Over 24 million individuals struggle with disordered eating; of those, about 8 million have a formal eating disorder. Ninety percent of them will never seek treatment. And of all mental illnesses, eating disorders have the highest mortality rate. Eating disorders are a growing area of concern, maybe in part because there is more media attention or more research dollars, but treatment options are still hard to come by.
Eating disorders are very complicated to understand and no one ever faces an eating disorder alone. Although individuals struggling with eating disorders tend to isolate, they are very much part of a family system that, knowingly or not, affects the patient’s recovery. Because those struggling with an eating disorder tend to feel a lot of shame and guilt, it is often challenging for them to talk about this problem. Asking them to invite their family in for a session is even less appealing. I find of all treatment modalities, family therapy is often met with the most resistance – by the patient and by the family. Understandably, it can be an incredibly anxiety-provoking experience, but yet we know that family therapy is an integral part of one’s recovery from an eating disorder. In fact, a recent study by Stanford University’s School of Medicine reported that family based therapy can be as much as two times as effective as individual therapy alone.
A family system is fluid and dynamic and ever-changing. Understanding one’s role in the family and one’s relationship to others in the family can be a critical component in the healing of the family. Family therapy can help identify negative aspects of relationships that may be contributing to the individual’s eating issues. Families are not in attendance to be blamed for the patient’s problems, but rather to help the therapist understand how the family operates, communicates, and faces adversity. It allows them to gain much needed skills to better recognize and communicate with the patient. Family sessions focusing specifically on cognitive distortions of the patient can leave the family members feeling empowered and more skilled at recognizing when the patient may be in crisis or in need of support.
Family therapy can also help educate family members on specific triggers being faced by the patient. While there may be some commonalities among patients, most individuals have different triggers, different distortions and different reactions to stressors. Helping the family understand the eating disorder that is specific to their family member is incredibly helpful. After family therapy sessions, I feel families are more likely to try to discuss what each other is thinking and feeling. Through family therapy sessions, all members gain valuable skills to help express what they are thinking and feeling. Communication lines are opened rather than shut down. The feeling of ‘walking on eggshells’ is dispelled.
Family therapy can also provide a much needed venue for the family members to realize and express how the patient’s eating disorder has affected their lives and their mental health. Family therapy can provide a safe environment for families to understand that they are all likely sharing the same fears, concerns, and worries even though they may be expressing them differently. When family members feel heard and validated, they are more likely to want to be involved in the process.
Another great outcome of family therapy can be educating the family on the stages and requirements of recovery. Many areas associated with recovery, for example nutrition and exercise, have many myths associated with them. Family therapy can help extinguish some of those myths and puts the family in line with the treatment team members. Once everyone has the same information and is on board with treatment expectations, the patient feels more consistent support.
In summary, recovery from an eating disorder is not an easy process. Every tool in the toolbox needs to accessed. Family therapy is just one of those tools, but it is an incredibly necessary part of the process. Every family will have different family therapy needs and therefore the process will look different for each family. However, if the family approaches the patient’s eating disorder recovery with an open mind and a willingness to participate, recovery is much more likely.