It is part of my job to support people and families at very difficult times in their lives. It wasn’t different with Gemma and her family. While dad looks through the office window and Gemma fixes her eyes on her shoes, mum tells me about the changes that have taken place in their lives over the recent months and how the family is functioning now. Gemma then snaps at mum. - I should have the right to choose what to eat and not to eat! My life is nobody's business – she says. Mum bursts into tears and says that Gemma never used to talk like that. Dad points out that although he agrees in principle with what Gemma is saying, he is concerned about the amount of weight she has lost. - She should have known when to stop dieting, but she is just so stubborn. And here we are, far beyond reasonable – he says. Gemma then tells me about dad's episodes of rage at mealtimes and how those make the whole thing unbearable: - I bet the neighbours can hear you screaming and threatening me. To which he replies: - Why can't she eat like a normal person? Mum, still tearful, shakes her head. The three of them disagree, but they feel equally as stuck. Mum understands that it is not Gemma's fault, and that there is something wrong with her daughter; so, shouting will not solve anything. She believes that buying the types of food that Gemma feels safe eating is currently the best solution, as at least her daughter is eating a little. But she also understands that this is not a long-term solution, not least because she feels a little manipulated by Gemma. Gemma then sighs. A dynamic that can perpetuate the problem I would like to pause for a moment to discuss the above scenario. This is a very common first session. Gemma doesn't want to be there (because, from her perspective, there is nothing wrong). Mum and dad are polarized: while one explodes in anger (like a rhino), the other struggles to be assertive and set clear boundaries (like a kangaroo). These are reactions to the extreme feelings of helplessness. As a therapist, I see how such dynamics can perpetuate the situation without really solving anything, and my aim is to invite them to see the issue through this perspective. At the beginning of treatment, the young person often denies the negative aspects of their relationship with food. They still see it as an option, a solution they are not willing to let go. Parents, on the other hand, are generally desperate for the problem to go away and are using the resources they have to try to address it. Understanding how these dynamics develop is essential to understand the role of the family in the recovery process. Driving away feelings of guilt Current guidelines advocate for family involvement in the treatment for eating disorders because families can be an incredible resource in their child’s recovery. Family support suggests a considerable decrease in the number of hospitalizations and residential care for ED treatment. But my work goes far beyond helping family members understand the problem and their role in the solution. It involves supporting them understand that many aspects of supporting their child's recovery feel counter intuitive compared to how we tend to care for our children as parents. One of my initial goals is to try and steer the family away from ideas around guilt and shame. Each parent is doing the best they can with what they have. And what do they have?, you ask. They have a teenager who refuses to eat, usually in a bad mood and quite depressed; they have a child who is clearly suffering from something very mysterious; they have disagreements about how to best handle the situation; they have an infinite amount of worry and anxiety; they don't have a clue about what is going on. Recovering from an eating disorder is the most difficult thing anyone will have to do in life, and they don’t even acknowledge there is a problem to start with. How would you handle it all? Back to regular meals and difficult feelings Treatment starts with re-establishing regular meals to help nourish the body and, where appropriate, restore the weight. When our body is in "shutdown" mode and there is not enough energy entering our brain, any therapeutic work will be impaired. - Okay, let me see if I got it right. You mean we must get Gemma to eat even if she is blatantly refusing to? - ask the parents. And a further question: - And you cannot provide individual therapy to make her regain her senses and start eating? And we can't force feed her? Yes, that's right. But there's more. In doing so, the family will remove Gemma's main (probably the only) coping strategy to manage emotions. So her difficult thoughts and feelings will surface and become much more intense. Interested in finding out how Gemma's parents begin to help her on her journey towards recovery? See you soon for my final chapter about Gemma and her fight...
