Filed under: Weight Loss. Tagged as: Weight Loss.
As a child develops, she passes through stages. At each stage the tasks that confront her increase in complexity. The challenges of one stage prepare her to tackle the next. The tasks of adolescence are to form an identity, to separate from the family, to develop more mature relationships outside the family, and to accept one’s growing and changing body.
Sometimes, however, family interactions combine with the fears of an eating disorder patient in a way that makes it difficult for her to face and overcome these developmental challenges. For example, when parents are overly critical of friendships outside the home, a child may limit the depth of her involvement with her friends. Later, as her friends grow and mature, she is left behind. To cope with abandonment, the girl retreats to a world focused on the things she can control -food and eating.
Family therapy identifies family problems that contribute to the child’s symptoms. Once they are identified, work begins to correct those problems and to help everyone, not just the patient, find other ways of interacting.
The key elements in any family structure, according to Minuchin, are hierarchy, subsystems, and boundaries. Hierarchy is the way tasks are assigned based on ability and maturity. In a normal hierarchy, leadership is shared jointly by the parents. Children take on roles that fit their age and development -helping around the house, caring for siblings, earning money. Subsystems are smaller units based on roles within the family: parents, spouses (not the same thing!), and siblings. Boundaries are the invisible, but very real, lines between subsystems, and between the family and the outside world. Proper boundaries allow each member the highest degree of freedom while providing safety and security. In some families, not only are boundaries between subsystems inadequate, but the boundaries between the family and the outside world are too rigid. Children can’t play with neighbors: “Not our kind, dear.” Dating is discouraged; a teenager may be told not to take a job: “We’ll give you more money, if that’s what you want.”
Minuchin’s approach to family therapy, which I have found helpful in my practice, changes these pathological interactions by firming up the boundaries between parents and child. We urge parents to take on their natural roles as family leaders and to collaborate with and support each other. We also work with all members to help the patient become more autonomous. The family members learn new ways to communicate, and pick up pointers on solving problems in more creative, effective ways. In the process, they lose the feeling of helplessness that drove them to seek help in the first place.