By James Thomas
The EMDR Association’s East Anglia Regional Group was delighted on Saturday 27th April 2019 to host Pam Virdi at Norwich Cathedral’s Hostry for an expansive one-day training session on using EMDR with eating disorders.
The presentation was an ideal introduction for EMDR therapists new to working with this often-misunderstood client population, and a powerful refresher for a good number of very experienced professionals in the room – their presence a tribute to Pam’s reputation as a first-rate trainer in this field.
Pam began by highlighting the need for clients with eating disorders, especially anorexia and bulimia, to commit to restoring sensible weight and eating patterns as essential to recovery, given how many come to therapy wanting change without letting go of their patterns.
Therapy for eating disorders, Pam made clear, isn’t just about psychological wellbeing, but very much also about physical health.
Pam summarised the overarching aim of therapy with this population as disconnecting weight and eating from wider psychological issues, as the more tangled these are, the more intense obsessions can get, with all the attendant impact on quality of life and personal relationships.
Pam took us through connections between eating disorders and trauma, with issues around food often starting out as a form of affect management from subtle and less obvious events in early childhood.
Her therapy philosophy is that no-one develops anorexia and eating disorders without good reason, reminding us of the importance of a thorough EMDR-focused history taking, particularly of the person’s relationships.
Pam went on to outline how eating disorders are defined, in the DSM diagnostic criteria and with their comorbid symptoms, suggesting a useful exercise to help clients engage with how therapy might help them.
Clients can be encouraged, she said, to write two letters addressed to the Eating Disorder, one as ‘Friend’ and the other as ‘Foe’.
This honest and open communication allows for acknowledgment of the problem’s origins, role and functions in the person’s life, in addition to an appraisal of the difficulties, barriers and life restrictions that it can also bring.
This process seems to offer multiple benefits, helping both client and therapist to a deeper understanding of the value of the disorder to the person, and towards compassion for its origins and purpose. The letters exercise also helps gauge the person’s current willingness to make changes in therapy, serving as a point of discussion for areas of life they may wish to reclaim.
Pam then introduced therapeutic approaches that can be used to promote engagement in change, including motivational interviewing and of course EMDR, with for example the two-handed interweave.
There was an enthusiastic audience response to Pam’s focus on the importance of psychoeducation on the theme of eating disorders, challenging common myths, making a case against dieting, and gradually creating a cognitive dissonance, as she put it, facilitating acceptance of new information that might challenge previously-held values and beliefs.
Psychoeducation is of course critical to all EMDR, not just with eating disorders, and bringing her comprehensive specialist knowledge to bear, Pam gave us useful context to understand 21st-century media (both social and broader) attitudes which inform both client and therapist experience of food and body image.
Pam’s aim was to promote health and acceptance for both parties in a world of often contradictory messages.
In Norwich our own psychoeducation as attendees started with an eating disorders awareness test, highlighting several areas where many of us found our knowledge lacking. We were not unusual, as Pam cited research confirming how many health professionals, including those working with eating disorders, struggle to provide accurate information.
The day moved on to the challenge of formulating with clients the origin of the problem, before fully discussing the use of EMDR in treatment.
Pam again stressed the importance of comprehensive history-taking, of timelines and careful treatment planning, always listening carefully for attachment history, for shaming early events, potential blocking beliefs and secondary trauma emerging from the eating disorder.
Throughout the day Pam emphasised the importance of safety and stabilisation for this client group, with medical safety prioritised. Medical monitoring was, said, Pam, a non-negotiable aspect of psychological therapy with these clients.
In addition, she stressed the importance of helping people to strengthen external resources with mindfulness skills or, for example, developing body awareness through massage, yoga or tai chi, the overarching aim being to help develop a compassionate and functional acceptance of the body.
Pam explored how therapists need to work with attachment repair, providing case examples and sharing helpful approaches for use in practice. This was supported by references from leading authors in the relevant areas whose practice and literature informs Pam’s approach.
The workshop focused special attention on the desensitisation phase and clinical considerations specific to EMDR for eating disorders, including how to sequence targets, when to use urge reduction (similar to addiction protocol), how to safely manage interruptions to processing , and the use of creative and education-based interweaves to help keep EMDR on track.
The workshop also discussed how best to close sessions, preventing relapse and strengthening integration, and not forgetting to include work with a future template before sessions were concluded.
Pam shared many anonymised examples from her practice, and the group expressed appreciation for her friendly approach and openness to questions and discussion.
Pam’s book on EMDR with eating disorders, co-written with Andrew Seubert (Trauma-Informed Approaches to Eating Disorders), comes highly recommended to any EMDR therapist keen to get to grips with this often-difficult presentation.
The EMDR Association UK’s East Anglia regional group is very grateful and privileged to have shared the day with Pam.