Families and Recovery

One necessary but often neglected component of recovery is the role of family and significant others in the treatment of an adult patient. Even with a cohesive, supportive and knowledgeable team, the patient has to navigate many hours and many meals alone. The people in her life who love and care for her can provide daily support. However, more often than not, this is not the case. Some families do not have the emotional stability to aide in recovery and others, much more rarely, are the source of the illness itself. Even for families capable of contributing to the treatment process, most patients exclude their family from recovery. This lost resource is the result of two problems in communication. First, families struggle to find education and guidance about their role in treatment. Second, patients feel misunderstood by their families and do not know how to ask for what they need. This rift only leads to an impasse and an unnecessary, added obstacle to progress. 
The essential piece of advice for families is don't talk about food ever. Don't ask about a meal. Don't ask if she ate. Don't ask if the food was good or bad. Just don't bring it up. If the patient talks about food, any response needs to be encouraging and brief. The patient's internal thoughts about food are critical and relentless. This means she will misinterpret any comment about food to mean that she ate too much or ate the wrong food or is fat. The entire process of eating causes intense emotional pain that she needs professional help to navigate. Any caring family will want to address what appears to be the problem, food. If only she would eat, the problem will go away. The hardest step is to recognize how discussing food is counterproductive. In fact, this is how the family becomes the enemy, not the source of support and comfort.   
So what does help the patient? Because she is bombarded with critical thoughts, she needs kind words of support and encouragement. By the time a patient is in treatment, families are already very worried and frustrated about how powerless they feel. This is primarily a reflection of how powerless the patient feels. The presence of the eating disorder makes normal, loving family interactions seem impossible. The daily conversation needs to shift away from food and back to the topics from before the eating disorder. Showing interest in the person outside of her illness will remind her of the other parts of her life. She needs to remember that she has relationships that matter to her. She needs to know her family cares about her, not just if she eats.   
Another important aspect of recovery is that progress is often not visible, especially early in treatment. Setting up a treatment team, establishing treatment goals and putting initial plans into action takes time. The changes begin in small ways. Many key transformations can be internal and involve quieting the eating disordered thoughts. But this progress is often not seen by families who want immediate, concrete changes. They want their loved one to eat meals and be herself again, almost instantly. This desire comes from love and caring but translates quickly into disappointment and frustration. As a therapist, I focus on progress and patience in therapy. This approach helps the patient learn how to treat herself with compassion through the process of recovery. When the family realizes how powerful patience and compassion can be, recovery can move forward even more quickly.      
If the patient will allow it, one session with the primary therapist can be very helpful. The goal is to understand the most effective ways to support the patient in recovery. This meeting allows the patient herself the opportunity to express what she needs. It also sends a clear message to the therapist that the family wants to be a source of support in recovery.  
Last, the family needs to recognize that eating disorder recovery is a long and trying process. Every family will be frustrated and will make mistakes. It is best for the patient if the family works hard to educate themselves about eating disorders and to find their own support. There are associations for families to provide these services. Individual and family therapy is also effective. Seeing her family seek out their own support will help the patient understand that everyone is working hard to be well and that she does not need to take care of the family too.  
This post has led me to consider the family's role in a different light. In my first post I wrote that I received a call from a father about how to feed his daughter. That conversation brought up the obvious question: how to feed your children? From my vantage point, if the goal is to help your children understand how to think about food, I think there is a more important question. How do you talk about food with your children? Look for the next post.

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