Dear Readers,
In my last post, the first of a two-parter, I outlined a form of meal-support therapy developed at the British Columbia Children’s Hospital by Dr. Pierre Leichner and his colleagues. This continuation of the post details how the team translated their program into a method that parents could use at home.
Dr. Leichner and his staff then went back to Intensive Treatment Service patients who had successfully recovered using the meal support program and asked them, “If you had to tell family and friends what was helpful to you and what was not, what would you tell them?” The results of these interviews formed the basis of a BC Children’s Hospital instructional DVD, “Meal Support Therapy for Friends and Family.” Basic ideas such as how to handle family conflict when it erupts at the table, or how parents should and shouldn’t encourage their child to eat are covered in the DVD.
Before a patient is discharged the ITS program conducts one to four “conjoint meal support” sessions with parents and child. Dr. Leichner admits that some families are too enmeshed to successfully practice meal support at home, but notes that this is only in a minority of cases. Most families are able to continue the positive changes at home. He points out that the more entrenched the disorder, the longer it may take for the family to get on track, a fact which argues for families getting meal support training as early as possible in the child’s recovery process.
Although there is some overlap of his meal support program with Family Based Training, Dr. Leichner says, “We don’t use the same language, “parent in charge,” or “the power of language.” It’s not about finding causality. It’s more about helping people with the skills of the family meal. It’s more like rehab, giving people the tools, coaching them without necessarily getting into any kind of causality. We emphasize collaboration.”
Just as in the clinic, parents sit down with their child before the meal to anticipate what might happen, possible difficulties and how they might respond to them. “Each family has to find the bottom line, something below which is not acceptable,” explains Dr. Leichner. Not eating at all, for example would be unacceptable. Other negotiated bottom lines could be the content of the meal or the length of time the child will sit at the table. A dietitian aids the family in setting up a meal plan, and can offer suggestions on food choices.
The key to family meal support, says Dr. Leichner, is patience. Recovery doesn’t happen overnight, and there will be ups and down, progress and relapses. He urges parents to find their own sources of help from a network of friends, family members and professionals so they do not feel alone in their efforts.
To order a copy of the BC Children’s Hospital DVD “Meal Support Therapy for Family and Friends,” click here. Dr. Leichner reports that the DVD and manual have been translated into French.
Take care,
Nancy
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