The Value of Emotion-Focused Family Therapy in Eating Disorder Treatment

By Allison Chase, PhD, CEDS-S

At Eating Recovery Center, involving families is a priority, using the tenets of Maudsley Family Based Treatment and Emotion-Focused Family Therapy. If family therapy is not taking place in treatment, are patients — and their families — missing out on the benefits?

In the past, family members — typically, parents — were blamed for their children’s eating disorders. As professionals, we now know that this blame isn’t warranted, but the myth still persists and causes some families to avoid seeking help for their loved ones out of fear that they may be blamed or shamed for their family member’s illness. 
The truth is that families do not cause eating disorders or mental illnesses. In fact, families are vital to the recovery process and can become true partners in their loved one’s healing! We see patients of all ages benefiting from family involvement and family therapy in eating disorder treatment. 
Family Involvement: Critical to Eating Disorder Treatment
When an individual is suffering from an eating disorder or another related mental health issue, family therapy is often a hallmark of treatment — serving as a mechanism to engage, educate, empower and encourage family members. When an individual is willing to support their loved one’s recovery with true understanding and a commitment to work alongside them, a great deal of healing and transformation can occur. 
My question today is: are we as eating disorder treatment professionals doing all we can to incorporate families into our patients’ care plans? If family therapy is not taking place, I can’t help but wonder if patients — and their families — are missing out on the benefits? For instance, are families missing out on receiving:

  • Education regarding the complexity of eating disorder treatment?
  • Knowledge about meal support?
  • Practice and guidance in how to talk openly and honestly with each other? 
  • Ways to identify and understand each family member’s struggles?
  • Strategies for applying the skills learned in therapy in the “real world”?
  • Clarity on family goals and creating a structure to achieve them?

Families with loved ones in treatment should be supported, educated and guided by their treatment team. This both supports the patient’s path to recovery and increases families’ connections with their loved ones.
At Eating Recovery Center, involving families is a priority, using the tenets of Maudsley Family Based Treatment and Emotion-Focused Family Therapy.
Maudsley Family Based Treatment
In Maudsley Family Based Treatment (or FBT for short), shown to be effective for children and adolescents suffering from Anorexia and Bulimia Nervosa, parents are recognized as an essential and active part of their child’s treatment plan — supporting healing and recovery. 
The Maudsley approach puts parents in charge of managing certain aspects of the patient’s life with a goal of eliminating eating disorder behaviors. The therapist serves as the parent’s coach and guides them by using the primary underlying principles of FBT, which include:

  • Treating the symptoms and behaviors
  • Not focusing on the cause
  • Not blaming parents
  • Encouraging parents to lead the way
  • Encouraging parents to take care of their children

In essence, FBT focuses specifically on addressing eating disorder behaviors, utilizing a behavioral approach to do this. 
Emotion-Focused Family Therapy

Emotion-focused family therapy’s (EFFT) underlying philosophy is that caregivers can play a significant role in supporting their loved one’s mental health, at any age, and that there are a number of ways to accomplish this.
EFFT consistently supports the behavior coaching principles used within Maudsley Family Based Treatment, as well as emphasizing the importance of emotion coaching.
Emotion-Focused Family Therapy (EFFT) includes:

  1. Both behavior coaching and emotion coaching — supporting and guiding caregivers and teaching them how to “emotion coach” their loved ones
  2. Skills training of caregivers and parents of children, adolescents, and adults of any age into the eating disorder treatment process. 

Thus, EFFT teaches caregivers skills and strategies to both empower themselves and support their loved one in recovery. It looks like this:

  1. Behavior coaching – Teaching caregivers how to interrupt maladaptive behaviors and symptoms in their loved one; the caregiver is taught how to work through both obstacles and fears that may surface as they support their loved one in recovery.
  2. Emotion coaching – Teaching caregivers how to support their loved one and their loved one’s ability to process and manage stress, emotions, and physical pain — this can help put out fires and de-escalate conflict; in addition, EFFT teaches caregivers how to manage their own emotions which can help both repair and strengthen their relationship with their loved one. 
  3. Relationship repair – Teaching caregivers how to facilitate healing, processing and recovering from past pain — to support their loved one’s recovery

An example of one of the key strategies in EFFT is teaching caregivers how to validate their loved ones. Validation is emphasized in EFFT as it can be highly effective in transforming family relationships. Not only is validation incredibly helpful for anyone, but it can be used both in recovery and throughout the lifespan. 
Skills training for clinicians
Emotion-Focused Family Therapy doesn’t just focus on families. The protocol offers a number of skills trainings for clinicians, as well. Indeed, as clinicians teach caregivers the skills and techniques of EFFT, clinicians will ideally be doing their own work to process any emotional blocks that may interfere with their ability to provide EFFT.
One of the most powerful interventions for clinicians supported by EFFT is for clinicians to look at their own biases, blocks, and fears. These blocks are behaviors (denial, avoidance, enabling, blame), fueled by unprocessed or maladaptive emotions (grief, shame, helplessness), that keep us from effectively behavior coaching and emotion coaching our patients. 
Let’s take a look. Are you able to quickly and easily identify your own biases and blocks? Consider these examples; do you:

  1. Fear pushing a patient too hard so that they can’t handle the session?
  2. Fear causing suffering and pain?
  3. Fear pushing caregivers so hard they leave or shut down?
  4. Fear that your patients don’t like you?
  5. Fear facing our own vulnerabilities or triggers?
  6. Fear being blamed or quick to blame others?

We all have very powerful emotions that guide our behaviors. And, even as therapists, it can be difficult to see where our own biases lie. This can be challenging and keep us stuck in our work with our patients. EFFT encourages us to free ourselves from these blocks through self-examination, guidance and supervision. At the same time, EFFT teaches us vital skills to help us deal with and manage these obstacles. 
Family involvement is key to eating disorder recovery
Families play a very important role in their loved ones’ treatment and are an integral part of their recovery. We must empower families to address and repair the family system and make long-lasting changes, so they are able to thrive together.
In summary, Emotion-Focused Family Therapy can help us empower caregivers to better support their loved one in recovery. EFFT not only gives us an opportunity to evaluate our own blocks and biases, but it teaches us a number of skills that deepen our work with families, caregivers, and patients — increasing our capacity to help.
During my talk at our 5 CME/CE San Francisco Professional Symposium: New Treatment Strategies for Complex Cases on September 20, 2019, I will talk more in-depth about how clinicians can apply Emotion-Focused Family Therapy in their own professional and personal lives. Please join us in person or via livestream. 
Register for the conference here.
I hope to see you there!
Allison Chase, PhD, CEDS, has been working in the field of eating disorder treatment for over 20 years and is currently a Regional Managing Clinical Director of Eating Recovery Center and Insight Behavioral Health Center locations in Texas. Dr. Chase’s areas of clinical specialization include child and adolescent mental health issues, the treatment of eating disorders, parental training and education, and family- or team-based therapy.
In addition to serving her patients, Dr. Chase enjoys helping others on a mass scale through presentations and media interviews. Dr. Chase has taught undergraduate psychology courses at The University of Texas at Austin since 2001 and has a faculty appointment as an Assistant Clinical Professor, where she trains and supervises graduate students.

Dr. Chase earned her bachelor’s degree in psychology at the University of California at San Diego. She earned her Ph.D. in clinical psychology at The University of Texas at Austin and completed residency training in Chicago at Rush University Medical Center, in both the departments of psychology and pediatrics. Dr. Chase completed a post-doctoral fellowship at Austin Child Guidance Center as well.

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Allison Chase, PhD, CEDS-S

Dr. Allison Chase is the Regional Clinical Director for Eating Recovery Center and Pathlight Mood & Anxiety Center in the Texas Region. Her areas of specialization include child and adolescent…

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