Family Therapy is Cutting Edge Treatment for a Family Disease
By Abigail Natenshon, MA, LCSW, GCFP

Eating disorders are family diseases.
87 percent of individual afflicted with eating disorders are children and young adults under the age of 20. As most of these young people reside at home, side by side with family members and loved ones, the onset, diagnosis, treatment and recovery of their eating disorders can be expected to play out at kitchen tables, behind closed doors in family bathrooms, in restaurants and gymnasiums.

• When young children, teens and young adults living at home become afflicted with an eating disorder, the entire family system becomes affected. Parents, siblings, extended family, friends and loved ones all share in the suffering.

• Unprepared as they may be, parents and family members typically become the primary diagnosticians of an eating disorder. Eating disorders are secretive and lethal diseases that rarely show themselves in the medical doctor's office. In addition, their presence is typically silent in laboratory tests till the latter-most dire stages of disease.

• The recovery process essentially happens at home, as well. Patients typically spend 45 minutes a week with their therapist or doctor. For the rest, 24/7, children live out their recoveries at home, and within the context of daily living; and that is as it should be. Parents, families, teachers, coaches, all need to become educated, enlightened, and supported in their efforts to support the child in recovery.

• The most complete and sustainable recoveries happen slowly, gradually, over time, incorporated as they are into daily life functions. This is fortunate in the face of the limited coverage provided through health insurance companies as compared to the duration of most eating disorder treatments.

• In research carried out at the Maudsley Hospital of London England, there is evidence to show that family treatment is more effective than individual psychotherapy for anorexics living at home who have been ill for less than 3 years.

• The nature and degree of parental involvement will vary widely with the age and needs of the child, the severity of the disorder and co-occurring conditions, the skills and capacities of the parent, the family therapy skills and welcoming attitude of the treatment team, and the nature and quality of the ever-changing parent/child connection.

• The family-based nature of eating disorders is also relevant to patients who have grown beyond childhood into their adult years. No matter what our age or life stage, we remain products of the system of our family-of-origin. The effective involvement of family members in the individual patient's recovery from an eating disorder can only enhance the speed, effectiveness and sustainability of the healing process

Family Therapy is the most effective way to treat everyone's needs.

Parents and siblings are deeply affected by the presence of an eating disorder within the family system. The potency of the eating disorder typically drives a wedge between family members, isolating the afflicted child from loved ones at the time of his or her greatest need; separating the other siblings from parents who tend to be hyper-focused on the eating disordered child; and at times, creating conflict and guilt between husbands and wives, particularly for those who fail to achieve a "united front" in offering their parental response. Family members need a vehicle through which to understand the complexity of the disease and recovery processes, a forum to communicate their own concerns and needs to the patient and with each other, and the opportunity to learn how best to support the child and the recovery process. They need personal support and bolstering in the face of what typically tends to be an extended, convoluted, jarring and frustrating recovery process for the entire family. Family therapy provides that vehicle.

Therapists treating eating disorders must be vigilant and respectful of the power of the family system in eradicating (or possibly sustaining) disease, tapping into the family system as a most powerful resource. The individual child's efforts to make recovery changes are facilitated and enhanced not only by a family that understands the recovery process, but by family members who are committed to making their own parallel personal changes to accommodate the needs and requirements of the changing child and family system. In instances where a child's resistance to recovery may be extreme, changes made within the wider family system can be sufficient to evoke required change in the afflicted family member. The potential for the family unit to facilitate change is far greater than the sum of its parts; children heal more completely, more sustainably, and more effectively, when families are enabled to become constructively involved. Clear communication becomes enhanced, and in becoming direct, eradicates the risk for confidentially breeches and privacy rights infringements. Moreover, children who learn to function and communicate more effectively within the context of their family carry these valuable interpersonal skills into their other relationships as well, making life a healthier, happier place to be, both now and in the future.


Eating disorder psychotherapists need to embrace parents and families in treatment

It is up to the eating disorder psychotherapist to "grow" the relationship between parent and child, for it is within the healthfully bonded connection that the greatest and most effective capacity for healing lies. The healing human connection in eating disorder recovery originates between patient and therapist in a quality therapeutic relationship. The therapist incorporates the willing and able parental unit into a bonding process that enhances parent/child connectedness, accompanied by increased trust, growing autonomy and the child's increased capacity for healthy individuation and separation; but most significant of all is the patient's healthy re-connection to his or her own re-integrated self, the very benchmark of recovery, healing and mental health.
Beware of the warnings of misguided health professionals who may imply that eating disorders are caused by parental involvement, which they consider to be controlling interference, in their children's lives. Such a professional might seek to exclude the child's parents from the psychotherapy process in order to protect patient/therapist privilege (confidentiality rights). This kind of advice might indicate a professional unaware of the unique requirements of eating disorder treatment, or the power of the family system to support the child's recovery; he or she may simply be inexperienced in this treatment specialty, unfamiliar with family systems theory, or otherwise uncomfortable treating family groups. Parents need to understand and keep in mind that the best prognosticator of healthy separation is healthy parent-child bonding and secure attachment. The best prognosticator of successful treatment is the practitioner who, in treating the individual, envisions, and is open to engaging, the wider family system as a context for cure. In instances where the patient may be resistant to, or geographically too removed from family involvement, the skilled practitioner will be able to conduct forms of family treatment "in absentia."
It is for the child-patient's therapist to role model loving limit-setting and problem-solving for parents, inspiring and enabling them to become their child's greatest resources as "most valuable players" on the treatment team. In educating and guiding parents to supersede the power of the eating disorder in restoring firm and grounded external values and guidance, parents regain the confidence and know-how they need to become "parental" once again. At the same time, they offer their child an invaluable opportunity to internalize self-regulatory controls; parents and child must both come to understand that the need for parental controls of the severely ill child is temporary, until such time as the recovered individual becomes once again capable of resuming the capacity and responsibility for his or her own self-regulation.

Taking action
Parents need to act on the knowledge they acquire. Parental involvement may vary from providing:

• on-going and unconditional support, day in and day out.

• nutritious meals which they prepare and sit down to eat together with the child.

• the monitoring of food intake and symptom management.

• involvement in family treatment to support the child and recovery process and to resolve underlying emotional issues that may be driving the dysfunction.

In summary, when it comes to the treatment and healing of eating disorders, simply loving one's child is not enough.