilizing Support Groups & Other Professionals

Once you have found the right therapist, there are other things that you can do that can also be helpful. For many, utilizing a Dialectical Behavior Therapy Group can be an excellent way to build safety and skills into you’re backback. Even if your primary therapist is not a DBT therapist, these groups can be very helpful for a variety of reasons.

Another suggestion is to have a team in place to help support the work you are doing with your therapist. Good team members might include:

• A registered dietician
• A physician who is aware of the work you are doing
• A psychiatrist if you are taking or considering psychiatric medication for support

My experience is that the work can be done more quickly and safely with a strong team in place.

Emergency Contacts & Staying Healthy

One of the very first things your therapist is going to ask you for is an emergency contact. I’d recommend providing more than one. Think of people that you would be comfortable with your therapist calling to have someone give you a ride home or to come spend the night with you.

If you have ever walked out of a hard session and gotten behind the wheel of a car, you can understand why this could be helpful. Add to that the possibility that you didn’t eat anything before the therapy session.

This leads to another important piece. If you are not getting the nourishment that your body needs, this work will be much more painful. This is why many therapists will not even begin to address Family Trauma until a client is medically stable.

Preparing You for a Worthwhile Battle

As I write this, I am thinking that it may seem as if I am preparing you for battle, and I actually am. I love to hike, and I’ve learned over the years that there are some essential items that will make my hike much more productive and satisfying if I just take the time to pack them in my backpack before leaving.

I rarely regret carrying the extra items, and I almost always use at least one of the items I pack. I’m always grateful to have them. So, think about what you need to pack in your therapeutic backpack before starting this work.

It will make it much easier to meet your goals and get to the top of your mountain to see the fabulous views ahead. This is true no matter what your “mountain” is made of.

Community Discussion – Share your thoughts here!

What has been your experience with addressing an eating disorder with family trauma?