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January 3, 2016

When is it Appropriate to Incorporate my Family into my Therapy Sessions?

Support group holding hands in group therapy

Contributor: Stephanie Auriemma, MS, LMFT-A, Family Therapist at Carolina House

Family should be incorporated into therapy as soon as possible. Starting family therapy immediately is essential for several reasons. First, eating disorders are a family illness and as such the family members need to be part of the treatment in order for treatment to have the best and most sustainable outcome. Research on eating disorders has shown that partaking in family therapy is more effective than receiving just individual therapy.

Second, oftentimes family members can feel lost and unsure of how to help the individual with the eating disorder. Family therapy is a great place to provide education to the family as well as to explore the most effective ways to support someone with an eating disorder. Lastly, family therapy can work on strengthening the family system so that it can be the support the individual with the eating disorder needs.

Eating Disorders Impact the Family

Happy Family On Beach Vacation Looking at OceanEating disorders are a family illness in that they have an impact on the whole family system. Family systems with a member who has an eating disorder tend to have dysfunctional familial patterns and/or characteristics such as enmeshment, overprotectiveness, rigidity, and lack of conflict resolution. If these dysfunctional familial patterns and characteristics are not addressed and shifted to be more functional throughout the course of therapy, they can help maintain the eating disorder.

The eating disorder often develops as a way to cope with something else that is going on in an individual’s life, for example anxiety, depression, or dysfunction in the family system. In order to effectively provide treatment for an eating disorder, the focus needs to not only be on the food and eating behaviors, but also on whatever the individual was struggling with prior to the eating disorder.

When an individual enters therapy, they have the opportunity to work through their struggles, make changes, and learn more effective ways to cope. As the individual changes, it has an impact on the family system. If the family system is not a part of the therapy, when the individual comes back into the system after being in therapy, they will no longer fit in the way they used to.

Think of each family system as having its own unique dance and each individual in the system having their own part in the dance, if one person changes their part, it is going to throw the whole dance off balance. The system cannot be sustained if it is off balance.

Either the family needs to adjust its dance to fit the new individual dance or the individual can fall back to doing their original dance, in which case the eating disorder would be maintained. This is why it is so important that the whole system be a part of the therapy process so that every member can learn this new more effective dance.

Family Therapy Influences Recovery

class_group_therapy_lectureThough little research has been done studying the efficacy of family therapy in treating eating disorders, from the research that has been done, it appears that family therapy does have a positive impact on the sustainability of recovery. Minuchin first started utilizing family therapy as the main modality for treating individuals with anorexia nervosa in 1970. According to research done by Minuchin, it was found that his course of treatment was effective in sustaining recovery in 83% of the cases after five years. [1]

In a study by Locke et al. (2010) which compared the efficacy of family based treatment (FBT) versus adolescent-focused individual therapy (AFT) in sustaining recovery, researchers found that 10% of those who received FBT relapsed versus 40% of those who only received AFT. They also found that more of the individuals who received FBT reached a full remission threshold, gained weight faster, and were hospitalized significantly less often than those who only received AFT. [2]

Family Therapy has Many Benefits

busy-happy-family Family therapy can be beneficial for numerous other reasons such as providing education, improving communication, working through conflicts, building family strengths as a way to cope with the eating disorder, strengthening relationships within the family system, allowing every member of the family to have a voice. Education is a big piece of the therapeutic work that needs to be done when a family system has a member with an eating disorder.

Eating disorders are a complex mental illness and oftentimes the family does not have the information necessary to provide the support needed. Families have the potential to be the best support for the individual throughout the recovery process.

The individual is their own best informant on what support would look like and needs to be at a place where they can effectively communicate this to the family. If the family is not effectively communicating, then the chances that the individuals will get what the support needed is greatly diminished.

Family Therapy is Essential to Recovery

Woman having a conversation with her therapist on couch in officeIn a study done by le Grange (1999), he concluded “engagement in therapy and the family’s continued commitment to treatment are crucial for the successful resolution of the eating disorder.” [3] There are certain circumstances when family therapy may not be appropriate, such as if there has been any type of abuse: sexual, physical, or mental.

In this case, the therapist working with the individual can help assess if and when family therapy would be appropriate. Based on the research that has been done as well as my own personal experience seeing the impact family therapy can have, I believe that family therapy is an essential part of recovery and should be started as soon as it is possible.

Community Discussion – Share your thoughts here!

Have you or your loved one experienced family based therapy in eating disorder treatment? How did this help in recovery?

About the Author: Stephanie Auriemma, MS, LMFT-A graduated with her master’s degree in Marriage and Family Therapy from Seton Hall University in 2012. After relocating to North Carolina, she received her associate license in Marriage and Family Therapy in 2014 and is currently working on fulfilling the requirements for full licensure. In 2014, she also began working at Carolina House, a residential eating disorder treatment center located in Durham, NC as well as the PHP and IOP levels of care treatment center located in Raleigh, NC, where she does work as a group therapist, family therapist, and is the coordinator of Family Day events for the two facilities.


[1]: Sargent, J. & Liebman, R. (1988). Family therapy for eating disorders. In B.J. Blinder, B.F. Chaitin, & R. Goldstein, The Eating Disorders (pp. 447-455). PMA Publishing Corp.
[2]: Lock, J., le Grange, D., Agras, S., Moye, A., Bryson, S.W., & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry, 67(10), 1025-1032.
[3]: le Grange, D. (1999). Family therapy for adolescent anorexia nervosa. In Sesson: Psychotherapy in Practice, 55(6), 727-739.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 3, 2015
Published on EatingDisorderHope.com

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