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WEIGHT LOSS: ROLE OF FAMILY THERAPY IN THE EATING DISORDERS’ TREATMENT PLAN AND INDICATIONS FOR FAMILY THERAPY

Role of family therapy in the treatment plan

The more doctors learn about eating disorders, the more we see the need to tackle family issues. As the number of people with the disorders has risen, so has the use of the family approach. Although we’re still learning which strategies work best, the success of family therapy has led to its increasing use for a range of other problems. Family therapy offers many benefits: It identifies the problem as solvable, it provides practical solutions, it creates a relationship with a caring professional, and, perhaps best of all, it offers hope.

Of course, family therapy often needs to be integrated into a more comprehensive treatment approach. Hilde Bruch, a pioneer in the treatment of eating disorders, stated: “Regardless of what the family contribution to the illness has been in the past, the patient has integrated these abnormal concepts about herself and others into her own personality.” Bruch felt that individual therapy is needed to correct the patient’s faulty assumption that starving will resolve her emotional conflicts.

Indications for family therapy

Careful assessment reveals whether family therapy will be appropriate in a given case. If so, we then work out when and how often sessions will be held, and who will attend.

I usually suggest family therapy in virtually every case where the patient is young – under eighteen – and living at home. If the family gets help early on, it may have a shorter and easier course of therapy.

Sometimes, though, the family comes for help only after it has struggled with the problem for years on its own. In some cases, the family gets treatment only when something occurs to upset the stability of the “sick” family system, such as another sibling going off to college.

Patients who are married or live away from home can still benefit. Despite their independence, these women are often still strongly tied to their families. Even if we can’t meet with other family members, we set up at least some sessions with as many as can attend.

Though valuable, family therapy is not required in all cases. A crisis doesn’t necessarily mean the family is sick or can’t function. Sure, parents might be angry or frightened – that’s a normal, even healthy response. One study by Dr. Arnold Andersen found that 12 percent of eating disorder families were enviably healthy, providing all the love, nurturance, and autonomy a child should have. These marriages were strong and loving, and the relationships among family members stayed within proper boundaries.

Thus, while family therapy isn’t always necessary, a family-oriented approach is.