Eating Disorder Family Therapy: A New Approach – Dr. Allison Chase

We must work with both caregivers and patients in eating disorder treatment. All caregivers have the ability or capacity to help their loved one work towards full eating disorder recovery. Thanks to the lessons of Emotionally Focused Family Therapy, I have more patience and tolerance to explore the emotional roadblocks that get in the way of both caregiver and clinician.

I confess: I still feel like a “young adult” (most of the time), but reality is sinking in. I am no longer a young adult; I am now quite close to “middle aged”.
This life phase has its benefits. Years of experience as an executive director, licensed psychologist and eating disorders clinician have certainly brought wisdom.
Young adults now come to me asking for guidance. And nothing is more fulfilling to me than talking about career goals with young adults interested in psychology. As I help these bright young people, I also continue to learn more about myself and the importance of being open-minded, regardless of how many years of experience one has.

The teacher becomes the student 

Recently, over coffee, a graduate student asked me, "how did you get where you are today?" Here’s what I shared:
My clinical passion to treat eating disorders was solidified early when I was on internship at a pediatric eating disorders treatment program at a large medical hospital. I provided both inpatient and outpatient care. During this internship, I was introduced to family based treatment. I was exposed to the intense challenges of working with eating disorder patients and their family members.

For young patients, I explained, family involvement is essential for eating disorder recovery.
I was hooked!
Back then, family based treatment was similar to what it is today, although we had more flexibility to draw from other family systems approaches, including relational and psychodynamic psychology. We hadn’t yet been introduced to the manualized versions that exist today.
Family therapy has always been my passion. Along with Maudsley Family Based Treatment for Eating Disorders training, this early learning has guided my practice.
My a-ha moment
As I explained this to her, I began to reflect on something that happened to me a couple of months ago.

I was introduced to an ERC training opportunity to learn more about Emotionally Focused Family Therapy (EFFT) in the treatment of eating disorders.
Of course, I wanted to attend. (And, since we are being honest here, with my years of training, I figured this training would be a nice review but not much more. Well, that was my first mistake).
Emotionally Focused Family Therapy opened my eyes to better recognize and understand caregivers’ underlying emotional “road blocks” that create challenges in recovery. These road blocks keep caregivers from doing the necessary work that their loved ones need.
Clinicians have road blocks, too 

Road blocks in clinicians can interfere with their ability to recognize, understand and help the caregiver move through their own emotional blocks.
As I sat in that training, I realized that, at times, I had been guilty of not believing that I could access some parents. I was guilty of assuming that certain caregivers may be contributing to, rather than helping, the problem.
The cornerstone of family based treatment is not placing “blame” so I am always careful to never use that word. But, I recognized that questioning a caregiver’s “capacity” or ability to be effective is just as problematic.
All caregivers are capable — it’s just that some are more motivated than others to avoid or stay in old patterns for fear of something worse happening. Hence, emotional road blocks in caregivers often need to be addressed!
As this was discussed, I turned to one of my colleagues during the training, in hopes of her validating me, “I couldn’t possibly be guilty of having road blocks!” But, she, too, was in the same quandary.
Guilt loves company. And company, or rather support, is the best anecdote for change. Our guilt was quickly washed away as we recognized that this conceptualization in EFFT — recognizing road blocks for caregivers and clinicians and being given new strategies to support the families — was exactly what we had been missing.
And, now, I was really hooked!
Thanks to the lessons of EFFT, I have more patience and tolerance to explore the emotional roadblocks that get in the way of both caregiver and clinician.

EFFT in family-centered eating disorder treatment 

Here’s how road blocks might look in therapy: A child has been in treatment for anorexia. A parent falls into the pattern of letting their child negotiate the designated meal plan in order to eat less.
It would be easy for a clinician (yet not necessarily accurate) to interpret that this parent was incapable or lacked sufficient parenting skills.
A clinician guided by the EFFT model would recognize that this mother’s greatest fear is that, by pushing her child to eat 100 percent, her child may go up to her room and harm herself as she has done in the past — or run away, resulting in greater harm.
Or, another example: a family has an adolescent that has been in treatment for bulimia; the father that appears to have no tolerance or patience for his child’s eating disorder behaviors — coupled with emotional withdrawal and social isolation — is actually suffering with his own frustration and guilt of his troubled upbringing. This father recognizes that he is angry because he overcame an abusive household, and has now provided everything he could for his family. He questions: how could his own child now be so sick? Could his indulgences be responsible for her current behaviors?
These are all emotional road blocks that need to be addressed and worked through — individual by individual, family by family.
We are adopting this new evidence-based family therapy approach at our eating disorder clinic and I couldn’t be more thrilled or supportive.
We must work with both caregivers and patients in eating disorder treatment. All caregivers have the ability or capacity to help their loved one work towards full eating disorder recovery.
Later, back at the coffee shop, the young graduate student asked me, "what advice would you give me?”
Instead of going through my usual spiel, talking about education, training, and various career paths, I changed my story a bit.
I talked about the importance of always keeping an open mind and never being complacent, despite how long or how successfully you have done the work.
Sometimes “older dogs” really can learn new tricks.
Allison K Chase, PhD, CEDS is Executive Director at Eating Recovery Center of Austin.

If your child is in need of anorexia treatment or bulimia treatment, please let us know how we can help.

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