Family-BasedTherapy for Eating Disorders
Eatingdisorders were recognized were first recognized about 125 years ago.Currently, researchers and the health care providers assume that thefamily-based approach is the most effective therapy for clientssuffering from eating disorders. An effective family-based approachshould follow at least three phases. Families are targeted whentreating clients with eating disorders because they have the capacityto influence eating patterns and the types of food that are availableto all family members. All research works reviewed in this paperindicate that the family-based therapy is effective in the treatmentof all types of eating disorders. The effectiveness of thefamily-based therapy depends on the age of the client, duration ofthe disorder, chronicity of the disorder, and the therapeuticalliance. This paper concludes that the future studies should focuson determining the mechanism of the family-based therapy, mechanismsof the therapeutic alliance, and the possible impact of combining thefamily-based approach with conventional therapies.
Keyworks: Family-based therapy, therapeutic alliance, therapeuticoutcome, relapses.
Family-BasedTherapy for Eating Disorders
Theeating disorder is among the key disorders that have not been giventhe attention they deserve by researchers and scholars. Althougheating disorder was discovered or recognized close to 125 years ago,it has continued to disturb millions of patients, their familymembers, clinicians, and researchers since a sustainable solution hasnot been identified (Grange & Lock, 2015). National Institute ofMental Health (2015) defined eating disorder as a type of illnessthat leads to significant disturbances to one’s everyday diet, andmay include severe overeating or eating extremely low amounts offood. Although eating disorders disturbs multiple stakeholders,family members of the affected person suffer the most since theyspend more time with the patient. This logic has been applied todevelop family-based therapeutic procedures that are intended toempower family members and given them an opportunity to help theirloved ones recover from the eating disorder. This paper will give anoverview of the family-based therapy, current research findings onthe effectiveness of the family-based therapy, critique the currentresearch findings, and suggest ideas for further research.
Overviewof family-based therapy for eating disorder
Theoverall perspective of the family-based therapy is to see familymembers (including parents, siblings, and other relatives) ascritical resources in the treatment of family members suffering fromeating disorders. The mobilization of parents as well as othermembers of the family is one of the key features that distinguishfamily therapy from other types of therapy. The primary goal of thetherapist using the family-based therapy is to develop a sustainableparental alliance, which will in turn align the client with thesibling or the peer sub-system (University of California, 2015). Thetherapists achieves this goal by equipping the patients or familymembers with skills that they need to guide their children or otherfamily members suffering from different types of eating disorders.Since adolescents are at the highest risk of suffering from theeating disorder, the therapists target parents, who are assumed to beregressed because they are more likely to support adolescents withrespect and regard for adolescents.
Phasesof family-based therapy
Family-basedtherapy follows three major phases that are compressed within 15-20sessions that are in turn offered within a period of 12 months. Thefirst phase, also known as the weight restoration phase, involves akeen focus on the key dangers of the eating disorder, includingchanges in the growth hormone, hypothermia, cardiac dysfunction, andchanges in cognitive as well as emotional development (Robinson,Dolhanty & Greenberg, 2015). In addition, the therapists assessthe family’s eating patterns and typical interactions with theobjective of guiding the family members on how to re-feed theaffected family member. Therapists also utilize the first phase toalign their patients with the family members and conduct a familymeal that serves two purposes. First, the family meal gives thetherapists an opportunity to observe typical interaction patterns ofthe family. Secondly, the family meal allows the therapists to guidefamily members on how to support the affected member.
Thesecond phase involves the application of efforts to restore thepatient’s control over their eating habits. During the secondphase, family members are equipped with the skills that can help themguide the affected members start adopting healthy eating habits andre-engage in social activities that had been suspended in the firstphase (Robinson, Dolhanty & Greenberg, 2015). The therapist triesto relieve some therapeutic roles to the family members by makingthem the client’s emotional coach. This calls for adequateempowerment of the family members to ensure that they have acquiredthe capacity to respond to the emotional needs of the affected familymember.
Thethird phase starts when the therapist becomes convinced that theclient is free of symptoms of eating disorder and has managed tomaintain the required body weight. This phase occurs when the familyis trying to adjust into a life without a single member with aneating disorder (Robinson, Dolhanty & Greenberg, 2015). Thisphase also occurs when the client manages to express feelings andfears to those who are offering the needed support. The therapistfocuses on helping the patients assert their identity and be able todevelop relationships with peers before terminating the sessions.
Reasonsfor targeting families
Althoughthere are some speculations that eating disorders are caused bygenetic disorders, family members play critical role in shapingeating behaviors and food preferences. This means that children tendto adopt the types of food eating patterns and eating styles thatthey learn from the senior members of the family (Lock & Grange,2014). In addition, families determine the availability of differenttypes of food to children. A family with poor eating patterns andavails more of fast foods to children than health foods increase therisk of suffering from an eating disorder. This implies thattargeting families can be the most effective strategies since thetherapist will have an opportunity advice and guide families on howto change eating patterns and the type of foods they avail to theirchildren. Some parents, especially those who are in the modelingsector can influence their children to adopt similar practices, whichincrease the risk of suffering from eating disorders (Lock &Grange, 2014). Changing parents and family members should be thefirst step and the most effective strategy for treating eatingdisorders since they have the capacity to determine the type ofenvironment that kids and other family members in the process oftreatment will live in.
Effectivenessof family-based therapy
Thepreference for any therapeutic approach should be based mainly on itseffectiveness in treating a given disease. Most of the researchfindings conducted family-based therapy has indicated that it is moreeffective than standard methods of treating eating disorders. Forexample, a study conducted to determine the outcome of family therapyindicated that about 75 % of the study subjects had recoveredcompletely by the end of the12 months of the therapeutic sessions(Robinson, Dolhanty & Greenberg, 2015). A long-term follow-up ofthe same subjects indicated that about 90 % of them had recoveredfrom their respective types of eating disorders by the end of fiveyears. A similar cohort study indicated that 75 % of patients witheating disorder managed to get the normal body weight by the end ofthe treatment sessions and recovered fully in the long-term (Hurst,Read & Wallis, 2012). The effectiveness of the family-basedtherapy was attributed to an improvement in emotional self-efficacy,which helped patients cope with the painful experiences thatincreased their risk of adopting unhealthy eating habits (Robinson,Dolhanty & Greenberg, 2015). A family-based therapy helpspatients to cope with physical stressors (such as conflicts withpeers and bullying from schoolmates) that reduce their ability tofocus on controlling their eating behaviors.
Effectivenessof family-based therapy in reducing relapse
Theeffeteness of the therapeutic procedures can also be assessed on thebasis of their capacity to protect patients from returning topractices that threaten their health. In the case of eatingdisorders, an effective approach should be able to prevent a relapseinto unhealthy eating habits and protect the lives of about 10-20 %of the patients who die within the first 20 years of suffering fromthe eating disorder (Hurst, Read & Wallis, 2012). A study thatfocuses on the relationship between therapy and relapse indicatesthat family-based therapy is more effective compared to otherapproaches. Although the research findings reported by Katman,Peebles, Sawyer, Lock & Grange (2013) indicated that thefamily-based therapy does not work for about 15-20 % of the patientswith eating disorders, the researcher concluded that it reduces thechances for relapse among patients who recover fully compared tostandard treatment procedures. A similar cohort study indicated thatabout 12 % of the patients did show any changes after undergoing the12 months of the family-based therapy sessions while 4 % of allpatients considered in the study relapsed soon after the therapysessions (Grange & Eisler, 2008). This indicates that about 84 %of the patients recovered successfully, which is sufficient toconclude that family-based therapy is effective and have a very lowrate of relapse.
Althoughmany stakeholders in the health care sector seem to support the useof family-based therapy in the treatment of eating disorders, veryfew studies have addressed the issue of therapeutic alliance. The fewstudies available indicate that there are significant differences inthe levels of parents-provider and adolescent-provider therapeuticalliance. For example, an independent observation of theeffectiveness of the family-based therapy revealed that parents areother family members of the affected person are very likely tocollaborate with the health care provider while the sick familymembers have a low alliance score (Forsberg, Tempio, Bryson,Fitzpatric, Grange & Lock, 2013). In addition, a case study ofadolescents suffering from eating disorders revealed that indicatedthat family members of the sick people have a high alliance scorewhile 30 % of the sick people expressed some desires to undergoindividual therapy (Loeb, Lock, Grange & Greif, 2012). Thisindicates that the health care providers are less likely to receivecooperation from the sick persons as compared to the family membersof the client.
Ageand duration differences in the effectiveness of the family-basedtherapy
Someof the current empirical findings have indicated the existence of agein the acceptance and effectiveness of the family-based therapy. Astudy conducted to determine the effectiveness of the family-basedtherapy indicated that this technology works better among adolescentscompared to transition age youth and adults suffering from eatingdisorders (Dimitropoulos, Freeman, Allemang, Couturier, McVey, Lock &Grange, 2015). The age differences in the effectiveness of thefamily-based therapy are associated with the difficulty ofexternalizing eating disorders and their symptoms among adults ascompared to adolescents. Externalization is among the key strategiesthat the therapists use to treat eating disorders (Robinson, Dolhanty& Greenberg, 2015). The findings of a case study conducted by(Loeb (et al., 2012) were consistent with the aforementioned findingsbecause the researcher identified that adolescents and children had ahigher probability of recovering from eating disorders compared toadults. However, a randomized controlled trial performed by (Loeb (etal., 2012) indicated that the family-based therapy worked well forindividuals with less than three years of suffering from eatingdisorders compared to long-term patients irrespective of their agegroups. Therefore, the age of the client and duration in which theclient has been suffering from an eating disorder are some of the keydeterminants of the effectiveness of the family-based therapeuticapproach.
Critiqueof the available research findings
Althoughthe findings discussed in this paper have indicated the progress madein the determination of the effectiveness of the family-based therapyin the treatment of eating disorders, there are several gaps in theseresults. First, Forsberg, Tempio, Bryson, Fitzpatric, Grange &Lock, (2013) focused on the impact of the therapeutic alliance in theprocess of delivering the family-based therapy, its role in therecovery of the client remained uncertain. Since the present studieshave already determined that the therapeutic alliance is significant,the future research should focus on the determination of themechanism as well as the role of this alliance.
Oneof the studies conducted by Robinson, Dolhanty & Greenberg (2015)indicated that a combination of the family-based therapy withemotion-focused therapy increases the therapeutic outcome as comparedto when each of the therapies is used alone. This indicates apossibility that most of the researcher who conclude that thefamily-based therapy is superior to other approaches fail to takeaccount of the emotional aspect of the therapeutic procedureperformed on their study subjects. Emotion is among the key factorsthat increase the preference of the family members to peers andneighbors when delivering a family-based therapy. This means thatmost of the therapists and researchers who conclude that thefamily-based therapy is effective combine it with emotion-focusedtherapy. Practically, it may be impossible to separate the expressionof emotions when the family members of the sick person are involvedin a therapeutic procedure, which means that some researchers combineemotional-focused approach with the family-based approach withouttheir knowledge and end up assuming that the family-based therapy iseffective when delivered alone. This suggests that the futureresearch work should try combining other therapeutic approaches (suchas cognitive behavioral therapy) with other alternative approaches(such as emotion-focused or the family-based approach) and determineif their effectiveness in the treatment of eating disorders canimprove compared to when they are used alone. This can lead to thedevelopment of more effective therapeutic approaches that can begeneralized to clients from different groups.
Mostof the research findings suggest that the family-based therapy issuperior to other approaches used in the treatment of eatingdisorders. However, none of these findings have gone beyondtheoretical suggestions to indicate empirically why and how thefamily-based therapy works (Lock & Grange, 2014). This has madeit difficult to tailor the family-based therapy procedures I order toensure that they can suit people with different socialcharacteristics other than chronicity of the eating disorder and theage of the client. Although the findings reported by (Loeb (et al.,2012) indicated that the family-based therapy targets and addressvariables (including blame, secrecy, passive as well as activeparental responses, and internalization of the disorder) at thefamily level, the researcher could not identify the mechanism throughwhich the family-based therapy resolves these variables. Thissuggests that the future research should focus on determining themechanism of action, through which the family-based client recoverfully and be safe from the possibilities of relapse.
Allthe studies reviewed in this paper have supported the use of thefamily-based therapy, but they have suggested its application in thetreatment of children and adolescents (Robinson, Dolhanty &Greenberg, 2015 and Katman, 2013). These studies have failed toaddress the impact of the inflexibility of the family-based therapyon its effectiveness in treating clients with eating disorders. Thefindings do not indicate whether the three phases can be adjusted toaddress the eating disorders and their related challenges amongdifferent age groups and categories of patients. The future studiesshould focus on the determination of whether the limitation of thefamily-based therapy in terms of age and duration is related to itsinflexibility. This can pave way for the review of the activitiesinvolved in each phase in order to increase the flexibility of thefamily-based therapy, and ensure that it works best for clients indifferent social and age groups.
Eatingdisorders have existed through the human history, but they got theattention of the health care providers about 125 years ago.Currently, the majority of the researchers and scholars are convincedthat the family-based therapy is the most effective approach used inthe treatment of eating disorders. This conviction is based on thecurrent empirical studies showing that the family-based therapyleaders in the full recovery of adolescents and children sufferingfrom different types of eating disorders. However, the availableliterature has some gaps, such as the uncertainty pertaining to themechanism of the family-based therapy, mechanisms of the therapeuticalliance in a family-based approach, and the possible impact ofcombining the family-based approach with conventional therapies.Therefore, future research works should seek to fill these knowledgegaps.
Dimitropoulos,G., Freeman, V., Allemang, B., Couturier, J., McVey, G. Lock, J. &Grange, D. (2015). Family-based treatment with transition age youthwith anorexia nervosa: A qualitative summary of application onclinical practice. Journalof Eating Disorders,3 (1), 1-30.
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