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On the last track, we discussed three manifestations of anger in anorexic clients. These three manifestations of anger in anorexic clients included: repression; acting-out; and defense mechanism.
On this track, we will examine three difficulties in employing the family of an anorexic client for treatment. These three family treatment difficulties include: inability to dissociate; eating strategies; and allowing for client independence.
As you are well aware, much of the literature and research involving anorexia nervosa cites family therapy as one of the most effective treatments for the disorder. This results from several criteria. For one, the family provides a constant monitoring system which can regulate the client’s emotional and eating patterns while providing an objective view of his or her behavior.
Specifically, the Maudsley model provides a basic and the most well-known format for treatment. The Maudsley model was first tested as a means of preventing posthospitalization weight loss in different subgroups of anorexia nervosa clients in a study by Russell, Szmukler, Dare, and Eisler in 1987. The study yielded several striking results. In the subset of younger clients with more recent onset, conjoint family therapy produced an impressive rate of recovery, 90% symptom-free at 5 years.
3 Difficulties in Employing Family for Treatment
Difficulties #1 - Inability to Dissociate
However, when a parent or sibling cannot dissociate, he or she becomes a risk to the client and to themselves. They may begin to interpret the client’s inability to recover as stubbornness or ungratefulness. Obviously, this poses a risk to the client and his or her support system.
Dana, age 15, had developed anorexia and weighed 85 pounds. Prior to being recommended for treatment by her high school counselor, Dana’s parents had attempted to break her of her self-starving behavior with little success. Her parents, Harold and Tisa, were of the belief that any problems arising within the family should remain in the family. However, because they could not force their daughter to eat, they became frustrated and began to belittle and bully her into eating.
According to Dana, Harold would say numerous times, "You’re sick and damaged! Why are you doing this to us? You are so selfish!" As you can see, Harold had interpreted Dana’s refusal to respond to treatment as a personal attack in the form of teenage stubbornness. Think of your Harold and Tisa. How do they interpret their son or daughter’s actions?
Difficulties #2 - Eating Strategies
Technique: Eating Contract
To help Christine and Mark gain consistent control of Molly, I suggested they write up an "Eating Contract." This contract will stipulate the exact food groups and gram sizes that Molly must consume in a single meal in order to be excused from the table. I asked Mark and Christine to write up the contract and to have Molly sign it willingly.
One stipulation of the contract stated that Molly could not move from the table until she had finished all of her meal on the plate. This contract was not only for Molly’s benefit, but for Christine and Mark’s as well. By giving themselves a set of guidelines to follow, they were less likely to give in to Molly’s requests.
Think of your Mark and Christine. Could they benefit from an "Eating Contract?"
Difficulties #3 - Allowing for Client Independence
Brittany, age 19, had reached a healthy 110 pounds, and wanted permission to live in the dorms of the local community college. Her mother, Georgia, refused, stating, "She may slip back into it! I don’t want to lose my baby at the age of 21." Unknowingly, Georgia may worsen Brittany’s condition by restricting her independence. Without the reassurance of her mother, Brittany may in fact believe that she is unable to live on her own.
To ease Georgia’s mind and allow Brittany her independence, I suggested a weekly home visit. Each weekend, Brittany would return home for Sunday dinner, during which she would share with her parents her feelings and concerns about school and her parents can simultaneously gauge Brittany’s eating habits. Think of your Georgia. Is his or her need for control affecting the client’s ability to function outside of the home?
On this track, we discussed three difficulties in employing the family of an anorexic client for treatment. These three family treatment difficulties included: inability to dissociate; eating strategies; and allowing for client independence.
On the next track, we will examine three concepts related to redefining identity in anorexic clients. These three identity defining concepts include: exposing the false self; allowing the self; and self-neglect.
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