If you are a health care professional working with eating disorders, it’s crucial to ensure that you are trauma-informed. That’s a clinical way of saying that you’re aware of trauma, how it can impact individuals, and how to manage it appropriately within the scope of your practice without inducing undue stress.
A significant body of research has linked trauma histories to the development of eating disorders, and even if you’re not working as a therapist with this client group you will likely have experience of clients disclosing trauma with you at some point in your career. As such, it’s important to reflect on how to respond to this in a compassionate way, and redirect to a therapist or appropriate mental health professional, without evoking shame. It’s a delicate balance that can feel scary without therapeutic training under your belt. I recently attended a seminar with Robert T Muller (a Toronto based trauma therapist) that outlined a way of doing just this in therapy. I found it incredibly useful, so I figured I would offer you an abridged and layman version of what I learned the hopes that it gives you a bit of insight. I’ll also add some additional references at the end — but you’ll have to forgive me as they are mostly all therapeutically informed.
Imagine this: You're a healthcare professional with no therapeutic training. You are in the midst of an initial consultation with a client when they suddenly decide to give you detailed account of a traumatic or abusive experience they've had in the past. How do you respond?
Muller emphasises the importance of empathy, compassion, and containment when we are trying to hold and pace a client’s trauma narrative.
Hold up...what does that all mean? Empathy: is the capacity to understand and vicariously experience someone else's experience and emotions. The phrase "put yourself in someone else's shoes" is often used to describe empathy. Compassion: to acknowledge and attend to another person's emotions in a kind and non-judgemental way. To Contain / Containment: the process of hearing, witnessing, and responding to someone’s painful emotions or experiences without being consumed or overwhelmed by the emotion or experience. To Hold/ Holding: the capacity to hear and witness someone else’s emotions with care, compassion, and a lack of judgement so that the individual can feel safe and protected. So basically when we unpick all of this, we can tease out the importance of creating a safe environment for our clients - regardless of whether you’re a therapist. This is critical for trauma survivors, who have experienced something (or many things) that have left them feeling unsafe within themselves, their bodies, and even the world. So how can you create a safe enough space for them whilst remaining within the scope of your professional training? Don’t: React in an overly zealous or very emotional way - as this can be interpreted as you being unable to handle (or contain) what they’ve said to you, and it can evoke shame. You don’t need to be a brick wall, but definitely try not to stand up and shout “oh my god!” when someone shares their trauma with you.
Do: Honour the sharing of their story. Acknowledge that they have shared something deeply painful and meaningful for them, and empathise with how difficult that must be to do. You can say something like: “I’m honoured that you chose to share such a painful and personal experience with me” or “Thank you for trusting me with your memory" or "Thank you for sharing such a meaningful part of your life with me”.
Don’t: Engage with the minute intricacies or details of the story. Muller explains that traumatised individuals can sometimes jump in to sharing all of the details of their story without first ensuring that they feel safe and contained because they no longer want to hold their experience alone (totally understandable!). However, this can be something that evokes shame or leaves them feeling overwhelmed and exposed. It’s important to note here that this can happen even if someone isn’t presenting as emotionally distressed - the traumatised mind knows how to keep itself safe and sometimes "turns off" the emotions or physical reactions when it comes to reflecting on something deeply traumatic. As an aside, this is what's known as dissociation. So rather than asking the client to elaborate on their story, you can gently engage with the client’s process of storytelling to validate their experience in the room with you (see above).
Do: Practice empathy. If you shared something deeply personal, scary, and emotional with a healthcare professional, how would you want them to respond? Would you be feeling vulnerable and a bit exposed? How would you want that to be acknowledged? If you are a bit unsure, you can start by acknowledging the courage and bravery it takes to share such a painful experience. “I’m honoured that you chose to share such a difficult experience with me today”.
Don’t: Shut them down by saying something like “You shouldn’t have told me that, I’m not qualified to deal with this”. This would evoke shame in the client, and it might even be re-traumatising for them. You may not be qualified to explore and support them to heal from their trauma, but as a human being in a helping profession you are definitely equipped to offer them the human experience of compassion, empathy, and kindness. Do: Enquire about how it feels to share their story with you. “That sounds like a really painful experience, I wonder what it was like to share it with me just now?” or "I wonder how you feeling now that you've shared that with me?".
Don’t: Use cliché cultural narratives. This involves things like, “Whatever doesn’t kill you makes you stronger”, or “Look at you now, you’ve come so far!” or "You're so strong for getting through something like that". Not only can these phrases be insensitive and shut someone down from connecting, but they can evoke a deep sense shame.
Do: Hold in mind the scope of your practice. If you aren’t trained as a therapist or mental health professional, it’s not ethical to dive in to trauma. This is why containment is so important, and you can do that by sticking with what’s happening in the room with the client instead of the details of the story. The above points support that process.
It’s ALWAYS advisable to refer to a therapist or appropriate M.H. professional when a client discloses trauma. You can do so in gentle ways. “That’s a lot for a person to go through and you deserve support for this. I wonder if you’re seeing a therapist?”. If they are, then you can gently reiterate that they deserve the support to explore this deeper and perhaps they can bring this to their therapist. If they aren’t seeing a therapist, you can reiterate that they deserve support and that you are committed to ensuring they find someone. You can refer them to the Counselling Directory (if you're in the U.K.) and suggest they look for someone in their area.
** You will have noticed that I have stressed the importance of naming that they 'deserve support'. This is important because some people tend to minimise their trauma or they dissociate from their experiences or their bodies as a way of trying to cope with the distress they've experienced. Basically, the heart of a trauma-informed practice is to be open to learning about trauma, how it might impact (or be impacting) your clients and your work, to be compassionate in your responses to clients, and to do your very best to minimise their stress.
Here are some resources that you might find useful to expand your understanding of trauma:
https://www.blueknot.org.au/Workers-Practitioners/For-Health-Professionals/Resources-for-Health-Professionals/Trauma-Informed-Care-and-practice Bessel Van Der Kolk's book "The Body Keeps the Score", which you can find here.
Robert Muller has written several books, including his most recent which you can find here. He also has also been on the Trauma Therapist podcast.
If you're interested in listening to the intersection of trauma with dieting, disordered eating, and the Health at Every Size paradigm, this episode of Food Psych is awesome.