By Abigail Natenshon MA, LCSW, GCFP

Knowledgeable, proactive and collaborative parenting is a critical factor in insuring effective and timely ED recovery. Eating disorders are family system disorders, their behaviors taking place around dinner tables, in family bathrooms, in the course of daily living. Enlightened parents enjoy the potential to mentor the child, family, and team in facilitating an effective and timely recovery process. In seeking health professionals to work with the eating disordered child, parents need to find experts supportive to the notion that parents and families are MVPs on any treatment team, and who will encourage family participation in the healing process through the family therapy process.

This mother’s voice strikes a chord….

"All your life you love something. Because you love it, you take care of it. You know what you need to do to make it whatever it is. You know how to provide for it, change it, feed it, care for it. You know how to fix what has gone wrong. Then, something like this comes and you can't fix it no matter how hard you try. She doesn't feel she needs fixing or changing. And I can't fix it. So I feel frustrated, helpless, angry, guilty. I can't do anything about it when she feels so unhappy with herself that she hurts herself, or she takes laxatives. I can't stop it. Because I can't be there 24 hours a day, 7 days a week, wherever she is. I don't know how to help her."

After 41 years of a psychotherapeutic practice specializing in the treatment of eating disorders, I make it my business to come cheek to jowl with parents of child patients as soon, and as often as possible, as a diagnostic and treatment priority, for information gathering, knowledge sharing and the assurance of an efficient recovery for the child. What has stood out most significantly for me is that in cases where a child's past therapies have not resulted in successful outcomes, their parents were invariably, under-utilized as resources, unprepared, frightened and clueless about the disease, their child, and what it takes to heal, having been excluded from treatment and recovery process. It is time for things to change. Eating disorders are family diseases. Parents and families are the warp and weft of the fabric of a child's life, the holding environment and context for the process of emotional and physical development from childhood into young adulthood.

Too frequently, health professionals consider intervening parents to be interfering parents, admonishing parents for honesty and openness in communication, for commenting on the child's eating behaviors, for expressing concerns or wanting to become involved in the recovery process. Too many health professionals still subscribe to the myth that parents are to be seen and not heard, that their involvement represents an attempt to sabotage their child's budding autonomy. Parents are typically instructed to look the other way in an attempt not to notice this "elephant under the chair, to avoid discussion of food and eating, of the child’s progress in treatment, of the status of healing of this, the most lethal of the mental health disorders.

In the face of eating disorder treatment, I believe the child's health professionals need to prepare parents to prepare themselves to prepare their children for the recovery challenges facing them. Parents need to learn to identify problems-in-the-making and seek their resolution, to seek out and find the best professional care, to persevere side by side with the child in support of a typically convoluted and frustrating recovery process, to realize their own potential as treatment allies and child advocates, team collaborators and mentors, perceptive and keen observers, cooks and bottle washers, role models and teachers… pivotal figures in the recovery of the child that takes place within the context of daily living, 24/7. By default, parents are the most potent diagnosticians of a disease that rarely shows up in the doctor's office but more readily presents at home… in bedrooms, bathrooms and kitchens. In my extensive experience with eating disorder treatment, I have found parents to be willing, loving, well-intentioned, supportive, capable, and ready to resume the role in their child's life that has been stolen from them by a tyrannical disorder.

Eating disorders are a product of both Nature and Nurture. Both must be treated.

Food and eating are primal elements in life, attached to early nurturing, comfort, parenting and trust.  Food and eating can become a metaphor for the child's expression of beliefs and feelings, perceptions, self-esteem, self-determination and an early means of communication for the youngster who is yet reluctant or incapable of communicating in any other way. Eating disorders are clearly biological disorders whose origins lie in gene clusters as determined by generations of heritability; their triggers, leading to disease onset, are often an integration of environmental and biological factors, of life events and traumas, or pernicious messages sent by media or peers in a society preoccupied with thinness.  Though parents are not to blame for their eating disorder, positive environmental influences of home and parents can be powerful factors in offsetting the negative forces responsible for waking up dormant genes that set the ED in motion. Nature abhors a vacuum; by raising healthy eaters with enough identity and self-esteem to nourish and care for themselves, and with the capacity to face and cope with life and resolve problems with support through loving human connections, parents may effectively bypass or eliminate the need for the likes of an eating disorder in the child's emotional repertoire. And if an ED should develop, the parents’ involvement and capacity to reinforce the healthy connections and developmental messages of childhood can facilitate recovery.

When brought up to speed on the recovery journey and kept there, parents typically become “MVP's” on the child’s ED treatment team. Parent advocacy can be counted on to carry the recovery ball through the good and tough times. With recovery, children invariably contend that they have gotten their personality back, and parents contend that they have gotten their child back. It is simply not enough for parents to love their child. They must be prepared, ideally by the child's treatment professionals, to put that love into action…. to seek change, to expect nothing less than progress towards wellness and healing …. and to not stop till “they are there.”  If a parent is willing, it is for the child’s therapist to make sure that that is happens.

Parents need to become self-advocates in preparing themselves to become child activists

I encouraged parents to understand how self-advocacy is a prerequisite to parents becoming effective advocates for the child, the treatment team, the recovery process, and the overall quality of the parent/child relationship.

As informed consumers, it is for parents to

• Recognize their inherent rights as individuals, parents and partners in the treatment team
• To dare to have expectations
• To make appropriate demands through limit-setting
• And to be steadfast in seeing to it that their own, and their family’s needs are met.

Just as patient activism has become a means for sustaining eating disorder recovery, (preventing relapse), parental activism is what it takes to insure and facilitate the child’s healing. Eating disorders never stand still; they are either getting better or getting worse. Matching the nature and demands of these disorders, parents, like therapists, must seek movement in recovery that is intentional, directed, and tracked. It is this systematic tracking and response to the typically unpredictable and counterintuitive recovery dynamic that yields the most significant learning (healing). With eating disorders, parental love needs to become an action.

The most critical resource for parents is themselves; their most critical tool, the gentle and familiar art of listening…actively and purposefully, to:

• Themselves; to their own values, attitudes, and biases about food and weight management, and to the courage it takes to maintain a parental presence throughout the child’s recovery process
• Their child; to help the child listen to and better hear herself.
• Their child’s health professionals; to discover whether the professional is truly listening to them.
• The unique and counterintuitive nature of recovery; to comprehend and interpret it to the child, inspiring reassurance, motivation and perseverance throughout an extended and challenging process.

Parents need no instruction about how to respond when their child has cancer or diabetes; interestingly, they tend to lose their emotional balance, self-confidence, and faith in their instincts when confronting the adolescent life stage, eating disorders, their own personal issues regarding eating, exercise, and weight management, and the search for the best professional team.

Choosing the best professionals for your child

Finding the “the “right fit” for your child will need to feel like a comfortable fit for you. Your child’s health professionals will need to listen to and respect your voice, understanding that the quality of your connection with your child will be the best insurance of a timely recovery and the best hedge against relapse. By hearing and addressing your concerns, supporting your strengths and facilitating your partnership in the treatment team, professionals advocating for parents will role model effective parental advocacy for the recovering child.

Recovery from these diseases happens at home, under your nose and before your eyes…not in the doctor’s offices. Though the eating disorder shows up in the child, their most effective solutions are to be found within the family system. The psychotherapist you hire to work with you’re your eating disordered child will ideally have experience, expertise and comfortability in conducting sessions both individually and in the context of conjoint family treatment in managing these cases.

The time is now for parents to become apprised of what they have been doing RIGHT… to recognize and appreciate what they already know, and to become educated about what more they need to learn. Parents with eating disordered children all too frequently have forgotten what it takes to do what they do best…to care for their child, purposefully and proactively. They need to be reminded. Through seeking and finding the best health care professionals, parents will also discover parts of themselves… strengths and capacities that they may not have previously recognized… as well as their precious child who has been lost to them.

Be sure to read Chapter 5 in   When Your Child Has an Eating Disorder: a Step-by-Step Workbook for Parents and Other Caregivers for more in depth information.

“Reaching Out For Professional Help”  Page 133

If seeking health professionals to work with your child, you will find it helpful to read my article entitled:  

Finding the Needle in the Haystack:
Seeking Expert Eating Disorder Care-Providers

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