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On the last track, we discussed three concepts of obsession in anorexic clients. These three concepts of obsession in anorexic clients included: obsessional behaviors; abbreviations; and internal withdrawal.
On this track, we will examine three components of the anorexic member’s effect on the family dynamic. These components of the anorexic member’s family dynamic effect include: negative familial reactions; polarization; and sibling rivalry.
3 Components Effecting Family Dynamic
Component #1 - Negative Familial Reactions
This denial elevates parents’ expectations of their child as compared to those for a "normal" child. It turns sadness about their child into annoyance, anger, and rage. These feelings also confuse the diagnosed client, who then withdraws more deeply into the illness for protection.
Rachel, age 15, had reached a staggering 77 pounds before her school counselor decided to refer her to therapy. Her parents, Lillian and Michael, were both negatively predisposed to therapy and counseling, especially in the case of a family member. Lillian stated, "There’s nothing wrong with our daughter! She’s perfectly healthy in mind, she just needs some discipline. Mental illnesses run in families and my family has a clean bill of health. So does Michael’s."
Lillian was in denial about her daughter’s illness and as a result, Rachel could not receive the support she needed from her parents. Think of your Lillian and Michael. Do they have a negative preconception to therapy?
Component #2 - Polarization
They have a difficult time believing that their son or daughter is involved with such unreasonable, irrational, "crazy" behavior. The family can become divided on the best way to handle the anorexic family member. While one side of the family may wish to be more aggressive and forceful with the anorexic members, the other side wishes to approach the client with more loving and less aggressive manners.
Jeanie, age 15, had been diagnosed with anorexia. At five-foot four, she weighed about 95 pounds. Her father, Jeff, believed in a hardline approach, forcing her to eat and scaring her into submission. Her mother, Heather, however, tried to be compensate for Jeff’s harshness and allowed Jeanie to eat much less.
Heather stated, "I just see how difficult this must be for her and I’m just trying to make it as easy as I can. If it’s too difficult, she may just give up." On the other hand, Jeff stated, "But if we keep allowing her to continue this behavior in any way, she may just get worse! What’s gonna happen when she wastes away!?" This extra tension within the family often causes anxiety in the anorexic client who fears the dissolution of his or her support system.
Think of your Jeanie. How is the conflict in his or her family affecting his or her disorder?
Technique: Parental Team
While Jeff had adopted the "tough love" philosophy, Heather wanted to kill Jeanie’s anorexia with kindness. I asked Heather and Jeff to come up with a list of rules that they would employ when Jeanie’s anorexia began to control her behavior. For instance, when Jeanie would ask them to leave the room so she could eat, Heather and Jeff both agreed to kindly but firmly refuse to agree to her demands. Heather stated, "We realized that we weren’t giving into our daughter, but rather to her illness. And Jeff also had to remember that this was our daughter we were dealing with. We had to compromise between firm decisions and a loving response."
Think of your Jeff and Heather. How could they form a Parental Team against their son or daughter’s anorexia?
Component #3 - Sibling Rivalry
The siblings may become abusive to the client as a result of this fear, which will quickly turn into jealousy. They may attempt to prove to the parents that they are the best children, and the parents should not spoil the client for being "stubborn" about eating and weight. This extra abuse from a sibling weighs down the anorexic client and causes extra distress.
Amanda, age 16, weighed 85 pounds when she was referred to me by her high school counselor. Amanda was the third child of seven in the family. Because of the severity of her condition, her parents, Jack and Suzanne, focused all their attention on Amanda. This provided a good support for Amanda in her time of need, but the other six children felt that they were being neglected. As a result, the other siblings formed a union against Amanda, believing her to be an "attention-hog" and a "drama queen."
They began to taunt and tease Amanda about her weight which caused her to go into further depression. Even the support of her parents was no match for the insults of six children. Her condition began to spiral out of control and Amanda lost another 10 pounds before I decided to bring in the other children and their parents for a private session. I stated to them, "Amanda tells me that the rest of you are making it quite difficult for your sister to get better. She says you make vomiting noises when she is in the bathroom and you leave pictures of skinny models around her room. Why are you so bent on preventing your sister from improving?"
The second eldest, Jim, age 17, stated, "Amanda really doesn’t have a problem. She just loves being in the spotlight and because she doesn’t have any talents, she loses weight." Because of his outspoken nature, I realized Jim was the leader of the onslaught against Amanda. I held up a picture of her before the onset of anorexia and after. I stated to Jim, "Your sister is 45 pounds underweight. Her hair is falling out and her teeth are beginning to rot. Her anorexia is making her sick. Fatally sick. If she continues to lose weight, she may very well die."
Although this method may sound extreme, siblings such as Jim respond well to these displays. They realize the severity of the situation and may become more supportive or at least less aggressive, towards their sibling. Think of your Amanda. Does he or she have siblings that are making recovery a difficulty?
On this track, we discussed three components of the anorexic member’s effect on the family dynamic. These components of the anorexic member’s family dynamic effect included: negative familial reactions; polarization; and sibling rivalry.
On the next track, we will examine three different exceptional situations with anorexic clients. These exceptional situations include: the chronic adult client; stressors and enablers; and very young clients.
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