Stuck-points and re-engaging in therapy for longstanding eating disorder with complex PTSD: a lived experience and clinical reflection

Background When engaging in therapy for co-occurring eating disorder and complex post-traumatic stress disorder (ED and CPTSD), a client and therapist may experience ‘stuck-points’ (feelings of impasse). Therapeutic stuck-points may be driven or complicated by chronic dissociation and/or disturbances in self-organisation that hinder the client’s self-connection and coping, the therapeutic relationship as safe, and the therapists’ understanding and responsiveness to their needs.Objective This article explores the use of poetry and objects as creative tools to navigate stuck-points for longstanding ED and CPTSD.Method The first author’s experiences are used as a case study, demonstrating how poetry writing and object use in Schema Therapy may support therapeutic re-engagement after prolonged emotional numbness, dissociation, ambivalence, and hopelessness.Results The first author provides examples of using these approaches in therapy, and their impact on trauma processing. The second author provides reflections as a clinician. Reflections on safety considerations and client fit are discussed, with flow diagrams.Conclusion For individuals with ED-CPTSD, stuck-points may be influenced by bidirectional relationships and symptoms, difficulty developing trust after trauma, and ambivalence. Clinical assessment and consideration of client preference, collaborative use, and individual tailoring can determine whether creative approaches may support therapeutic engagement, trauma processing, and mitigation of ED-CPTSD impacts.