And the Role they Play in it

By Abigail Natenshon, MA, LCSW

Things you may not know about eating disorder treatment

If the child’s underlying behavioral and/or emotional issues resemble or roughly approximate those of an eating disorder, or if the dysfunctional behaviors you observe in your child are similar though not precisely as described in the DSMIV diagnostic manual, the treatment protocol should follow that of the clinical eating disorder.

Parents of eating disordered children and the professionals treating them must be careful to distinguish general psychotherapy from eating disorder therapy; they are not the same thing. The requirements of eating disorder treatment are unique and must be treated by professionals who are experienced and expert in this specialty. Generic psychotherapy tends to overlook the lethal behaviors that underlie these disorders; strictly behavioral treatment tends to overlook pivotal underlying emotional issues driving the disorders as well as the power of the quality therapeutic relationship in bringing about healing.

But they said "It's Her Treatment, Not Yours"

You've probably heard this warning before: "It's his or her treatment, not yours." "Stay out of your child's affairs, disease, treatment, food," you might have been told. “You'll only make matters worse.” One parent testified to me that things did get worse when she discussed eating with her child. "I needed to back off totally," she said, "and refrain from ever mentioning food to show my son that he could be in control of himself and to let him know that what he does, he does for himself, not for me."

The issue of parental involvement is complex and a function of factors such as the age of the child, the stage of recovery, the availability of parents, the quality of the parent/child relationship etc.  Hopefully, the therapist’s competence in treating parents and families together, in conjoint family treatment, would not preclude that option. When parents need to back off will depend on the capacity of the timing of the child patient’s readiness to progress in recovery without assistance or active support. 

The child’s needs are the best determiners of the parental role. While your child is consumed by the disorder, he or she is less able to exercise the self-regulatory aspects of self-care; with accruing recovery progress the patient will benefit from an increased autonomy permitting self-regulation and determination. However, if you opt for a hands-off posture prematurely, before your child is capable of responding appropriately to and for himself, you may be doing him or her disservice. Without your input (s)he may choose not to recover at all, or may flounder about in the recovery process.

Don't expect to put your head on your child's shoulders in an effort to force him to see things as you do. Your adult child’s treatment choices must be his own, but this does not mean you should be without a voice.  He or she needs to hear from you about your ideas, your concerns, your values, and how you might approach this problem, even as (s)he makes his/her own decisions and determines his/her own course of action.  Your input now will teach him to function well without you later. 

Your young child who has not yet reached the age of consent relies most heavily upon your values, teaching, support and input.  As a parent, you are your child’s educator, responsible for guiding him or her through developmental tasks and life stages; it is for you to teach her to face and resolve problems, strengthening values and external controls until such time as she is capable of resuming her own responsible self-direction.

Even if your input does little more than evoke opposition, at least you will have stimulated some self-awareness and perhaps helped your child face certain difficult issues, whereas a passive response to an active disease can inflame and enable the disorder.

If you or your child are entering eating disorder treatment, it is important that you understand the following basic tenets of eating disorder treatment:

1. An eating disorder is essentially a device designed to solve problems and insure emotional survival in the world; though its intentions are noble, its functions are harmful and potentially deadly. Eating disorder recovery results in more effective and less harmful ways to accomplish life goals. Eating disorders are not addictions, though they behave as such; these disorders are completely curable with effective treatment in 80% of cases.

2. Eating disorders are integrative disorders that are best treated by an integrative and collaborating multi-disciplinary team of experts specializing in individual and family therapy, nutritional counseling, and medical and psychopharmacological aspects of care. Patients and parents need to be collaborating members of the treatment team.

3. The eating disorder practitioner helps to set and achieve goals that may yet be unknown to the patient at the start of treatment. The eating disorder treatment and recovery processes are learning processes. In recovery, weight loss or gain becomes secondary to the patient’s ability to develop the internal resources and emotional resiliency he or she needs to nourish oneself healthfully enough to develop a healthier relationship with food. A person’s relationship with food becomes a metaphor for self-care and problem-solving. A discussion of eating behaviors, as well as the cognitive and emotional issues that reflect or evoke them, needs to be part of the fabric of every treatment session.

4. If you are currently, or have been, engaged in treatment that has been less than successful, your next treatment experience needs to be different, turning the process around for you. It is up to you to make sure that this happens. Your treatment goals need to become change-centered, action-focused and outcome-based; your therapist needs to be directed and intentional, skilled in cognitive behavioral techniques as well as in connecting with you within mindful, psychodynamic treatment.  That person needs to give you a sense of confidence and trust, in himself or herself, in your, and in the treatment process.  Trust your own instincts in your choice of your team. As a consumer of these services, do not be afraid to get your questions asked and answered, your concerns addressed.

5. Eating disorder recovery successes are often camouflaged in what might appear to be "failures," so don't be discouraged along the way; just keep moving forward, maintaining realistic expectations for recovery. Though progress may be slow, expect to experience changes, even if small, from the very start of treatment and throughout care. Every mistake, every failed effort, every session should provide fodder for learning and change and be a source of empowering self-understanding. Expect eating disorder recovery to feel worse before it feels better; it is anxiety-provoking for an anorexic person to restore lost weight, but in the end, re-feeding the malnourished brain is the best “medicine” for reducing that anxiety.

6. As collaborating members of the treatment team, the choice and pace of recovery belongs to the patient…. unless, of course, he or she is at physiological risk. Be aware that an eating disorder temporarily strips it victims of the judgment and capacity for self-care. Under dire circumstances, eating disordered individuals need to put their care in the hands of others, until such time as they can resume responsible self-care.

7. Everyone with an eating disorder needs to be under the care of a medical doctor. Eating disorders are the most lethal of all the mental health disorders and require careful vigilance.

8. It is up to patients and parents to hold treating professionals accountable for accurately and fully diagnosing and medicating co-occurring conditions and mood disorders. Impulsive behaviors connected with bipolar disorders may typically take on the appearance of addictions or ADHD. Be aware that to miss an accurate diagnosis of a mood disorder diminishes the opportunity for a complete diagnosis and eating disorder recovery and for appropriate medications capable of greasing the path to healing.

Psychotherapy Is About Making Changes

Change develops out of ferment and signifies the breaking apart of an old system. A potent diagnostic and treatment tool, change indicates where the patient has been and where he is going; its rhythm sets the pace of treatment. The goal of change through eating disorder therapy is not for the patient to be “right” but to become flexible and emotionally versatile, developing the wherewithal to more effectively cope with life’s adversities.

The mark of a successful treatment process is change in behaviors and thinking, whether it takes the form of a bold epiphany or a small “tweaking,” perceptible only to the patient. All change begins with one small step. The cumulative impact of small steps may not be apparent at once, though you and your child should become aware of changes of various sorts and degrees almost immediately with the start of treatment. Behavioral changes will generally be easier to discern than those confined to emotional expression. With patience you will observe your child's small steps grow into big ones, along with the melding of behavioral and emotional changes in an integrative wholeness that describes recovery.

Note that even small changes may evoke big anxieties in your child… minor alterations will lead to potentially large and sometimes unsettling, consequences. It is important to stay mindful of the fact that normal eating disorder recovery progress often takes on the look of failure, so don’t become prematurely discouraged. Your courage and support through the tough times will be very much appreciated by your struggling child.

North American Serial Rights 2011