When a client begins eating disorder treatment, their parents often share a variety of concerns with clinicians:
· “When will she be fixed?”
· “I had no idea this was going on!”
· “How much weight will he gain/lose?”
All of these common and understandable questions reflect a fundamental lack of understanding about what eating disorders, how they function, and what treatment entails – none of which we would expect parents to come into the experience knowing.
Eating disorder clinicians know a big part of their job when working with families is providing that education and showing them what support for their child looks like at home in practical ways. They also trouble-shoot issues that arise while their child is in treatment, and try to set them up for success moving forward.
This support often happens in the context of family sessions while a client is in program and may continue to happen even after they’ve discharged to an outpatient provider. However, sometimes family sessions are met with resistance – from clients and parents – and the reasons are as varied as the families themselves.
So let’s take a look at some common experiences for family members while one of them is in eating disorder treatment, then explore how family support can help.
Common experiences for parents
Probably the most common experience for parents when their child enters eating disorder treatment (especially for the first time) is feeling completely overwhelmed. They may not understand why their child has been engaging in eating disorder behaviors or how it’s gone for so long without them noticing it. This is often accompanied by a decent amount of guilt.
As their child’s treatment goes on, they often feel confused and overwhelmed by the meal plan they are supposed to enforce at home, and frustrated when their child fights them on every meal, snack, or exchange. They report feeling more anxious or depressed as a result, as well as any number of the following struggles:
· A reduction in their quality of life
· A need to understand the causes of their child’s eating disorder, and frustration if it isn’t clear-cut (which it typically is not)
· Difficulty finding support for their child or themself
· Difficulty communicating about their child’s eating disorder to others
· Managing challenges with siblings around the eating disorder
· Having to reorganize their family life around eating disorder treatment
· Feeling inadequate to support or help
· Ongoing conflicts with their child
· Coping with their child’s distress
· Feeling scared about a potential relapse
If this feels like a lot to handle, it’s because it is. Supporting a child through their eating disorder recovery can be incredibly difficult. So can trying to figure out how to support their siblings.
Common experiences for siblings
Siblings of people with eating disorders (here, we are referring to the ones who still live together) often report a variety of feelings, including confusion about what’s changed with their sibling; sadness that they are struggling; and frustration or irritation about their sibling receiving more attention from their parents.
They report that mealtimes have become more stressful because their sibling often struggles to get through them or gets in power struggles with their parents. It’s common to hear them express fear or sadness around their sibling’s eating disorder, which often stems from not understanding it or worrying about them having to go to the hospital if the eating disorder worsens.
Siblings may respond in different ways to feeling overlooked or neglected by their parents, including becoming angry and lashing out at their parents or sibling, or retreating and
holding in what they’re feeling because they think their sibling’s needs take precedence over their own.
How people with eating disorders experience their family’s reactions
Clients themselves are often aware of their parents or siblings’ feelings around their eating disorder and recovery process and carry guilt about the impact it’s having on them. They may also feel helpless to do anything about it since trying to overcome their eating disorder feels like such an insurmountable task on its own.
If their parents are angry and critical of them around their recovery, they may internalize these feelings, which tends to deepen their sense of guilt and shame. This has also been shown to negatively affect treatment outcomes.
All of this paints a very complicated and perhaps negative picture of families in this experience, but that is where family therapy can make a big difference.
How family therapy can help everyone when eating disorders are in the house
Having someone outside the family system who can help everyone navigate their individual feelings and experiences and figure out practical changes that can improve day-to-day life in the home can be a real game-changer.
When a client is in treatment, having regular family meetings with the client and parents provides a safe space for everyone to be heard, for education to be provided as needed, and for solutions to be worked out collaboratively. The therapist can also help set realistic expectations on both sides, teach more effective communication skills, and identify ways that each person can better manage their own feelings and behaviors.
After a client discharges from a program, continuing to work with a family therapist allows them to receive ongoing support in managing the issues that inevitably arise during long-term recovery efforts. Siblings can also attend these sessions, as appropriate, which is a good place for them to be heard and their feelings validated in front of the whole family. Regular family sessions ensure that problems are quickly addressed, shifting the family’s focus to solutions rather than allowing time for resentment to build amid unresolved or unspoken frustration.
Additionally, having a family therapist monitor the wellbeing of each family member allows them to make recommendations for other support as they see needs arise (such as individual therapy for a sibling). They will also be able to gauge the client’s recovery efforts and get ahead of potential relapses – or recommend a higher level of care if the client demonstrates that need.
Eating disorders impact an entire family, so family therapy is an important way to help each person through the recovery process.
Reference: https://journals.sagepub.com/doi/full/10.1177/1066480722112589
