Family-based treatment boasts many advantages. As suggested by the University of Chicago Medical Center study and similar research evaluating the Maudsley method, families are in a unique position to monitor eating patterns at home and encourage those with eating problems to eat well. This is something that therapists, doctors, and dietitians generally can't do.
Beyond this, it's generally healthy for those with eating disorders to have a structured place to learn about how they affect their families and vice versa. Family members often have strong convictions about who is responsible for various problems, but it's much easier for others to see us than it is to see it ourselves. A therapist with a neutral perspective has an advantage.
For those with eating disorders, family-based treatment provides a way to explore how families have influenced them -- for good, bad or (usually) both. When truth emerges, it's harder for a teen to see her parents as perfect or as diabolically evil. In any case, the son or daughter can express what it has been like to be a child in the family without fear of needless retaliation from parents or siblings.
Further, having things out in the open can be a relief for a family that feels like a pressure cooker to its members. There is much secrecy when an eating disorder is present, and this creates pressure. Family therapy can help to break the intimidated silence family members often feel.
An eating disorder therapist who practices family therapy must view the entire family - rather than the person with the eating disorder - as the client. In some ways, each family is its own tiny culture. It's the therapist's job to learn the strengths and weaknesses of the family's unique norms and beliefs. There may be ways that family members' behaviors and communication create barriers to better functioning. Family members may also have untapped resources that, when encouraged to blossom, benefit the entire family. The therapist can find and focus on each family member's strengths and how they can contribute to solutions.
Occasionally, patterns of behavior or communication in a family are extremely destructive (for example, when it's clear that there is domestic violence or some other form of abuse in the home). A therapist may decide that eating disorder treatment must wait until issues of safety have been addressed. This may entail enlisting other resources. With these pressing problems under control, eating disorder treatment has a much greater chance for success.
Much more research must take place before the promising results in these studies gain general acceptance and change treatment processes. Do the results indicate that it is the involvement of the family that makes the difference? Or is it the focus on constant monitoring? Maybe it's both. Research in the area of family-based treatment must continue to pursue solid answers, allowing therapists to refine their approaches to achieve optimal results.
Sources:
Eisler I, Simic M, Russell GFM, and Dare C. A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: A five-year follow-up. Journal of Child Psychology and Psychiatry 48 (2007): 552-560.
Goldman HH. Review of General Psychiatry. 5th ed. New York: McGraw Hill Medical; 2000.
University of Chicago Medical Center. 2007. Involving parents in therapy doubles success rates for bulimia treatment. Accessed 6 September 2007.
