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Monday, 17 January 2011

Remember The Carers (And Try Not To Blame Them)

Carers can be a valuable resource in helping the patient to change. He adds that educating them in the treatment model can help them to assist the patient.There are now a great many books written specifically to help the parent help their loved one to fight the eating problem.
Therapists are taught not to attribute blame to families and to consider them a useful treatment resource. I can still remember, however, when family therapists such as Minuchin and Selvin Palazzoli claimed great success in treating anorexia by targeting unhelpful patterns in family behaviour such as detouring (avoiding issues) enmeshment (not giving the patient "space") and putting a nice face on no matter how you feel.
Families factors are also known to increase the risk of someone getting an eating disorder. There may be weight specific pressures such as mothers who go on diets and who are always groaning about their size, fathers who reward their daughters for losing weight, brothers or sisters who tease each other for being too fat, or even mothers who are overweight and their daughter says to herself "I surely do NOT want to look like you when I grow up!"
And there are pressures associated with eating disorders that come from families, like pressure to succeed, parents who teach their children to behave like adults all the time, and parents who put out messages that it is not acceptable for the child to have any feelings.
Personally, I have read hundreds of life stories from sufferers and from counsellors who want to specialise in treating eating disorders, many of them have had their own experience of anorexia, bulimia or binge eating. Sometimes I say to myself no wonder this person had an eating disorder when I read what has gone on in a family, the lack of caring, the abuse, the cruelty, the awful examples of weight control behaviour that has passed from mother to child.
Then I meet parents who bring their child for help and I ask myself, why is it the father who more often than not brings their daughter, while the mother is "busy" and the mother who usually brings their son because father is "busy" and do these patterns mean anything where the eating problem is concerned?
Many carers call us up at NCFED and beg us to give them some advice about how to help a loved one who is clearly suffering but will not admit to it. We have discovered, by experience, that even the most reluctant sufferer will come to accept some help if the parents come together to get some support for themselves in coping with the eating problem. This will often lead to an extended period of counselling for either the carers or for the sufferer. And how many eating disorder counsellors know what is going to be helpful?
So we rise to meet this need in the following way. We have some information on our website which can be useful for carers. There is a carers page and some information on our information page about how eating disorders are to be treated. http://www.eating-disorders.org.uk/helping_carers.html
We are also offering a 1 day Masterclass in Counselling Carers in April 2011 and hopefully also in 2012. Check out http://www.eating-disorders.org.uk/information.html and please come and join us on what should be a really helpful and inspiring day.
Acknowledgement to Professor Glenn Waller writing in CBT Today December 2010

Tuesday, 4 January 2011

More Top Tips For Eating Disorders: How Important Is The Working Alliance?

Professor Glenn Waller writing in CBT Today, December 2010 says that a good working alliance is necessary but not sufficient to bring about change in eating disorder symptoms. He says that despite the commonly held belief that this relationship is a key agent of change, the benefit attributed to the working alliance is "relatively small".
I agree. I have met hundreds if not thousands of sufferers who have not recovered despite getting along really well with their therapist. I have met people who are so good at doing therapy that they can deflect the therapist from the real work of change with all kinds of diversion tactics. If we tell a sad enough story we might even find therein reasons why we have an eating disorder but it may not really be the truth.
As a trainer I have suggested that being a good listener while being important, may sometimes deflect from the work that must be done to elicit and change the eating disorder mindset. Everyone needs to tell their story and the story must be heard - but sometimes listening must give way to questioning, guidance and teaching new skills including skills for thinking , or thinking about thinking as well. Some of the techniques of eating disorder treatment are not very person centered at all  (though they can be delivered with respect for the person who can "become").
I hope that therapists can suspend the need to be liked by their clients. The eating disorder client knows how to manipulate and sometimes wants to take a diversion from the issues that need to be faced. It is better to know the skills that eating disorders really respond to - so that respect for the therapist's competency can grow into the client's own self respect and self regard.
As Prof Waller says, there is evidence that when clients do change as a result of proper clinical practice the working alliance is enhanced, not the other way round. If you want to be liked, get a puppy. If you want to be trusted, be congruent.. If you want to help people change, know your stuff. Know nutrition, cognitive therapy, emotional resilience training, body image work, lapse prevention, when to stop listening and interrupt.The rest will follow.