Trauma-informed therapy for eating disorders (with Sherry-Lee Smith)

[00:00:00] Bronwyn: Hey, mental workers, you're listening to the Mental Work Podcast, your companion to early career psychology, and I'm your host, Dr. Bronwyn Milkins.

Today we've got a little bit of a different episode. We're talking about eating disorders, trauma, and a trauma approach which can be used for eating disorders, which is called EMDR therapy. I think it's a really interesting topic because we've been hearing this word trauma informed, but what is it? What does it actually look like in practice? And how can we apply that to the clients who walk through our door and really help them?

And here to help us go through it and unpack it is Sherry Lee Smith. Hi Sherry.

[00:00:42] Sherry-Lee: Hi Bronwyn.

[00:00:44] Bronwyn: It's lovely to have you on. Thank you so much for joining us. And Sherry Lee, could you just tell us a bit about yourself?

[00:00:51] Sherry-Lee: So I'm the director of the Phoenix Holistic Health Centre, a psychologist , an EMDR consultant and credentialed eating disorder clinician.

[00:00:59] Bronwyn: Fantastic. And what is your non psychology passion?

[00:01:03] Sherry-Lee: It's not much outside of psychology, but I'm a parent so that takes up a big chunk of my time as well.

[00:01:08] Bronwyn: I bet. Yeah. So, listeners and Sherry Lee, I think we're going to start today by talking about what is a trauma informed approach? Because like I said, I think there's been a massive increase in this word and this approach. It's like we want everything to be trauma informed, but what does it actually look like in psychology?

So Sherry Lee, what is trauma informed? What do we actually mean when we say that?

[00:01:35] Sherry-Lee: So, I think for me, in my therapy room, it's about taking a very, uh, collaborative approach with the client as far as giving them choice and power over what we're doing in therapy. But it also comes down to, I guess, looking at the background of what it is that they're presenting with and how trauma plays into that.

[00:01:53] Bronwyn: So it's like, let's say somebody comes to us with depression or they say that they're feeling down and they're just not really enjoying the things that they used to. They've had a bit of stress in their life. So would a trauma informed approach look beyond what they're coming to see us with and be like, "Oh, I wonder what's happening in this person's history".

[00:02:15] Sherry-Lee: Yeah, so be looking at the roots of what it is that's generating those symptoms.

[00:02:20] Bronwyn: Yeah. And why is it important to do that? Why not just be like, okay, here's your behavioral activation worksheet... on your way.

[00:02:28] Sherry-Lee: So I think a lot of the time some of the approaches can be a bit of a band aid approach. So what we're trying to do with trauma informed approaches is get to the root of it and create longer, lasting, deeper healing for people rather than just trying to reduce symptoms that often just leads to relapse.

[00:02:46] Bronwyn: Yeah. Okay. So it's like taking a person with depression. If we're like, okay, great. You've done some activities that are in line with your values and you started to feel a bit more pleasure and enjoyment out of them. Okay. Bye. They might come back to us in 12 months time and that might be because we haven't addressed the root cause of it.

 What brought you to really wanting to focus on trauma informed approaches? Like, had you always practiced in this way or was there a light bulb moment where you were like, this isn't working if I'm focusing on Band Aid approaches?

[00:03:21] Sherry-Lee: I think it's probably two things. One that I think has sort of got to the point in my career where in private practice, the presentations you're seeing are people with lots of different comorbidities, and they often, once they've built that relationship with you, they don't want to move on to someone else to then address their trauma.

So I was getting a bit of pushback from clients not wanting to be referred on, and I thought it was probably about time that I start learning a bit more about how to approach this in different ways.

[00:03:50] Bronwyn: Yeah. And has that been beneficial?

[00:03:53] Sherry-Lee: Absolutely.

[00:03:55] Bronwyn: Yeah.

[00:03:55] Sherry-Lee: Probably the best move I've made in my career, I would say.

[00:03:59] Bronwyn: I wonder, like, was there anything that surprised you in that, now that you apply a trauma informed lens do you find that you pick up on stuff that maybe in the past you wouldn't have?

[00:04:10] Sherry-Lee: Absolutely, and I think I just couldn't work any other way now.

[00:04:13] Bronwyn: To you, it's just the most obvious way to work.

[00:04:16] Sherry-Lee: yeah.

[00:04:17] Bronwyn: And just so listeners know as well, how long have you been practicing for?

[00:04:21] Sherry-Lee: So I've been a psychologist for probably about 15 years, but I was doing therapy and counselling before that.

[00:04:27] Bronwyn: Oh, wow.

[00:04:28] Sherry-Lee: So it's been a while.

[00:04:30] Bronwyn: Yeah and I think that's really important for listeners as well, because one, because it shows that like with all our training, we can learn new approaches and integrate them into our practice. Um, and I think secondly, it shows that you can really change a lot the way that you practice. Like you don't have to have it figured out from the start pretty much.

[00:04:51] Sherry-Lee: Absolutely, I think it's a continual process of growth. I don't ever want to stop learning.

[00:04:57] Bronwyn: No, I think, um, I think that would be really boring to me I mean, the great thing about psychology is that there's so much to learn. So thankfully I feel like I've barely scratched the surface. Do you still feel the same way after 15 years?

[00:05:07] Sherry-Lee: I still, still feel the same way. There's just, so much.

[00:05:11] Bronwyn: That's so cool. It's really, it's really good to know. Cause it'd be so bad if you were like, Oh no, I'm very jaded. I don't actually have anything else to learn.

[00:05:21] Sherry-Lee: There's always more passion there, I think.

[00:05:23] Bronwyn: Yeah, I think so, which is great. So, Sherry Lee, I guess is there anything else to a trauma informed approach? I guess we've got the making sure that we're considering the person's history, giving them choice and control about how they proceed with treatment. Are there any other aspects that make it trauma informed?

[00:05:42] Sherry-Lee: I mean, there is lots, but I think things like just really explaining to them how the process is going, so they kind of know up front, well, what is it that's happening next and what's going to happen after that. I think that can be really important to people that, you know, if they've experienced trauma, then they're often really anxious, so they want to know what's coming next.

[00:06:02] Bronwyn: Totally, and I guess like as clinicians, not, not fobbing off those questions and being like, Oh, this is so annoying. Why are they asking me so much?

So we've worked out that trauma informed is a good approach to have. Let's apply it to a kind of case study then. And I do that in air quotes because one of your passion areas, well, actually two of them... you're passionate about eating disorders and you're passionate about EMDR, right? And you've kind of found a combination with them by applying EMDR to eating disorders.

[00:06:33] Sherry-Lee: Yep. Integrating the EMDR into the , the general eating disorder approaches.

[00:06:39] Bronwyn: A thing about eating disorders is that there's such a spectrum of eating disorders, right? So we've got anorexia, bulimia, um, ARFID, binge eating disorder, uh, PICA, and then a few other, I guess. Um, in between eating disorders or atypical presentations, and they're all quite serious. Like they do have debilitating impacts on people and the people around them.

[00:07:04] Sherry-Lee: I think because it's such a disorder that engages the body, so it can be quite detrimental to people's health if it's not something that they get on top of.

[00:07:15] Bronwyn: Yeah, absolutely. I did the eating disorder credential this year as well, and I just learned so much about how serious eating disorders are. And so one of the things that I learned was that one, anorexia nervosa has the highest mortality rate of any psychiatric illness, but then secondly, that early intervention, so in the first one to two years of experiencing an eating disorder, can result in a way better outcomes compared to if you let that slide.

So it's like people don't often spontaneously recover. It's that the eating disorder might get worse. So I guess, like I say, psychologists is having a really important role in assisting people with eating disorders. Is, is that similar to how you feel?

[00:08:00] Sherry-Lee: Absolutely and I think a lot of the time people either don't mention it to their psychologist, um, so it doesn't get treated when they're getting treated for the depression or the anxiety, or they just don't get treatment for years.

[00:08:14] Bronwyn: Uh, that's so true. That just like triggered a memory in me that like, yes, that has happened multiple times in therapy and it's like, well, I didn't know that this was happening. And so now through the eating disorder credential, they really emphasize the importance of screening almost everybody for eating disorders or just asking them about their eating schedules and what they are eating to see whether it's adequate or whether they have any other potential disordered eating behavior. So it's been, yeah, quite an eye opener.

[00:08:42] Sherry-Lee: There tends to be a lot of shame around it, so sometimes people won't even, they'll come in with a referral for anxiety and they'll be like, oh, do you have to tell the GP about the eating disorder? I'm like, yeah. Um, they've, you know, they've been seeing their GP for years and they've never mentioned it to them.

[00:08:56] Bronwyn: Wow. like, yeah, that person might be feeling quite isolated and like you said, ashamed of what, what's happening for them when we've got treatments for eating disorders and that person could be assisted.

So I'm curious to know, like you mentioned that some of the main approaches like CBT-E, so that's CBT and a protocol for eating disorders and a few other therapies but is the main one that you use, is that EMDR?

[00:09:23] Sherry-Lee: So I'm very integrative in my practice, so I'll tend to use a combination, it really depends on what the client is presenting with, what their biggest concerns are, what's creating the biggest impairment in their functioning at this particular time.

[00:09:40] Bronwyn: That makes a lot of sense. So let's say that we've got hypothetical case of a person who's presenting with some restrictive eating, uh, some binge eating episodes and maybe some episodes of purging. And then through your trauma informed assessment, you work out that they've got an extensive trauma history. What would you be thinking in your head?

[00:10:03] Sherry-Lee: So it really depends on how malnourished they are as to whether we're going to need to focus on that sort of area first or whether there is capacity to start moving into trauma processing. But with EMDR there's a lot of prep work that sometimes needs to be done with eating disorders, so that, you know, depends on how well they regulate emotions, depends on what sort of support they've got, what other risk factors are involved.

[00:10:28] Bronwyn: Yeah. And I think that's really important to highlight for listeners because it's like, if you don't have training in eating disorders, somebody may come to you and be like, They may present and they may be quite malnourished, but saying to you, I want to treat the trauma, but they might be medically at risk and in that case, then if the psychologist proceeded with the trauma therapy, then that might not be appropriate for the client. So if that's the case and the person is more malnourished, then they should go seek medical attention. Is that right?

[00:11:03] Sherry-Lee: So generally at that point it would be, they'd be seeing their GP quite frequently. Ideally one of the non negotiables of eating disorder treatment when there's restriction is engagement with a dietician. Sometimes we need a psychiatrist on board as well. So it really depends on what they're presenting with. But generally, ideally, we would have the GP involved from the get go.

[00:11:25] Bronwyn: Yeah, so it's really a multidisciplinary approach when it comes to eating disorders.

[00:11:30] Sherry-Lee: A hundred percent.

[00:11:31] Bronwyn: Yeah. Well, let's say that we've got a client who would be like a suitable candidate to do trauma processing with. Can you tell us a bit about EMDR therapy? So firstly, what does EMDR stand for? Secondly, what is it?

[00:11:48] Sherry-Lee: So EMDR stands for Eye Movement Desensitization and Reprocessing, which is a bit of a mouthful. Um, so it started off as a treatment for trauma but has since, um, become quite a transdiagnostic approach to many different things. Anxiety disorders, depression, eating disorders.

[00:12:07] Bronwyn: And what led you to becoming interested in EMDR?

[00:12:11] Sherry-Lee: So, it started when I had a client that just did not want to be referred on, um, and so at that point I was like, well, you know, a lot of my clients are presenting with trauma, maybe it's about time that I get trained in this.

[00:12:24] Bronwyn: And had you been trained in other trauma approaches? Like, was there a reason why you selected EMDR over, say, the prolonged exposure or another trauma approach?

[00:12:35] Sherry-Lee: So I had trained in schema therapy at that point, but I felt like I needed something just a little bit more and when I approached colleagues to give me recommendations about what they thought was the best approach for trauma, it was EMDR. Every, every single one of them said EMDR. So I was a bit sceptical at first, because it seems like it's quite a strange type of therapy, but, um, the people that I'd asked, I highly respected them, and so I just trusted that they knew what they were talking about because they had all, had a lot of experience with trauma, so that was the one I chose.

[00:13:07] Bronwyn: So knowing that EMDR originally started as a treatment, say for like PTSD and traumatic experiences, I'm curious to know how you progressed to then applying it for folks with eating disorders. Like, did you gain a lot of experience in training and you were like, I feel more confident to do this, or was there another path?

[00:13:28] Sherry-Lee: So the vast majority of my eating disorder patients had trauma in their background. Um, so we'd already sort of done a lot of the stabilization work. We got, you know, a fair chunk of the eating disorder symptoms under control and so the trauma processing was basically the next step in their treatment process.

[00:13:48] Bronwyn: So this is part of, I guess, the trauma informed approach. It's like, we want to get to the core of why people are experiencing their symptoms and really help them in the long term rather than putting them at risk of relapse.

[00:14:02] Sherry-Lee: Absolutely.

[00:14:03] Bronwyn: Yeah. And can you walk us through what EMDR looks like? Because I think for people who haven't done the training, and before I did the training, so I'm EMDR trained as well, but not a consultant. Sherry Lee's a consultant, which means that she's just like, I don't, I just see you as like a lord, a lord of EMDR. Ha ha ha ha. But like before I did EMDR, I, I had no idea what it was. It did sound kind of like mystical and magical, and so maybe just for listeners who don't have a clue, what, what does it look like?

[00:14:35] Sherry-Lee: So to be honest, it looks a little bit like witchcraft. So it involves rapid eye movements with the clinician moving their arm, waving their arms back and forward and the client's eyes following their fingers. It looks very strange, but it's very effective.

[00:14:55] Bronwyn: Yeah, that's sometimes how I explain it to clients. And one of the reasons I actually decided to get trained in EMDR was because I really, the only thing I'd heard about it was that it was very structured and like, as a clinician starting out in trauma, I, I really wanted a structured approach. Like, I wanted to be told exactly what I need to do and how to do it and that there's a right way and a wrong way to do it.

So there's eight phases, I can't remember them all off the top of my head... that might feel like an exam to you if I ask you that, but there's eight, there's eight stages that you need to progress to. So you're not starting out the first session, like doing the rapid eye movements, right?

[00:15:32] Sherry-Lee: No.

[00:15:33] Bronwyn: And I think that can be a misconception that you just get in and do it, but there is a lot of preparation required.

[00:15:38] Sherry-Lee: Yeah, so we look at history taking first and then we move into the preparation and it's not until after that, um which we move into the trauma processing. But sometimes that can take a significant amount of time to get the client ready to do that.

[00:15:52] Bronwyn: I'm just curious... from your perspective, did you find it quite an easy approach to learn or, you know, compared to the other approaches that you know, how did it fit in terms of difficulty?

[00:16:01] Sherry-Lee: I think the comprehensiveness of the training. Really, um, I guess padded that out for me. So I don't know who you did your training with, but I did mine with Graeme. And we were sent tons and tons and tons of articles and things to read, which took an enormous amount of time. But I felt like when I stepped into that training that I already had a really good understanding of the theory behind it, the background of things. And then it was really just learning I guess the practical aspects of how do I then apply all of that.

[00:16:37] Bronwyn: Yeah, I did the same instructor so Graham Taylor, he was fantastic and what I really liked about his training was like a lot of practice. Um, so we literally said the words that we are saying in session. He also gave us a huge yet comprehensive manual, which has things to say, what to do, which was really fantastic.

So it was a matter of practicing for me. So I think the hardest thing for me was that EMDR has its own kind of glossary and vocabulary. So when it was like memory networks and I'm like, what the hell is that? It's, there's a few words which are just like, you need to learn the EMDR lingo.

[00:17:16] Sherry-Lee: Yeah but I think like if anyone's going to do training in it, do all the reading beforehand and then it'll definitely make sense once you get there. And I think with the EMDR training there's so much, there's so, it's so practical that once you've done it, you can literally just walk out back into your therapy room and you can start with clients that you've already been working with.

[00:17:40] Bronwyn: Yeah, no, I agree. And one of the things that Graham really emphasised to my group at least was like, you don't have to have it perfect in your head. So he encouraged us, like, if you need the paper in front of you, you just say to the client, like, I really want to make sure that I, I say everything that I need to say. It's quite a structured approach. So I'm just going to have this in front of me. Um, and like, I did that. Nobody had a problem with it, and it made sure that I did everything correctly, and it made sure that the client got a good outcome as well.

[00:18:08] Sherry-Lee: Yeah, and I definitely had the cheat sheet there right when I started with my client as well. And so I think if you can pick someone that you've been working with for quite some time, the, the relationship is going to carry the work anyway, even if you do, you know, even, even if it is a bit clunky or you do make mistakes.

[00:18:27] Bronwyn: No, absolutely. So coming back to eating disorders and trauma, I guess like trauma might be one aspect of a person's presentation who is seeking assistance through an eating disorder. There's other aspects which are encompassed in the CBT model, particularly, like, I know the CBT model covers over evaluation of shape and weight as a pathway to the eating disorder, so if we just address that, then the eating disorder is fixed, right? Like, we don't need trauma.

[00:18:59] Sherry-Lee: If only it was that easy.

[00:19:03] Bronwyn: There is like good evidence that for some people, CBT is quite helpful, right?

[00:19:07] Sherry-Lee: It tends to be for some people but I think there's a very high dropout rates.

[00:19:12] Bronwyn: Oh, that's true, that was in my training. Yep. Yeah. So sometimes it's hard to get them to stay in that. And that makes sense to me. Like I remember learning that in the training and with CBT, you do ask folks with eating disorders to go through a lot of difficult, um, things, like a lot of behavioral experiments where they face their feared foods and these are the things that, because of the over evaluation of shape and weight, feel very frightening for them to do. So it's, it's sometimes hard for them to tolerate that distress.

[00:19:45] Sherry-Lee: And I think sometimes it's taking their coping strategy away. So if they're using the eating disorder to cope with trauma symptoms and we take the eating disorder away, it's not going to be very easy for them to cope and to stay functional in their life.

[00:20:00] Bronwyn: So I guess from that perspective, what's a potential downside of focusing only on, I guess, um, reducing the over evaluation of shape and weight?

[00:20:11] Sherry-Lee: Potentially it means that we get a bit of a whack a mole effect um, and I've seen this in, um, you know, treating other things where you treat one thing and then something else pops up because they need something to, to be able to cope with the underlying anxiety, other trauma symptoms that they might be getting.

[00:20:30] Bronwyn: Yeah, it's, it is a whack a mole approach. So, then if we conceptualize the eating disorder as a way to cope with trauma, then that's where the trauma approaches come in, right?

[00:20:41] Sherry-Lee: Yeah, and that means we can get to the very, you know, root of what it is that's causing those symptoms and sometimes when we do that, you know, we don't even need to address the eating disorder at the end of it because there's no need for it anymore.

[00:20:55] Bronwyn: Mmm. so maybe like a bit of a sidestep, but this is something I'm interested in, which is, I guess one of the things that I've heard the public say about eating disorders is like, it's all about control. And that's why people develop an eating disorder, because they want to control things that are outside of their control. But I'm just curious from a trauma perspective... Why might somebody develop an eating disorder as a way of coping with life? Like, what are some common pathways?

[00:21:26] Sherry-Lee: So I would say one of the biggest ones is emotion regulation. So one of the biggest impacts of trauma is it's challenging to regulate emotions. And so often the eating disorder will become the answer to that. So that could be through, you know, control mechanisms by restricting food intake. But it can also be things like binging because it's an emotional, it's a way to emotionally soothe.

[00:21:51] Bronwyn: That makes sense to me cause when I think about trauma, it's like people have all sorts of ways of regulating their emotions there. So some people might turn to substances as a way of soothing their emotions, or turn to like pornography as a way of soothing their emotions. I guess when you think of it like that, it's like, uh, controlling your eating... which is like, you know, food is in our western society it's readily available. It's tasty. Um, it feels good. Sounds like a good way to cope with overwhelming emotions.

[00:22:22] Sherry-Lee: It becomes a way for them to dissociate, to detach from, what's overwhelming in their body.

[00:22:28] Bronwyn: So if we heal the trauma, and let's say like we help them process the trauma, does that mean that they develop some other way of coping with life that's healthier?

[00:22:40] Sherry-Lee: Ideally, that's what we're trying to do, is we're trying to link them up with other more healthier coping strategies, whether that's, you know, reaching out to other people to talk to them when they're upset, whether it's using exercise to regulate anxiety, anything else that's not going to be as damaging to them.

[00:22:59] Bronwyn: I guess, like, maybe that prompts me to ask about the aims of EMDR. So, what are the aims of EMDR? When we say processed, what does that actually mean?

[00:23:10] Sherry-Lee: So what we're aiming to do is to desensitize the emotional distress related to it. We're trying to distance from the memories and we're trying to link them up with adaptive memory networks. So, for example, if you've got something that's related to, like, I'm not safe, we're then linking it up with a memory network that's connected to a positive belief like I am safe or I am okay. So that when the things that would have triggered people before, that's no longer triggering that negative memory network.

[00:23:43] Bronwyn: So, say it was like, when they thought of the memory... Prior to EMDR it might have been like 10 distress. I can't even, think about this without becoming dysregulated. After EMDR we'd want them to be like a 2 out of 10.

[00:24:00] Sherry-Lee: Ideally zero.

[00:24:02] Bronwyn: Yeah.

[00:24:02] Sherry-Lee: One, maybe. Two, I'd be doing some more work on it if it was still two.

[00:24:07] Bronwyn: Good to know.

[00:24:08] Sherry-Lee: Yeah, I mean, it depends on the situation. Sometimes there, there is what we call ecologically valid, but generally we're trying to get it to a zero so that there's no tiny little embers that are going to create flames.

[00:24:22] Bronwyn: So they won't forget the memory, like we're not, you know, we can't make people forget it, but it's that when they look at it or choose to view it, it, one, it's not intrusive, so it's not coming in, but if they look at it, it kind of feels like that's a distant memory in the past, you know, like I'm not as strongly reactive to it.

[00:24:38] Sherry-Lee: Yep.

[00:24:39] Bronwyn: And they've got that more positive belief about themselves. So it's like, I was, that was an unsafe situation then, but I am safe now.

[00:24:48] Sherry-Lee: Yep. It's really connecting them to adaptive, adaptive beliefs, adaptive functioning.

[00:24:54] Bronwyn: Yeah, and I know like some people, they have grown up in really impoverished environments. So they might not have had that sense of safety or stability or any, any really, like, positive memories. So it's like you're trying to search for one and they're just coming up blank. Um, what do you do then if they don't actually have any adaptive memory networks?

[00:25:16] Sherry-Lee: So there's a few different things. The first one that comes to my mind is something that Graham Taylor developed, which is called Stacking the Deck. So it's actually about trying to go and find whatever we can that links with that network and then strengthen that. There's other attachment informed approaches where we might be actually installing, like, psychological resources that are things that help in everyday functioning, but also help with the processing.

[00:25:43] Bronwyn: Yeah, and have you seen that being successful?

[00:25:47] Sherry-Lee: Absolutely, yep.

[00:25:49] Bronwyn: the reason I'm asking is I think, like, some early career psychs might be working with clients who have quite complex trauma and quite a significantly, uh, impoverished background, and they might be feeling quite anxious themselves, like, oh, this person's got nothing, but what we're saying is that we can find, however small, some positive things.

[00:26:12] Sherry-Lee: I mean, for most people there's something positive there. Even if it's, you know, some teacher from Year 3 or something like that said this one thing to them. Um, we can find those instances of those things and we can build on that.

[00:26:28] Bronwyn: Yes. Yep. So it's really grabbing what you can.

[00:26:31] Sherry-Lee: Yep.

[00:26:32] Bronwyn: So, the overall picture I'm building of EMDR and applying EMDR with eating disorders is that it does require some training. And I'm wondering, like, as an eating disorder credentialed clinician yourself, have you found that that training has been useful in your practice?

[00:26:52] Sherry-Lee: So, the eating disorder credentials came for me much later in my career. So I'd done pretty much everything that needed to be done for that by the time I got there. Um, so there was lots of different trainings that I did over the years, but I think the ones that they've developed specifically for the credentials are very much based on giving you a really general overview of everything, of all the types of eating disorders that people are going to be working with.

[00:27:22] Bronwyn: Yeah, yeah, that's true. Yeah. Having done it this year, it was a general overview and then you can obviously do more training. So part of the credential is that you need to do professional development specifically in eating disorders and because I'm in private practice, I felt more equipped to do binge eating disorder rather than focus on the anorexia and bulimia, which generally require a more multidisciplinary approach.

But, when you think about treating eating disorders, do you think it's something that a psychologist can come to with just a basic training, or would you recommend that they do get more professional development around it?

[00:27:59] Sherry-Lee: I think it's a good idea to get as much as you can if you're going to go into that area. Um, especially with things like anorexia. But I think the majority of the presentation that I would see in private practice would be bulimia and binge eating disorder. And I think there's this real misconception that it's the teenage girl with anorexia that is, you know, the most common presentation. But it's really not from what I see anyway.

[00:28:23] Bronwyn: I do think that that is a misconception as well about, yeah, who actually presents and in what setting and yeah, I would agree that training is really important, I guess, just with the seriousness of eating disorders and the impact that they can have on people's lives... I think we owe it to people with eating disorders to give them the best possible treatment we can.

[00:28:44] Sherry-Lee: Yeah, and I think that really highlights the importance of having a GP and a dietitian on board because they're really going to carry the medical risk associated with that. So it's probably, you know, the first thing that you'd be asking, Do you have a GP? Do you have a dietitian? Alright, let's get you linked up with those people.

[00:29:02] Bronwyn: I found it really helpful to link in with other eating disordered credentialed professionals. So for example, dietitians, because I guess a key part of the training and doing eating disorder training is examining your own beliefs and biases when it comes to weight and eating.

So like in our society, I guess we're very fat phobic and we may unintentionally transmit those beliefs onto clients whereas like something that I learned in the training is that it's very important to be Weight neutral and for binge eating disorder, it's like weight loss is antithetical to treatment for binge eating.

 I just wondered, have you noticed a shift in how you think about weight, food, eating, like your attitudes or have you always been weight neutral?

[00:29:52] Sherry-Lee: I'm not sure to tell you the truth, um, but I think that the Health at Every Size kind of movement has definitely helped shift that thinking.

[00:30:00] Bronwyn: Yeah, and like, what do you do when clients tell you about those sorts of attitudes, like, that, oh, that being fat is bad, and if I overeat, I'm a bad person, or stuff like that?

[00:30:10] Sherry-Lee: I think it's really about educating them on, I guess, trying to focus on the, for their goals to be related to health goals rather than weight goals because generally when they walk into the room, one of their goals is to lose weight, and it's about helping them understand that that may not actually be possible , and we need to really shift that thinking as part of that recovery process.

[00:30:33] Bronwyn: I would agree with that, because even for clients who may present and being like, their exercise is healthy, they may be exercising, Three hours a day in like 40 degree heat outside and yeah, it requires some assistance to see that maybe that's not a healthy behavior for you.

[00:30:52] Sherry-Lee: Yeah, and I think it, you know, highlights the need for moderation in any type of behaviour really.

[00:30:59] Bronwyn: Yeah. So I'm just curious, do you find it easy to like leave out your attitudes, I guess, towards like eating or white from the therapy room?

[00:31:08] Sherry-Lee: Look, I think because I'm so focused on trying to get to what's underneath it all, that I try not to spend too much time talking about that and being too focused on that because I think it does just reinforce The over importance that is placed on on that aspect of it I mean it is important to address it in treatment, but really trying to help the client to understand What it's actually really about for them.

[00:31:34] Bronwyn: Yeah, we had a lengthy debate about something similar to this in my training, um, which was one of the mainstays of cognitive behavioral therapy for eating disorders is weighing every session. And I think in my training, we literally had a for and against, and we were like, but if we weigh them every session, that emphasizes that weight is important and it makes it the focus. why are we using this as a marker for health? And then other people were like but it can show them that they can eat normally and then it doesn't affect their weight, which is the, which is the core fear. Um, but then we're like, well, why is weight important? Um, and it's, yeah, it's, it was a real tussle. So I can see how you just sidestep that completely with well, what's underneath here?

[00:32:14] Sherry-Lee: Yeah, and that way dietician and GP can focus on that.

[00:32:18] Bronwyn: Yeah totally, and it was calling into question what is my role here? Why am I as a psychologist weighing people?

[00:32:25] Sherry-Lee: Yeah, it's an interesting debate.

[00:32:27] Bronwyn: Yeah, it was very, it was very interesting.

For listeners, just so you're aware, like you can get an eating disorder credential. I'll put the links in the show notes where you can find out more about it and you can sign up if you'd like to. I think an aim of the organization running it is to have like many more clinicians trained in eating disorders and I think that's a really admirable goal because it's such a important area.

[00:32:51] Sherry-Lee: It's definitely made more people get trained, I think.

[00:32:55] Bronwyn: Yeah, totally. And let's go on to EMDR itself... as a consultant, what does that mean exactly?

[00:33:04] Sherry-Lee: So we've done our basic training, which is Level 1 and Level 2 and then 10 consult hours. Um, and then you go on after that to do accreditation as a practitioner. So that involves more consultation. It involves submitting tapes for them to be scored to I guess ensure that there's a minimum level of competence in EMDR and then the next level after that is to be a consultant and then there's the trainers after that.

[00:33:33] Bronwyn: What would you recommend if someone is interested in gaining training in EMDR, what should they do?

[00:33:40] Sherry-Lee: I think contact one of the MDRA accredited trainers and at least try your level one training and that way you can get a feel for whether it's going to be something that's going to be useful to you or not and then you can decide whether you know you can do further training along that process.

[00:33:58] Bronwyn: And what prompted you to continue your training in EMDR? Because it sounds like such an involved process, you know, like getting your videos rated, hugely anxiety inducing I'd imagine... why did you want to continue? Yeah.

[00:34:10] Sherry-Lee: I had a lot of support, um, from the consultants that were taking me through. Um, and I was just really passionate about it and I had so much success using it with clients that I just, just wanted to keep going and I just wanted to learn more and more.

[00:34:24] Bronwyn: Mmm. No I think that's really awesome and just shows like, I guess, like the level of training that you've got in this and how much you feel like it really is helping people.

So sometimes people have negative views towards EMDR. They may say that, it doesn't work, or they may just say, like, it's a pyramid scheme, or it's a scam, and I don't like it. What would you say to people who have, I guess, these quite negative views towards EMDR?

[00:34:57] Sherry-Lee: I think it important to just try it if you are curious about trauma treatment. Part of a lot of the training that we go through is to practice EMDR on our clinicians and then generally in the EMDR community it's quite encouraged to go and do your own EMDR therapy and I think once you've done that and you've experienced it for yourself you can really understand the power behind it.

[00:35:22] Bronwyn: No, I think that's a really sensible thing and I guess I'd just add to that, like, there is a lot of Really good research behind EMDR, and I guess as a psychologist, like as an early career psychologist, I did feel that, I guess there was an imperative for me to be able to serve my trauma clients well, and I did feel like EMDR was a great thing to pick up quite early in my practice.

Have you found that that's been similar maybe for early career psychs who you've supervised, that it's been helpful for them?

[00:35:55] Sherry-Lee: Well, I think because it's trans diagnostic and it can be used across so many different presentations, you're not having to learn like another different treatment for every single presentation. You can just kind of look for, well, what are the common denominators for this client? Is it that they have a belief that they're not good enough? That they're not safe? That there's something wrong with them? And then often those beliefs will underpin a a lot of the symptoms that they're presenting with, and that way you can address, you know, multiple, different symptoms at once. Wow.

[00:36:25] Bronwyn: Wow. Yeah, that already like alleviates some of my like, feeling of anxiety, which I didn't know I had.

[00:36:30] Sherry-Lee: [Laughter]

[00:36:30] Bronwyn: But, but yeah, it's like, oh, I can actually use this approach like, for a number of different clients and I think that's been true. For example, like EMDR goes really well together with schema therapy and like you're passionate about schema as well, right?

Yeah. Um, and yeah, they, they go very well together. Um, And so yeah, there's a lot of applications for EMDR and I just find myself like when I do therapy, sometimes in my head I'm categorizing and like they're showing a trauma experience and I'm like okay, I can see the negative belief here about yourself, other people, the world around you. I can see the coping styles that are developed as a result of this. I can see the anxiety that's been generated by this experience... so I feel like it provides a really, good way of understanding trauma.

[00:37:12] Sherry-Lee: Yeah, the Adaptive Information Processing model is very good for conceptualising things and I think when you've got that matched up with a Schema Therapy conceptualisation, it really does give you a really thorough conceptualisation.

[00:37:26] Bronwyn: Totally. And I think it also provides a lot of hope as well, like the adaptive information processing model. It provides hope that people can heal from trauma because the whole thing with it is that the person has been prevented from going through the natural processing that takes place with memories and it's been blocked by, I guess, the overwhelm that this traumatic experience has produced so if, we can assist with rejigging and restarting that natural processing, then they can heal from trauma, which I think is really significant.

[00:37:56] Sherry-Lee: it really can.

[00:37:58] Bronwyn: And so it provides a lot of hope because I think as psychs, sometimes we can feel a little hopeless and helpless ourselves. Someone comes to us with trauma and we're just in our heads, I don't know, buddy, if you can recover from this, but I feel with EMDR, this is possible, you know?

[00:38:11] Sherry-Lee: And I must say that I do feel a lot more empowered as a clinician now in that chain.

[00:38:15] Bronwyn: Yeah. No, me too. Yeah, no, that's really good to hear.

Sherry Lee, I feel like we're coming towards the end of our discussion, but is there anything that we haven't touched on which you would really love to share with listeners, either about eating disorders or EMDR or trauma informed approaches in general?

[00:38:32] Sherry-Lee: I think if something they are interested in, just bite the bullet and go and get some training and give it a go. There are so many clients out there that need our help, and the more clinicians that are trained in these areas the better we are able as a community to, to treat people.

[00:38:50] Bronwyn: I agree, 100%. So, Sherry Lee, if listeners want to learn more about you or get in touch, where can they find you?

[00:38:57] Sherry-Lee: Uh, probably my website, which is www.sherryleesmith.com. So there's information about me, some of the groups that I'm running for EMDR consultation.

[00:39:07] Bronwyn: Fantastic and I'll pop that link in the show notes so that people can find you. So are you available for like supervision, group supervision?

[00:39:15] Sherry-Lee: So I've got some groups running next year, so I can do group supervision, I do individual supervision. Um, I'm not taking any new clients at the moment, as far as client clients, but, um, definitely for peer consultations.

[00:39:29] Bronwyn: Wonderful. I just want to thank you for coming on. It's such a pleasure to have someone with your level of experience come on and really share with us like how valuable it has been to learn EMDR and to receive training in eating disorders and how much you use it in your practice. It sounds like, you know, like every session you're applying this learning.

[00:39:50] Sherry-Lee: Just about.

[00:39:51] Bronwyn: Yeah, so I think that's hugely validating for listeners to hear. So thank you so much.

[00:39:59] Sherry-Lee: thank you very much for having me.

[00:40:01] Bronwyn: My pleasure, and listeners, thank you so much for listening. We really appreciate you. Hope you have a good one and catch you next time.