When an eating disorder strikes an individual, his or her entire family is affected. According to an article by Abigail Natenshon, MA, LCSW, GCFP, 87% of eating disorder patients are children and adolescents under the age of 20. As many in this age group still live at home, the eating disorder develops and plays out within the family dynamic. It often takes on a life of its own and can be the cause of many battles at meal times, family gatherings, holiday events, and can even affect extended family and school environments. Family therapy is an essential part of eating disorder treatment and is necessary to ensure everyone who is a part of the family system is cared for.
The Family System Theory
Developed by Dr. Murray Bowen, family systems theory posits that the family is a unit and the emotional connections fostered by thoughts, feelings, and actions create an interdependent environment. This interconnectedness helps the family to become cohesive and supportive of its members. If there is unrest and tension, emotional connections can become more stressful. If there is a member of the family who tends to take on the emotions of the other members and may take on an accommodating role, leading to overwhelm and isolation. This is the family member who may become more susceptible to addictions, depression, anxiety, eating disorders, and illness.
There are eight concepts to the family systems theory:
- Triangles: A three-person relationship system
- Differentiation of self: Variation in how people are susceptible to pressures to conform to the group
- Nuclear family emotional system: Four basic relationship patterns (marital conflict, dysfunction in one spouse, impairment of children, emotional distance)
- Family projection process: The way parents transmit their emotional issues to children
- Multigenerational transmission: Differences in differentiation across generations
- Emotional cutoff: Managing emotional issues by cutting off family members
- Sibling position: Impact of sibling position on behavior and development
- Societal emotional process: Emotional systems govern behavior on the societal level
Family systems theory can be used to help clinicians understand the dynamics of the family presenting to work through one member’s eating disorder.
Family Involvement in Eating Disorder Treatment
Comprehensive treatment plans at all levels of care will involve family therapy. Center for Discovery residential programs involve the family weekly in a therapeutic way, not only in family therapy but also at meal times by facilitating therapeutic family meals. The purpose of these activities is to observe family dynamics at meal times and in social situations in order to best prepare the family for realignment and a return to balanced interconnectedness.
Some clients benefit from a type of family therapy called Family Based Therapy (FBT, also known as Maudsley). This outpatient approach, which places the refeeding process in the hands of the parents and moves the family through phases of treatment as recovery develops, has proven to be very successful for adolescents with anorexia.
In outpatient settings, family therapy is usually recommended in conjunction with individual therapy, nutrition services, and group work. As the eating disordered member reintegrates back to the system after being away at treatment, therapy is needed to help the family adjust once again. An eating disorder has the potential to isolate family members from one another, create discord in the system, and indeed can be either sustained or eliminated depending on the dynamics of the family system. It is important for clinicians and parents to know that parents do not cause eating disorders. The entire system needs attention and support to thrive again.
Natenshon, A. Family Treatment is Cornerstone of Effective Care for Eating Disordered Children. Treating Eating Disorders, www.abigailnatenshon.com
The Bowen Center for the Study of the Family. www.thebowencenter.org
I have seen so many of my own patients with Eating Disorders (ED) struggle with how to move beyond the Stage of Change in recovery : “I know I have a problem but not willing to do anything about it ” and get to the Stage of Change: ” I know I have a problem and I am willing to do everything I can to get better”.
With my patients who tell me that they can’t get better, they won’t get better or they don’t even really have a problem, I have noticed a few things:
- GREY MATTERS: The majority of people that have the disease of an eating disorder think in absolutes. Black and White. I am either fat or thin. I have no control or I am in total control. I have to do everything perfectly or not at all.
- They feel they can not survive life without their Eating Disorder. They believe that if they choose to start recovery they will lose all control, their voice, their protection, their identity and their purpose in life.
- They believe that if they do not have their ED they will no longer be successful, fulfilled, special and worthwhile.
So to be able to get to the next stage in recovery, one must believe:
- That they are capable of anything they put their mind to. Someone with an eating disorder is a very determined and capable person. Perseverance is key.
- Their ED has begun out of some form of unmet need. They need to learn to be able to fulfill their wants and needs out of assertiveness, determination, perseverance and creativity.
- They are capable of change. They are not made of stone, but of soft clay that they can continue to mold, sculpt and make into their best selves.
As a therapist, my role is to never give up on finding a way to communicate these truths, to motivate them to take risks and to take one baby step at a time.
I think of the “little engine” who despite it’s limitations, never gave up, believed in it itself and always had someone cheering him on.
Heather Baker, LCSW, CEDS
What is perfection? Current society would have us believe that it is the Stepford Standard, that anything less than keeping up with the Joneses makes us substandard, less relevant, not good enough, or just plain not enough. Webster’s defines perfection as “having all the required or desirable elements, qualities, or characteristics” and “completely free from faults or defects”. Maybe it’s just me but I feel like these definitions are in conflict. Why can’t I have all the required or desirable elements, qualities and characteristics, AND still have faults? Why can’t I be perfectly imperfect? Perfection can be found in the faults, in the quirks that make us who we are and the experiences that we grow from that have been less than perfect.
Is it even possible for anyone or anything to be truly perfect (i.e., without flaws)? Rationally, I think most would agree that it’s not. Rationally, we know that it is part of the human experience to be flawed, to make mistakes, to rise from the proverbial ashes. But how can we rise if we’ve never been burned? Rather, in perfectionism we are consumed by the flames, the need for this unattainable perfect. Why is accepting imperfection so hard? Brene Brown has done an amazing job of addressing this question, in fact much of her work focuses this very topic.
The point of this post is not to delve into imperfection, but rather how we know when our need to be perfect, to be “completely free from faults or defects” is getting in the way of this thing called life. Society tells us that if we aren’t the highest performers, if our parties aren’t the biggest, the best, the ultimate event that has Gatsby in envy, then we aren’t doing it right.
How does this happen? How do we miss the point of the very thing we are trying to achieve? It’s simple, we forget to think about the intent of the goal itself. And, when we forget about the intent (the desired end state or outcome) we go into the perfectionistic planning mode. If you are prone to this mentality then you know how time consuming and crazed the planning gets around a desired goal. The flaw here is that the obsessive planning, the extensive preparation and painstaking compulsion to think about everything that should happen, everything that might happen, the need to think (aka obsess) about all of the knowns and unknowns, gets in the way of the goal. Not to mention it makes the process of reaching the goal exhausting. Essentially we run ourselves into the fire of worry about the “what if’s”, all the while missing the point of the event.
Take this for example, say you want to get friends together for a game night. The idea being that you would get folks together, maybe have some food, maybe some drinks, and everyone has a night full of commercial worthy fun. The perfectionist dives immediately into the planning and organizing of the “perfect” game night. Sending out the fancy semi-formal electronic invitations with the “perfect” play on words that “perfectly” captures the theme of the night. Then to the food, drinks, and venue prep. The perfectionist struggles with letting everyone bring a dish (what if two people bring the same thing, or some other catastrophe happens?!), people can bring a side but no matter what the “perfect” host needs to have the “perfect” culinary item that could make Martha Stewart green with envy. Everything must be organized, “perfectly”… heaven forbid the drink cooler not match the centerpiece. The games, must be selected with care, to facilitate the most fun of course. And then amidst all the planning and preparation for the “perfect” party, the home must be spotless. Above all cost’s this house must not look lived in!!! In the perfectionist frenzy, you stop thinking about the intent of game night, and start obsessing on the need for “perfect”, the rave reviews; you’re looking for the 5 star yelp review for what started as a means to connect with your friends/families.
Rather than connecting, you’re disconnecting. There’s no room for fun and friends when there’s a “perfect” party on the horizon. If you think your friends can’t feel the anxiety of your perfection obsession aura puts off, let me tell you, in no uncertain terms, they can. Your “perfect” planning is imperfect. It’s driven by an unattainable need to be “perfect”. Did you ever stop to wonder what perfect was?… in this case it’s not the best party favors, or the game selection, or the food, or the drinks. What makes game night perfect is the intent. You are creating a space for people that you know and love to come together and have fun (that’s the intent, that’s the desired outcome). It doesn’t matter if people love the food, or find a speck of dust under the coffee table, or if no body plays games at all on game night. What matters is that you brought people together for an evening of levity.
Some of the common cognitive distortions associated with perfectionism are:
- Black-and-white thinking – “If this is not perfect, I am a failure.” Or “Only lazy people ask for help.”
- Catastrophic thinking – “Everyone is watching me, if I make a mistake they will think I am stupid.” Or “If my presentation isn’t flawless, I will lose my job”
- Probability overestimation – “Even if I study a lot, I still won’t do well on my exam.”
What happens in the above statements is that there is no room for life; because perfect isn’t defined and the intent hasn’t been identified, there is no way to determine success. There are always things we can do differently or do better in the future, that’s part of the learning curve of all life’s situations. Perfectionists have a hard time thinking about what success looks like ahead of time, instead they look retrospectively and judge themselves harshly for the things they “should” have known, never accounting for the fact that these things could not have been known at that time.
Here are some questions to ask yourself to make sure you aren’t going into a perfection obsession.
- What is the intent? (really think about it)
- Are the thoughts and actions you are engaging contributing to or detracting from the intent?
- Are you enjoying it? (If the answer is no, ask yourself 1. Why am I doing this (i.e. is it aligned with my intent or my need to be perfect)? 2. What about this am I not enjoying? 3. Could I approach this differently to feel better about this?
- Am I being competitive? (With myself? With someone else?)
- Am I willing to ask for help? (perfectionists tend not to ask for help and/or have trouble truly delegating, also known as micromanaging)
Be kind to yourself, be kind to others, and keep it moving.
Ashley Steelman, MSW
[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][vc_social_links size=”normal” email=”” facebook=”www.faceboook.com/prosperityedwell” twitter=”@ProspEDWELL” google=”” linkedin=”www.linkedin.com/in/heatherbprosperity” youtube=”” flickr=”” instagram=”” behance=”” pinterest=”” skype=”” tumblr=”” dribbble=”” vk=”” rss=””]A couple of years ago a friend and I started dating churches. We were both looking for a safe and sacred space to grow, question, and feel connected to something more than ourselves. It’s a church, how different could they really be? SOOOOO DIFFERENT my friend, and so began our journey of courting churches. We went to… a lot; some were too big, others too small, some too rigid, others too righteous, and others still who were too “cliquey”, too passive, or too vanilla. Eventually, we landed in one we liked, it was just the right size, focused on what we viewed as important, had activities we were interested in and a message we found engaging; in essence we finally felt in sync with our spiritual path that was facilitated by the church’s mission and objectives.
Though church and therapy aren’t a one to one connection, I believe one thing to be true, we are all looking for acceptance and connection. Spirituality is one of many ways to find peace and centering. But what happens when we need just a little more help? When we need an objective and supportive voice to help us process our past, present or future? Therapy is a valuable mechanism to help people do just that.
Much like the quest for the right church, the quest for the right therapist can be a daunting one. Every therapist (at least ones worth their salt) will view and use themselves as a tool to help their clients along their journey. To do this we, use our personalities, our strengths, and evidence based practices to encourage and challenge our clients to reach their personal goals. That means our personalities matter just as much in the process, liking and trusting your therapist will get you a lot farther in your growth and development than if you were “out of sync” with the person across the couch.
The idea of therapy can be very intimidating. It can mean being vulnerable (potentially for the first time), it can mean letting go of people or things that no longer serve you, it can mean realizing there are different ways to view and interact with the world (aka HOMEWORK!); but most importantly, it can mean a new beginning, an end to unnecessary burden, and a new appreciation for the human experience.
Since this is such a personal and powerful journey, you need to make sure you are choosing the right partner for the job. Therapy is a partnership, it requires two people to be in sync and is most effective when there is a strong alliance in the relationship. How do I find this you might ask? Like dating a person or finding a church, it is okay to court your therapist or multiple therapists (as many as you want for as long as it takes). You’ll know you’ve found the right one, you’ll feel it, trust the feeling.
Below are some tips and tricks for finding the right therapist for you.
Identify Your Need (i.e., what are you looking to address?)
You don’t have to have this fully fleshed out, you and your therapist can work on identifying the specifics, but knowing what you want to work on will help you scope your search.
- Do you want self-work or couples work, or both?
- Do you have a unique need, perspective, or stressor (e.g., LGBT, challenges with the Military Life Cycle, Self-Harm, etc.)
- Do you have a known diagnosis (e.g., Anxiety, Depression, Eating Disorders, Addiction, etc.)
Ask Around / Look Around
Mental health problems affect nearly every family in America, and by extension, nearly every family in your community. I am a firm believer that everyone can benefit from one hour a week to talk about themselves and process what is going on in their world. If you are comfortable, ask around! Chances are someone you know is going to or has gone to a therapist; if you feel comfortable asking for a referral go for it! Remember there is no pressure to stick with the referred practitioner if they aren’t the right fit for you.
There are many sites available to help you search and select the right therapist for you. You can always do a good old fashioned google search, but some of my favorite sites are:
- Psychology Today https://therapists.psychologytoday.com/rms/prof_search.php
- Good Therapy http://www.goodtherapy.org/find-therapist.html
- Theravive http://www.theravive.com/cities/locations.aspx
My Therapist is… (Think about the characteristics your ideal therapist would have)
Knowing what you are comfortable with and what personality styles work best for you will help you narrow your search, do I want young, old, male, female, high energy, low energy?
- Do you prefer a man or a woman, some people feel more comfortable with a same sex therapist (i.e., a survivor of sexual trauma may feel more comfortable with someone of the opposite sex as their abuser)
- Do you prefer a certain age (someone older or younger)
- Do you want someone more enthusiastic or calm (think about your personality and who you feel most comfortable with)
Time and Place
- Everyone has spinning plates, engaging in therapy is a commitment of time and energy. Make sure you account for convenience and potential competing priorities.
- Be mindful of your location, what commute is reasonable, accounting for traffic.
- What does your schedule look like, what are your normal work hours, what days and times work for you? Many therapists operate outside of the normal business hours (9-5) to accommodate their client’s schedules.
Test the Waters
Once you have done a little research on your end and found a potential partner for your journey, it is important to do a test run. You wouldn’t marry someone you’ve never met; give the new relationship a try, see how you feel. The right therapist for you will be able to meet you where you are (cognitively and emotionally) and put you at ease with the process.
1.Give the office a call
– Is the call answered or responded to in a timely manner?
– If you talk to the therapist about setting up an appointment, what is your sense of their personality? First impressions mean a lot, trust yourself!
2. First Visit
– Were your first impressions validated?
– Is the space comfortable for you to be in?
– Do you feel comfortable talking to this person, therapy is not an interrogation! It should feel conversational at first, you’re two people getting to know one another.
What happens when I do all this and the therapist and I are not in sync? Nothing… and that is okay! It just means that that therapist was not the right partner for you in your journey. Therapy is a sacred space for you to work in, it can be an amazing and self-empowering journey; so if the first therapist is too this, and the second is not enough that, keep going! With each experience you will hone your skills and be better informed of what you need and want in your therapeutic relationship.
Don’t give up, give it a little time, court your way through the candidates until you find the one that is right for you![/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]