The Psychology of Eating: From Healthy to Disordered Behavior

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Treating Eating Disorders 265

particularly, the therapist will encourage a change in these relationships and
suggest that the patient become more independent by finding new interests
outside the family. In addition, the symptoms of the eating disorder can
come to dominate the family, creating a focus for the family and dimini-
shing the role of other potential points of contact. Specifically, the symptoms
can be seen as a “common concern” which holds the family together. A
remission in the symptoms can feel threatening to the family as they have
to learn new ways of interacting. The family therapist can address these
issues by announcing any change in the place of the symptoms and
encouraging the family to fill any opening space with new activities and
new ways of relating to each other. Specific interventions used as part of
family therapy include instructions, interpretations, and the facilitation of
negotiations between the parents and between parents and children.
Further, the therapist can facilitate a change in the dynamics by challeng-
ing and blocking any unhelpful interactions which occur within the family
during therapy, supporting particular family members, and pointing out
new ways of interacting. The aim of such interventions is described by Dare
and Eisler (1995, p. 339) as the following:



  • The clarification of roles and of communication

  • The establishment of age-appropriate hierarchical organizations and
    boundaries within the family

  • The encouragement of a clear alliance between the adults in the family
    for the sake of effective parenting


This component of family therapy has been described as the family systems
component.


Effectiveness of family therapy

The effectiveness of family therapy has been assessed involving patients who
vary in the severity of their problem, and in comparison with a range of
other interventions. One trial involved 80 patients (57 with anorexia and
23 with bulimia) who were randomly allocated to receive either family
therapy or individual supportive therapy just before discharge from an
inpatient unit. The results showed that family therapy fared better than
individual supportive therapy for patients who had developed anorexia
before 19 years of age and had had it for less than 3 years (Russell et al., 1987;
Dare et al., 1990). This difference persisted at the 5-year follow-up (Eisler

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