When psychological treatment is carried out on an eating disorder in girls and adolescents, it is essential to carry out therapeutic sessions with the family, since it is essential to obtain the support of their family to facilitate the patients’ recovery.
Family therapy for eating disorders (ED) can be a good solution to treat these psychopathologies in adolescents because the effects of this type of disorders are not limited to the person who suffers from them, but also tend to affect their family nucleus, so that EDs can cause certain difficulties in coexistence.
Therefore, although the intervention focuses mainly on patients who suffer from some type of ED, the support of their parents is important for a faster and more solid recovery, thus there will also be a greater chance of avoiding future relapses.
We’ll see now What does this model of family psychotherapy applied to eating disorders consist of? as well as its structure and objectives.
In younger patients with eating disorders, the most recent guidelines on psychological treatments recommend the use of family therapy, the most popular being known as “Family Based Treatment” or FBT (Family Based Therapy), which began to be developed by a team of professionals from the Maudsley Hospital in London in the 90s, being a therapy that requires the work of a multidisciplinary health team, which includes a psychologist and/or psychiatrist, medical and nursing staff and a nutrition specialist.
This therapy model is based on the fact that The participation and support of parents during treatment is essential for the therapy to work and the patient can successfully overcome the eating disorder. Furthermore, another objective during the sessions is to strengthen the resources of the patient’s parents in order for them to support their daughter in the change towards a lifestyle and a relationship with healthy food, in order to prevent hospitalization may have to be resorted to.
It should be noted that it is very important that parents learn to separate the eating disorder from their daughter’s identity, so that this disorder is externalized and they do not blame their daughter for her way of behaving with respect to eating and eating. physical appearance.
FBT is a therapy model that has demonstrated good results with two thirds of parents and adolescents who agree to undergo this treatment, achieving complete remission of the eating disorder in 40% of cases with relapses in the rest, which does not mean that all is lost, since there is always the possibility of trying again or resorting to another model of psychotherapy, such as cognitive-behavioral therapy applied to mental disorders. eating behavior.
Among the reasons for the failure of this therapy modality are the following: lack of support in the treatment from the parents and their lack of availability to accompany their daughter to the therapy sessions.
Objectives and techniques used in this psychotherapy
For family therapy for eating disorders to work, it is important to keep the treatment objectives in mind at all times and for the psychotherapist to use a series of techniques that facilitate their achievement.
1. Objectives of family therapy for eating disorders
The fundamental objective of this therapy is, in addition to achieving eating habits and a healthy weight, to promote positive communication patterns between parents and their daughter, so that they help their daughter achieve the goals of the therapy, feeling supported. and understood by their parents.
At the same time, we must work on skill strategies that allow emotional regulation in situations that generate frustration and anguish in the patient. To do this, the way to express her emotions in an appropriate way must be taught and this is achieved by expressing her feelings and ideas more clearly. This way her parents can better understand what is happening to her daughter and, at the same time, she will feel more understood.
Clear interpersonal boundaries must be established between family members, supporting parents and also promoting their daughter’s autonomy in those cases where it is necessary for her to have a little more freedom.
Furthermore, jointly, with the parents and their daughter, the advantages and disadvantages that the solutions could have for the problems that may exist in the family must be sought. For this it is important analyze the way each family member perceives problems and thus be able to work on an individual style of constructive coping with these problems.
It is important to set realistic goals for family therapy and establish step by step how to approach problems and find solutions.
As in any type of psychological therapy, it is very important to establish a good alliance with all the members participating in it, so that it develops in a therapeutic environment that facilitates the improvement process. Within this environment, the family must reinforce a structure of mutual support among its members to face the treatment together in order to successfully overcome the therapy, as well as any type of problem that may arise in the future.
It is essential that family therapy for eating disorders be carried out by a psychotherapist specialized in systemic or family therapies so that the treatment can develop correctly.
2. Intervention techniques most used by psychologists in this type of therapy
One of the most used techniques in this family therapy is active listening by the therapist, in order to facilitate understanding and show interest in the patient and her parents, so that they feel that they are being understood by the psychologist.
The psychologist must encourage the patient to recognize her personality traits and the factors that are hindering the recovery process.
It is important to work on training expressions of support between parents and their daughter through behavioral tests that must be explained in detail by the psychologist in advance, using modeling techniques, repeated practice, feedback and generalization.
Family therapy for eating disorders is a structured treatment, whose sessions have already been scheduled in advance and, therefore, the sessions and steps scheduled in advance must be followed, so it does not leave room for improvisation.
Phases of family therapy for eating disorders
This therapy lasts approximately between 6 and 12 months, depending on the severity of the symptoms, as well as the response to treatment, among other factors and; On the other hand, it is structured in 3 phases, which are divided between 10 to 20 sessions, depending on the needs of each particular case. It may be extended in some cases where necessary.
1. Complete parental control
This first phase of family therapy for eating disorders It is made up of the first 10 sessions, which are carried out with the frequency of 1 session per week.
The main objective in this phase is to provide the necessary support to the parents of the young woman with an eating disorder so that they promote the reestablishment of correct and healthy eating habits in their daughter, as well as a healthy weight, especially when you suffer from anorexia nervosa and your weight is well below what it should be for your height.
Throughout the entire psychotherapy process, work must also be done with any emotional aspect that could be causing the patient discomfort (for example, symptoms of anxiety, depression, addictive behaviors, etc.).
2. Gradual return of control to the adolescent
This phase covers the following 6 sessions, which are carried out with a frequency of 1 session every 15 days, after having completed the first phase, starting when eating habits and weight are practically normal within margins that could be considered healthy.
Throughout this phase, an attempt should be made to reduce the need for supervision by her parents and it is the daughter who should progressively begin to take responsibility for maintaining a correct eating style.
3. Establish healthy independence
This third phase usually lasts 3 or 4 sessions, with a frequency of 1 session per month or every 3 weeks, and begins when eating habits and weight have normalized, without any risk to the patient’s health.
During these last sessions The therapy will be focused on psychological aspects related to the construction of the patient’s identity.
Likewise, during this phase the family must also be supported in their process of adaptation to the life cycle crisis that could arise from having to adapt to their teenage daughter’s demands for greater independence, always within reasonable limits. .
Family therapy modules for eating disorders at Maudsley Hospital
This family therapy model is made up of four modules, each of them being prepared to achieve different objectives.
1. Module for correct power relearning
This module seeks to reestablish a healthy eating style focusing on a varied and balanced diet, understanding the pleasurable and social aspects that food has for people.
2. Module for rehabilitation
Here we fundamentally work with the erroneous cognitive biases that patients usually have regarding food, body image, self-image, etc.
3. Module for reward-emotional system
In this module the main objective is to search the patient the balance of the emotional approach-avoidance system.
4. Module for psychoeducation
Psychoeducation and the teaching of communication skills are carried out, with the patient accompanied by her parents, with the aim of avoiding confrontation with the patient and thus helping to alleviate the psychological discomfort she is suffering.
