Family Therapy for Bulimia
People who purge (undertake compensatory behaviours) are likely to have significantly higher levels of appearance dissatisfaction, anxiety and depressive symptoms, alcohol consumption, self-concept instability and loneliness than those with other forms of eating disorders. Research also indicates that people who develop bulimia tend towards impulsive activities; activities which reflect the typical affect/mood/emotion regulation strategies of insecurely attached individuals; 96% of people with eating disorders evidence an anxious attachment style with its concomitant sense of diminished self-worth and self-efficacy.
In treatment, the attachment perspective views a secure emotional connection to significant others as an adaptive, wired-in survival mechanism that fosters optimal development and mastery of the environment. A secure connection to an accessible and responsive parent fosters a sense of felt security, which then allows for flexibility, open communication, and autonomy. The perspective views autonomy and secure connectedness with significant others as two sides of the same coin, and parallels the literature on adolescent development.
Successful adolescent development is optimised by a family's ability to balance needs for individual growth and connectedness while providing nurturance. The challenge in adolescence is to realign and reorganise the connection with parents in a way that maintains the adolescent's sense of the family as a safe haven and fosters confident exploration of the world, rather than to lessen that bond.Several approaches to family therapy explicitly focus on separation distress and attachment insecurity and use attachment theory as a general guide to intervention.
The goals of emotion focused family therapy (EFFT) are to modify the distressing cycles of interaction that create and maintain attachment insecurity in family members particularly in the adolescent with bulimia, and foster positive cycles of accessibility and responsiveness. These positive cycles then define the family as a safe haven for the adolescent and create a more secure bond; a bond which fosters optimal development and adaptive coping. It also allows the adolescent the sense that they can, when ready, leave his or her family without losing that family.
In anxious attachment, attachment figures (parents or partners for example) are viewed as both potential sources of emotional comfort and nurturance and which is longed for and pursued, and yet is also pushed away and mistrusted. It is striking that the person with bulimia repeats exactly this strategy with food, another form of nurturance. Binge eating may be turned to as a source of self-soothing at a time when they are facing the task of growing up, confronting independence, leaving home and perhaps perceive at some level that they will have be facing the world alone. A sense of security comes from controlling needs for food and nurturance, rather than from safe attachment with others. Eating disorder behaviours also act to distract one from, suppress or repress those uncomfortable yet normal emotions of sadness, fear and anger - and which are often then channeled into disgust. The eating disorder then becomes a way of managing (purging) and avoiding (restricting) feelings of disgust.
In EFFT the attachment framework focuses family members on the relationship rather than on the individual members' faults of mistakes. In EFFT, the family is seen all together for the first one or two sessions, and I encourage each member of the family to describe his or her perception of the problems faced by the member with the eating disorder and how the family has tried to deal with this situation. I also elicit specific descriptions of problematic interactions, incidents, or crises that the family has experienced along with the strengths of the family and its members. A history of how the family has evolved is also elicited. From here, I identify the problematic relationships and family cycles that appear to be associated with the problem and beings to place family members; individual responses in the context of this cycle. After the initial sessions that identify the attachment patterns and negative cycles in the family, different family subsystems are invited to the sessions.
Typically parents are invited to talk about their parenting role, the sibling subsystem will be seen alone with both parents of with one parents. This approach involves a flexible combination of dyadic, triadic and family group sessions as well as at least one individual session with the adolescent. Dyadic sessions allow for more emotional engagement and a more intense focus on the quality of an attachment relationship. Individual sessions strengthen the alliance between the adolescent and the therapist and allow the adolescent to disclose events that are difficult to talk about in front of the parents.
Treatment usually involves 10-12 weekly sessions and ends with a session where all family members are present to ensure that specific changes are integrated into the system as a whole.
In treatment, the attachment perspective views a secure emotional connection to significant others as an adaptive, wired-in survival mechanism that fosters optimal development and mastery of the environment. A secure connection to an accessible and responsive parent fosters a sense of felt security, which then allows for flexibility, open communication, and autonomy. The perspective views autonomy and secure connectedness with significant others as two sides of the same coin, and parallels the literature on adolescent development.
Successful adolescent development is optimised by a family's ability to balance needs for individual growth and connectedness while providing nurturance. The challenge in adolescence is to realign and reorganise the connection with parents in a way that maintains the adolescent's sense of the family as a safe haven and fosters confident exploration of the world, rather than to lessen that bond.Several approaches to family therapy explicitly focus on separation distress and attachment insecurity and use attachment theory as a general guide to intervention.
The goals of emotion focused family therapy (EFFT) are to modify the distressing cycles of interaction that create and maintain attachment insecurity in family members particularly in the adolescent with bulimia, and foster positive cycles of accessibility and responsiveness. These positive cycles then define the family as a safe haven for the adolescent and create a more secure bond; a bond which fosters optimal development and adaptive coping. It also allows the adolescent the sense that they can, when ready, leave his or her family without losing that family.
In anxious attachment, attachment figures (parents or partners for example) are viewed as both potential sources of emotional comfort and nurturance and which is longed for and pursued, and yet is also pushed away and mistrusted. It is striking that the person with bulimia repeats exactly this strategy with food, another form of nurturance. Binge eating may be turned to as a source of self-soothing at a time when they are facing the task of growing up, confronting independence, leaving home and perhaps perceive at some level that they will have be facing the world alone. A sense of security comes from controlling needs for food and nurturance, rather than from safe attachment with others. Eating disorder behaviours also act to distract one from, suppress or repress those uncomfortable yet normal emotions of sadness, fear and anger - and which are often then channeled into disgust. The eating disorder then becomes a way of managing (purging) and avoiding (restricting) feelings of disgust.
In EFFT the attachment framework focuses family members on the relationship rather than on the individual members' faults of mistakes. In EFFT, the family is seen all together for the first one or two sessions, and I encourage each member of the family to describe his or her perception of the problems faced by the member with the eating disorder and how the family has tried to deal with this situation. I also elicit specific descriptions of problematic interactions, incidents, or crises that the family has experienced along with the strengths of the family and its members. A history of how the family has evolved is also elicited. From here, I identify the problematic relationships and family cycles that appear to be associated with the problem and beings to place family members; individual responses in the context of this cycle. After the initial sessions that identify the attachment patterns and negative cycles in the family, different family subsystems are invited to the sessions.
Typically parents are invited to talk about their parenting role, the sibling subsystem will be seen alone with both parents of with one parents. This approach involves a flexible combination of dyadic, triadic and family group sessions as well as at least one individual session with the adolescent. Dyadic sessions allow for more emotional engagement and a more intense focus on the quality of an attachment relationship. Individual sessions strengthen the alliance between the adolescent and the therapist and allow the adolescent to disclose events that are difficult to talk about in front of the parents.
Treatment usually involves 10-12 weekly sessions and ends with a session where all family members are present to ensure that specific changes are integrated into the system as a whole.