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April 23, 2009
Family therapy – the treatment of more than one member of a family in the same session – is based on the idea that an emotional disorder in one person may be just the tip of the iceberg, hinting at problems with the way the family operates as a whole. The eating disorder will only get better if the whole family system can change.
(In family therapy, the “patient” is really the family itself; the girl with the poor eating habits is sometimes known as the “symptom-bearer.”)
The family approach looks at the disorder as a kind of nonverbal message from the patient. The symptoms are her reaction to problems in her family relationships.
In therapy we ask, “What function does the behavior serve in the family context?” That seems like an odd question, but it’s really not.
You see the trap. Sometimes, as dangerous as it is, an eating disorder can actually stabilize a family. When that happens, the disorder can become even more entrenched. The longer the illness persists, the worse it gets, and the more focus it gets from the family.
Goals of family therapy
As with any treatment, the first task is to help the patient break her abnormal eating pattern. Family members can support her better if they learn the facts. Part of therapy, then, involves educating other members about what’s going on. Once that’s done, the family can shift its focus away from the symptoms and onto the deeper issues.
We then work to change the harmful ways the family interacts. We help parents to pull back, to disentangle themselves. In doing so, they help their daughter develop her sense of autonomy. They also help themselves by shifting responsibility for the illness to where it needs to be -on the patient.
In therapy, we try to shore up the good things the family does and curb the bad things.
Often, family members find that they suppress huge chunks of their personalities when dealing with one another.
Sometimes, getting rid of these masks is hard because families have become so rigid. In this sense, the patient is a “victim of tradition.” Therapy helps families loosen their grip on the past and concentrate on the here and now.
The exact goals of therapy depend somewhat on the patient’s age. When the patient is under eighteen, we usually focus on the parents. We want them to work together to combat the illness. With an older patient, we concentrate more on her need for autonomy. Our aim is to help her separate from her family and live life on her own.
Through therapy, a patient takes control by changing her relationships with others in the family. She learns she can’t “protect” her family through her illness; she also learns how to get others to stop being so protective of her. She sees new sides of her family members’ personalities. If the patient is married, we need to work on marital issues as well as her eating problems.
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