The Parents’ Role in their Child’s
Eating Disorder Recovery
By Abigail Natenshon, MA, LCSW
Gathering Knowledge for Effective Response
Eating disorders are multi-dimensional disorders that require integrative
and highly specialized treatment.
Because eating disorder pathology impairs every aspect of the
patient’s physiology and emotional development …including brain chemistry
and function, cognition and concentration, nutrition, mood, behavior,
interpersonal relationships, and the capacity for problem-solving and
self-regulation…a complete healing needs to be a comprehensive healing,
addressing and repairing all of these processes. In seeking treatment for a
child with anorexia, bulimia, binge eating disorder, or EDNOS, (eating
disorder not other specified) a parent’s first responsibility is to
recognize and respond to this crisis that has befallen child and family,
finding resolution in specialized professional care.
Generic psychotherapy overlooks the
immediacy of the need to extinguish potentially lethal behaviors that
underlie and perpetuate these disorders; strictly prescribed behavioral
treatments overlook the pivotal underlying emotional issues driving these
disorders, often ignoring the power of the quality therapeutic relationship
to motivate healing.
The Importance of Parental Involvement in Treatment
Eating disorders are never stagnant; they are either getting better or they
are becoming more deeply entrenched. Response requires taking action,
without delay. Despite this,
parents are typically warned to "steer clear” of their child's eating
disorder, food intake, treatment and recovery, for fear of making matters
worse; “It's her treatment,
not yours.” One therapist advised a mother to “back off” when her son
became a binge eater to demonstrate her faith in his ability to be in
control of himself, to let him know that “what he does, he does for himself,
and not for me.” What she failed to
understand is that informed parental involvement is not
synonymous with interference, and that in the face of an eating
disorder, the child’s malnourished
brain and disregulated personality is not emotionally or cognitively
prepared to assume self-control.
The appropriate degree of parental involvement will be dependent upon the
child’s physical condition, age, life stage and developmental status,
motivation to heal, recovery status, quality of parent/child relationship, a
parent’s emotional and geographic availability, and the therapist’s
willingness to be inclusive. Paralleling
the ever-changing needs of the afflicted child,
the nature of parental support will change throughout the healing process,
diminishing with the child’s increasing capacity for self-care. It is only
after a disordered brain becomes sufficiently re-fed and a healthy
relationship with food is re-established that the patient becomes free to
engage optimally in treatment, setting the stage for parents to step back
safely, gradually and with sensitivity. Where parents prematurely opt to
assume a hands-off policy, the child
is more apt to lack the wisdom,
incentive, support and skills required to heal, and to choose not to
recover at all.
Staying Alert to Recovery Challenges
The path to recovery is never clearly defined. Beware the inevitable
pitfalls that line that path.
in misconceptions, eating disorders are difficult to comprehend; it is not
uncommon for patients, parents, and even some health professionals to
believe that eating disorders are incurable, that parents are the cause of
their child’s disorder, or that disordered behaviors will respond to will
power alone. In
fact, eating disorders are completely curable in 80% of cases where
treatment is timely and effective.
· Beware of the widely held belief that weight restoration alone, (though
essential to physical and mental health) is the definitive standard for
measuring eating disorder recovery.
Healing is a learned process
that occurs through self-awareness and self-discovery, the result of the
patient’s efforts to restore or regulate weight in accordance with the
body’s self-determined set point.
The acknowledgement and growing trust in one’s own internal resources and
emotional resiliency marks the return of the previously exiled Self.
emotional versatility and effective coping
mechanisms that signal eating disorder recovery applies to all life spheres.
· Eating disorder recovery essentially occurs throughout the course of daily
living and within the context of the family system, 24/7, at home, in
kitchens and bathrooms, at restaurants and gymnasiums. As
models of healthy values, problem solving and lifestyle, it
is a parent’s responsibility to
guide and mentor their child’s emotional and developmental tasks throughout
the life stages… tasks that essentially define
eating disorder recovery. It is the
responsibility of therapists to involve and inform parents. Therapists have
limited and temporary access to the recovering child; parents never stop
· Challenges for parents appear at every stage of a child’s disease and
recovery. As the suffering child becomes increasingly withdrawn, secretive
and irritable, parents tend to lose confidence in their capacity to know
what to do, and to say, in response to the child who increasingly becomes a
stranger to them. The process of
recovering feels worse (more anxiety provoking) to the child than does the
disease; positive recovery changes
are often not discernable in a child’s behaviors, and are often camouflaged
in what appears to be ‘failed attempts’ at recovery tasks; a
recovery that is not complete is a partial, or managed recovery, that can be
anticipated to end in relapse. A parent’s
understanding and communication about the counterintuitive nature of
recovery is the best antidote to countering a child’s recovery resistance,
unrealistic expectations, and/or hopelessness.
· Despite reaching the age of consent and one’s right to privacy offered
through HIPPA laws, afflicted teens, young adults and grown children living
away from home also benefit from a parent’s clear voice of concern and
guidance. In some instances, parents may be able to provide incentives to
heal, or may assist by advocating with insurance companies for treatment
coverage, or by researching hospital programs and other community resources.
A passive response to an active
disease can only enable pathology.
The Importance of Finding Truly Expert Care
As consumers of possibly the most important function in their child’s life,
parents need to evaluate professional caregivers carefully before choosing
the best one for their child and family.
The initial phone conversation offers a great deal of information to
those parents who are savvy enough to use that vehicle productively. It is
critical to assess a candidate’s knowledge of eating disorders, treatment-
and relationship- style, and willingness to embrace parental input through
family therapy. If at any point the treatment relationship ceases to evoke
trust in the therapist, the healing process, and in ongoing positive change,
it may be time to look elsewhere for more effective treatment. No one knows
a child and his needs throughout this process better than does a parent.
During initial contacts, the therapist needs to generously offer information
and education to patients and parents alike, explaining
what eating disorders are about, their origins in
biology, and their implications for the child; their unique treatment
requirements and optimistic expectations for recovery; and the importance of
an ever-changing, supportive role of parents within the recovery process.
Eclectic in skills and methodologies, versatile in the use of self within
the therapeutic relationship, and skilled in cognitive-behavioral protocols,
therapists model and fortify the role of parents in their child’s healing;
through conjoint family treatment and professional coaching, they provide
answers to questions asked, as well as to those not yet formulated.
The eating disorder practitioner fosters the
recovery process through a behaviorally based, change-centered,
outcome-driven ongoing treatment plan, motivating and inspiring the healing
process through the quality of the therapeutic connection with both child
The mark of a successful treatment process is ongoing positive change… in
eating and in behavior, in cognition and in emotions,
in judgment and relationships, in problem solving and self-awareness, in
self-regulation and self-esteem.
Indicators of various types of change should be sought within
the fabric of each and every treatment session.
Therapists need to be directive, intentional, and vigilant of the patient’s
ever-changing level of physiological risk, offering options for the use of
psychopharmacological medication and/or alternatives for more restrictive
treatment venues for those patients who are unable to continue to make, or
sustain, positive changes throughout the full course of treatment.
It is critical that parents hold the professional team responsible for
facilitating continuing change and improvement in their child to the point
of a complete and sustainable recovery. As active members of the treatment
team, parents enhance the recovery process by offering pivotal input,
support and feedback at critical junctures during treatment, particularly at
times of recovery stagnation and regression. There is no better support for
treatment or therapist than what an informed and motivated parent can
North American Serial Rights 2014