By: Kipling Rasmussen, PhD
Although the origins of eating disorders are complex and multifaceted, the family can be one of the most important means to intervene in the lives of clients suffering from these difficult problems. What nearly all family members of eating-disordered clients want to know is how they can help in the healing process. Here are some of the most important ways (though certainly not all) therapists can approach the families of eating-disordered clients.
The most basic form of intervention is to help families understand the vast complexity of the disorders. It may take three or four sessions just to help families become familiar with the intense self-hatred, depressive thinking, and almost total preoccupation with food, calories, weight and general appearance their daughters display.
Families find it hard to believe that their daughters can hate themselves so utterly. It is also difficult for them to understand that this intense self-loathing makes it extremely difficult for their daughters to “just eat”. Therapists need to impress upon the family how important it is to look beneath the “distraction” of the eating disorder and examine the emotional turmoil driving it. Uncovering “what is really going on” is a constant theme in treatment with eating-disordered clients.
It is typical for clients with eating disorders to have felt rejected, unworthy, unacceptable or friendless as children. These clients were often called names ridiculing their physical appearance. Feeling this rejection, they often learned to channel all their efforts into overcoming inadequacy – into looking a certain way, invariably thinner. Derogatory comments about body were damaging enough if they were made by peers at school or in the neighborhood. If they were made by older siblings or parents, the effect can be much more devastating. These pervasive subterranean feelings of unacceptability are not easy for parents to keep in mind as they watch their daughters struggle with eating disorders for years on end. Therapists need to help the family understand where this self-hatred came from and recognize that what their daughter needs more than anything else is acceptance, warmth, and love from all family members.
Emphasis on Appearance
Many families of clients with eating disorders emphasize dieting, calorie counting and appearance. There is often considerable talk about and monitoring of the amount and type of food eaten around the family dinner table. This can be extremely “triggering” for the client with an eating disorder. In fact, other family members may also be flirting with moderate to severe eating disorders as well. Therapists should broach these topics in family therapy and help the family understand the effects that preoccupation with appearance and calories can have on all family members.
With anorexic clients, family emotional boundaries should be examined. Clients with anorexia often grew up with feelings of responsibility for their parents’ emotional well-being, especially that of their mothers. Frequently, these mothers suffered from a chronic physical or emotional illness and the sensitive young daughter felt she was the only thing preventing her mother’s death. As she grew up feeling like the caretaker, she often felt like the emotional nurturing she craved was being denied her. Now that she is older, the only way she may know to receive emotional nurturing is for her to be in the “sick role”. In addition, the anorexic client may have often repressed her feelings for the sake of the “good” of the family. The families of anorexics are frequently very close. They have usually worked hard to be good families and give each other everything that they need. Somehow, this feeling of caretaking each other in the family leads anorexic girls to submerge their feelings in the service of other family members. Therapists need to help these clients meet their emotional needs in healthy ways. The family may have to learn to allow the client to separate somewhat from the family emotional process. The family should begin to allow her to express her needs and feelings, even if they differ from the family “party line”. The client may also need to express the anger and hurt she may be harboring about feeling emotionally abandoned as a child.
While anorexic clients often feel too emotionally close to their mothers, clients suffering from bulimia often feel abandoned by their fathers. These fathers are frequently caring, responsible men but, over the years, were often preoccupied by work or other activities. In addition, many men may have had great difficulty showing their daughters how much they loved them. In fact, the binges of bulimia are often described as attempts to fill the emotional void created by their longing for nurturing from fathers. The fortunate thing is that these fathers are frequently eager to spend time with their daughters and to try to make amends for this perceived distance over the years. Therapists usually need to give very specific “nuts and bolts” ideas about how to accomplish this reconnection on a daily basis.
Sibling Rivalries and Resentments
One of the most helpful and easily approached ways to intervene with families is through siblings. As mentioned, brothers and sisters, as children, often made comments about the client which then became a part of the client’s emotional life. Later however, when all siblings are in their teens or older, they usually feel only overwhelming love for their sister. When clients ask their siblings why they said hurtful things to them when they were little, the siblings are often mystified that the client has kept these things in her mind for so many years. The siblings themselves have usually long-since forgotten these comments. Therapy sessions with these siblings almost invariably allows the client to express her age-old hurt and provides a way for the siblings to both apologize and express their love. Clients often come away from these sessions with a sense of profound relief, since so many of their fears and anxieties about what their siblings thought about them over the years have evaporated.
Interacting With Food
Parents are often eager to know how to interact with their daughters if the eating disorder resurfaces. The therapist should help the family understand that they have very little power to control what their daughter eats. Parents are not the eating disorder police. Their interaction around food should be neutral, that is, food is not the enemy, nor is it the cure for the emotional problems their daughter is experiencing. What parents can do is be there to help their daughter when she asks for it. In the meantime, they can reach out to their daughter with love, acceptance and respect for her individual ways of expressing herself.