Enlisting family support: When family therapy is appropriate for BN treatment

Contributor:  W. Travis Stewart, LPC, NCC writer for Eating Disorder Hope

Bulimia nervosa and the associated behaviors have far-reaching impact on the lives of those who suffer with it. The compulsive behaviors negatively affect mental health, including poor choices, anxiety, depression, self-hatred, distortion of body shape and size and feelings of despair. Medically, bulimia can result in problems with the esophagus, digestive system, tooth decay, and imbalances with sodium, potassium and electrolytes, all of which can dangerously impact heart health. Relationally, those struggling with bulimia can become deceptive, disconnected and in conflict with family and friends.

Because of the far-reaching consequences of bulimia, the support of family is incredibly important in therapeutic process. “Dr. Ken Littlefield of Phoenix, Arizona, suggests that families should be involved in the treatment of bulimia “as soon as possible” and that it is “helpful for accountability, reconciliation, and  communication. Because it affects the whole family they also need to express it and deal with it.” Let’s explore each aspect in more detail.

Getting family involved as soon as possible

If the individual who is using bulimic behaviors is a child or adolescent then likely the family already knows and is involved at some level. If the individual is not living at home, then there is a chance the family is not involved. Either way, professionals should explore the family dynamics early in the treatment process in order to explore two things: how might the family best support the recovery process and how might the family hinder the recovery process

Dr. Laura Bumberry, a therapist at Webster Wellness Professionals in St. Louis, Missouri, states,

“It is quite common for an individual with an eating disorder to decline family involvement or state the family is causing more harm than good. While this can certainly be true, it is also dangerous as it means the individual is more alone with a very serious, potentially life threatening illness.”

If the family is available, willing and safe (i.e., not an abusive situation) then professionals should ask for a release to be signed to talk with family members and enlist their support in treatment as soon as possible.

Family Accountability

It is possible that the family has already been involved in trying to help the client stop the bingeing and purging behaviors. Obviously, if the client is still struggling, this has not been successful. Many times this can create a great deal of conflict and pain in the family system. Often, because of the raw emotions and intense anxiety around the situation, family members may do and say things that are not helpful. This does mean that families should not play a role in providing accountability, though.

In fact, Family Based Therapy (FBT) is built around this idea and heavily relies on family involvement to provide structure and accountability. As a trained professional in FBT, Dr. Bumberry believes strongly in family involvement,

“Family members must learn to create an environment that keeps their loved one safe from the eating disorder through structure and accountability, while maintaining a non-judgmental and compassionate stance. This is a very difficult balance to strike and each family may do it a bit differently.”

Families need Reconciliation

When a family member is struggling with bulimia, the normal hurts and conflicts that all families experience can be magnified and may contribute to the ongoing eating disorder behaviors. For the non-eating disordered family members there will often be feelings of betrayal, anger, fear and suspiciousness of the words and behaviors of their loved one with bulimia. For the bulimic individual, there can be feelings of isolation, shame and blame. It is important to address these issues in therapy.

Many treatment centers include intensive family therapy to deal with these very issues. When I worked as a primary therapist at Remuda Ranch from 2003-2011 I was involved with what the treatment center called Family Week.

Therapy with the family started from day one, including weekly family sessions (by phone if the family lived out of state) to begin addressing these concerns. Midway through the treatment stay the family would come and attend Family Week with other families and patients. There were many moving parts and goals for Family Week, however, one of the primary hopes was to bring reconciliation to the family and address how the eating disorder behaviors had impacted all family members. Often, when patients were discharging from treatment, they cited this week as a highlight of their treatment.

Improving Communication

There appear to be multiple factors that contribute to the development of bulimia nervosa, including genetic susceptibility, culture attitudes on food and the body, individual temperament, life experiences, brain functioning and trauma. Ranking high on that list though is the ability to be aware of and express emotions. This skill is learned primarily in the family system. For those struggling with bulimia it is going to be important to learn to communicate thoughts and emotions more effectively.

In my experience, many women and men struggling with bulimia, have intense emotional experiences of shame, anxiety and self-hatred. In order to overcome these powerful and often debilitating emotions, bingeing and purging behaviors are used by the individual to escape and comfort herself or himself. In order for recovery to happen, it is going to be critical that those in recovery learn to better communicate with family members and friends.

By involving family in the therapeutic process, professionals will have the opportunity to assist individuals learn to express opinions, handle conflict, confront misunderstanding and correct negative assumptions which may exist within the family system. As the individual grows in these skills, and improves relationships, the opportunity for recovery will increase.

Healing for the Entire Family

Fathers and mothers, brothers and sisters, often feel helpless and alone as they watch a family member struggle with bulimia. Even the most angry fathers and anxious mothers, when given the opportunity to identify and express what they are feeling are, at the root of things, terrified for the life of their loved one. Behind the anger, suspicion and harsh words that get spoken in the heat of the moment is usually a terrified parent doing the best that they can.

In the recovery process it will be important, not only for the person with the eating disorder to be given a chance to express themselves but also the family members. Within a guided and supportive therapeutic environment, family members can be helped to express frustration, fear, betrayal, confusion and a longing to see recovery happen.

 

Community Discussion – Share your thoughts here!

What relationship struggles have you or your loved one faced in recovery from disordered eating?  What steps were taken to heal and reconcile strained relationships?

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About the Author

Travis Stewart earned a Master of Arts in Counseling (2001) and a Master of Arts in Theological Studies (2003), both from Covenant Seminary in St. Louis, MO.  Travis is a Licensed Professional Counselor in the State of Missouri and a writer for Eating Disorder Hope and Addiction Hope.

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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 a 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 October 5, 2015. Published on EatingDisorderHope.com