Why is Family Therapy an Important Part of Treatment?
Family therapy can be extremely helpful in the treatment and recovery process for both adolescents and adults experiencing anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder (ARFID), or any combination of eating disorder symptoms.
Eating disorders are complex and multifaceted mental health concerns that not only affect daily life functioning, but also physical health. Many individuals who experience eating disorders also suffer with co-occurring mood disorders such as depression, anxiety, bipolar disorders, personality disorders, obsessive compulsive disorder and various other mental health concerns such as trauma.
Eating disorders, although extremely dangerous, become a strong coping mechanism for emotional discomfort. Many of my clients describe their eating disorder like a toxic relationship. Although the eating disorder can give them a sense of comfort in the moment, overtime the eating disorder creates a sense of isolation from peers, supports, and even a personal sense of self-worth and self-identity. The eating disorder can leave your loved one feeling very alone and without any true skill of asking for help and needs around emotions or emotionally provocative situations.
Due to the nature of eating disorders, research shows that treatment that involves family or other supports in the client’s life helps lead to better treatment outcomes. In addition, family therapy can help individuals learn how to rely on supports for help after treatment rather than go back to their eating disorder as a coping mechanism.
Family therapy within eating disorder treatment can include all supports, such as family, friends, partners, or any other individuals that a client feels could help empower them in their recovery process. Below, I have created the goals of family therapy within eating disorder treatment, as well as how family therapy could be helpful to not only the client, but to the supports throughout the treatment and recovery process.
Is Family Therapy Just for Adolescents?
Because I find family therapy to be so influential to client’s eating disorder recovery process, I require my adolescents to attend family therapy or have their parents involved in our individual therapy sessions. However, the answer is that family therapy can benefit clients of all ages!
It is important for therapists to consider the needs of each individual client no matter their age. Generally, eating disorders affect how a person navigates both their internal and external world. What I have found is that when someone is suffering from the effects of an eating disorder, the eating disorder tends to freeze relational and emotional development at the age eating disorder symptom use begins.
The therapeutic process, including family therapy, can help an individual relearn various skills in relational connection within their peer and family groups including confrontations, need expression, asking for help, setting boundaries, and emotional expression. For this reason, family therapy can be helpful for a client of any age.
What Should I Look for when Finding a Family Therapist?
Firstly, just like with finding an individual therapist, it is important to find a family therapist that you feel safe and connected to. Due to the nature of eating disorders, I do recommend working with a family therapist that has an expertise in eating disorders. I find having a therapist that has an expertise in treating eating disorders to be important, not just due to the nuances in understanding that eating disorders are not just about food, but because it is important that family members, peers, partners, and the client themselves do not feel shamed, blamed, or judged that they have in some way created or caused the eating disorder.
Again, eating disorders are multifaceted mental health concerns. There is not just “one thing” that causes eating disorders. It is important for all family members to have a space to process their emotions around the eating disorder. The family therapist should normalize any emotional reactions, while helping family members focus on concrete steps that they can take now to create a nonjudgmental space for emotional development and needs expression.
What are Emotionally Focused Therapy (EFFT) and Family Based Treatment (FBT)?
I tend to use either Emotion-Focused Family Therapy (EFFT), Family Based Treatment (FBT), or a combination of those two treatments within family therapy sessions. I find these approaches helpful depending upon the age and needs of the client. Family Based treatment is specifically only used for children and adolescents when these individuals are not in the place to make healthy choices around food or feed themselves. FBT puts parents in control over food choices and is a more behavioral approach to change.
EFFT utilizes behavioral approaches of FBT treatment, while helping empower all family members through emotion coaching. Emotion coaching allows each person in the family to identify both their strengths and struggles, while identifying validation techniques and communication strategies to work through stressful situations. Both approaches can be successful in addressing long term recovery.
Family Therapy Goals:
Providing Psychoeducation Around What is Maintaining the Eating Disorder
It is important for family members and supporters to begin to have an understanding not only around the severity of eating disorders, but also that eating disorders are a way of emotional expression and not just about the food. One of the questions that I ask my clients is, “What in this present moment is maintaining your eating disorder?”. Helping family members understand the unique components of why their loved one is currently struggling can allow the family to create concrete goals for change that each family member or support can take ownership of and help. Please visit “Looking Beyond Your Child’s Disorder Eating Behaviors: What Should Parents Know about Eating Disorders in Childhood and Adolescents?” for more information.
Decreasing Self-Blame and Shame, by Focusing on the Here and Now of Treatment
It is extremely normal for each family member, support, and the client themselves to feel shame and blame about the eating disorder. It is important that family therapy helps everyone in the family have a space to process their shame and self-blame, without the therapist invalidating these emotional responses. Many individuals do not discuss their shame, which can cause maladaptive patterns of responding to the eating disorder in the moment.
For instance, sometimes self-blame can make individuals lash out, push away support, or avoid emotional conversations due to a fear of making it worse. It makes perfect sense that supports have a fear of making things worse! How hard it is to be in that space, where you know you want to help your loved one, but also struggle to know the best way to do that in the moment.
Family therapy can help each family member identify their own emotions in the moment and how to navigate emotional conversations utilizing components of emotional labeling and validation in the present moment. Eating disorders can be a distressing and traumatizing experience for the whole family. Fear can cause avoidance of emotions for each family member. Family therapy can help family members learn how to lean into emotional discomfort and learn confidence and skill of how to do that in the present moment.
How to Label Emotions and Encourage Emotional Validation
Helping family members learn how to label emotions and how they discuss certain emotions is part of the treatment process. Not only do clients that suffer with eating disorders struggle with emotions, but also family members can have their own negative experiences with emotional expression as well.
First, family members learn how to label emotions and the functional purpose of certain emotions in family therapy. Second, I work with my families to understand the difference between emotional validation and practical support. Although natural to provide practical support and try to “fix” emotions, clients tend to find this invalidating when expressing emotions. Learning to sit with emotions and communicate understanding of emotions can be helpful for all family members when learning new communication strategies.
Family members can feel shameful that they struggle with their own emotional expression. Emotional expression, or lack thereof, quite frankly is a generational process – we learn about it from our own parents. Truly, emotional expression was determined prior to the family sitting in front of me.
Family members can be empowered to know that emotional expression, although a generational process, can be taken in their hands and something they can change in the present moment. Breaking the cycle around maladaptive emotional expression can be difficult, but in a safe space, can be helpful to creating long standing change.
Exploring needs, While Emphasizing Family Members’ Unique Strengths
When family members and supports learn that they are now in control of changing their dynamics around emotions, longstanding change can occur. Needs and needs development can be an important part of family therapy and eating disorder recovery. Many times, learning what needs a client has is part of the process. Learning how needs can change depending upon the emotion is something we work on during family therapy.
I like to teach family members, supports, and my clients struggling with eating disorders that you cannot put all your eggs in one basket. Needs cannot be met that way. It is helpful for supports to understand what areas they feel more competent in meeting a need. For instance, maybe a client feels more comfortable discussing sadness with their mom and anxiety with their dad. This is completely okay! It is important to know what strengths each family already possesses, while working on developing areas of improvement.
Developing Support Roles and Nonjudgmental Communication Patterns
Each family has a unique way of communicating. Family therapy can help each member learn to communicate more effectively with one another. It is important for family members to rely on nonjudgmental forms of communication. Sometimes this can be done through learning a confrontation model, where the individual learns to consider not only their own emotional perspective, but also how they themselves contributed to the issue at hand. However, communication patterns can be more creative. For instance, I enjoy using Janet Treasure’s animal models to help learn communication patterns, while decreasing shame and blame.
Creating a Relapse Prevention Plan and Empowering Change
During family therapy, family members should work on a relapse prevention plan that identifies triggers including emotional, relational, and behavioral signs of relapse as well as what the individual may need and from whom if these triggers arise. Relapse prevention plans can also include coping plans or ways of tolerating emotions depending upon the trigger.
I like to use a “red, yellow, and green light” approach to relapse prevention plans. This includes signs and signals that things are going well (green), when a client might be struggling and need more support (yellow), as well as when a client might be going into more of a lapse and a pattern of more eating disorder behaviors (red).
It can be extremely beneficial for family members and supports to be involved in a conversation ahead of time of what they can do to prevent a relapse and be able to change patterns of approach when things are not going well throughout family therapy.
If you think that family therapy could be a right fit for you and your treatment process it is important to reach out for help! You can contact us or ask any current treatment providers if they have suggestions for you. Any therapist that you feel connected to may be able to help identify the best family therapist fit or modality for your unique needs.