From Carolyn Costin’s Excerpts from Family Therapy Chapter

The Goal of Family Therapy:

These days, more than ever, parents want to know whether or not their son or daughter’s eating disorder is due to something they said or did or something handed down in their genes. Suffice it to say that both nature and nurture are at work here. Researchers are finding evidence of a genetic predisposition, but a definitive answer is a long way off, and even further away is a treatment or cure for any genetic abnormality. Consider what top researcher Cynthia Bulik says regarding parents: “There is nothing they can do to alter the passing down of DNA, they can alter environments that influence the likelihood of genes being expressed.” With this in mind, part of the goal in family therapy and in preventing eating disorders is the same, to find out what is protective and what is triggering.

So what can parents do to help? What do they do that is harmful or has negative consequences? It is difficult for parents to sort through all the available information.

What Therapists Do:

Tasks of an Eating Disorder Family Therapist

The therapist helps family members learn to empathize, understand, guide without controlling, step in when necessary, foster self-esteem, and facilitate independence. If the therapist can help family and significant others provide a healing, therapeutic relationship for the person, the length of therapy will be reduced. Good parenting and good therapy require firmness and empathy, as well as guidance, advice and collaboration.

I asked my clients in our multi-family group to share with their family members what the therapists at Monte Nido do that they find helpful.

What clients reported is key regarding how the therapists communicate with them was:

  • They allow all feelings
  • They speak in the moment
  • They tell the truth without judgment
  • They ask specific questions and draw out information
  • They don’t assume things
  • They acknowledge our fear and our ambivalence regarding about better
  • They know that it takes time
  • They validate and acknowledge our experience
  • They are not emotionally connected to our behaviors

This list is valuable and includes important concepts for the therapist to help families put into practice. For example, telling the truth without judgment is one of the most important concepts I teach my clients and significant others. When every person can tell their own truth, calmly with no anger or judgment, then human beings can live together and work out problems harmoniously. (It sounds easy, but try it.) I encourage other therapists to use this list and ask clients to come up with their own to share with their families.

The family therapist has many tasks. I start out telling everyone that I am there for the most amount of healing for the most people. The idea is for everyone to bring everyone else’s best self forward. Aside from the normal responsibilities of any family therapist, which are explained in other books, there are tasks specifically related to eating disorders. For example, we will not be trying to get things back the way they used to be. The person will be changed when he or she gets better, and I tell family members, “Don’t ask for things to go back to the way they used to be, because how he or she used to be led to an eating disorder.”

[blockquote]”Don’t ask for things to go back to the way they used to be, because how he or she used to be led to an eating disorder.”[/blockquote]

Working with Family Members in Family Therapy

To help clients recover and family members understand, accept, and work through all the problems a loved one with an eating disorder has, successful treatment often warrants working with all family members together–even when the client no longer lives at home or is a dependent. In some cases, it may be better if the client has her own individual therapist and another therapist does the family work, but my experience has been excellent with the same therapist doing both, and this is how I usually work.

I have not met a family with whom I didn’t want to work, although some scared me, some were very difficult, and I knew others were probably not going to change. I can find the value in talking to an accused abuser and his daughter. Bring on screaming, out-of-control husbands; they are hurting too. Get restricting, exercise-addicted moms in; they need a better understanding and to be understood. Then there are all those parents and spouses who do not have any major psychological problems, lead pretty normal lives, and think they would have no issues to bring to therapy if it weren’t for their suffering child or spouse. These people will be surprised at how much help and healing they can get from family therapy. It serves to educate people about and help them deal with the disorder (a sort of do’s and don’ts list). It helps everyone learn to communicate and deal with each other in the most loving way possible.

Family therapy emphasizes responsibility, relationships, conflict resolution, individuation (each person developing an individual identity), and behavioral change among all family members. The therapist assumes an active and highly responsive role within this system, significantly altering the family rules and patterns. If the therapist appreciates the vulnerability, pain, and sense of caring within the family, he or she can provide support for all members. Supportive, guided therapy can relieve some of the tension created by tenuous and previously disappointing family relationships.

In doing family work, the client’s age and developmental status are important in outlining the course of treatment, as well as in highlighting the responsibility of family members. Adolescents who are older or developmentally more advanced require parental involvement that is more collaborative and supportive and less controlling. The younger the client is, both chronologically and developmentally, the more responsibility and control the parents will have. This is why FBT or Family based treatment is most effective with adolescents under the age of 17 suffering from anorexia.

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