When Parents are Partners by Judith Brisman and Judith Ruskay Rabinor

You've Got Mail! Part 2

 


      A couple of weeks ago I described a situation where the father of one of my patients e-mailed me, concerned about his daughter’s vomiting. I was in a difficult situation, for on the one hand, this was important information, but on the other hand: gotten behind his daughter's back-- without her consent-- (you will have to scroll back to see more details about that post). In any event, after the Dad contacted his daughter, she agreed to have him join us for a session.   Lets pick it up from there.....

When—NOT IF- Parents are Partners

 

Having just returned from Renfrew’s 20^th Anniversary conference, I’m filled with good spirit and inspired thoughts having been surrounded by such a remarkably smart, challenging and creative group of colleagues.  If you have yet to attend one of Renfrew’s conferences, don’t miss it next year.  The conference is not just a nexus of information, but it is an anchor of heightened professional exchange and support. It’s also always fun!

And of course I’m left with many thoughts.  Not surprisingly, the role of family-based treatment took center stage at many points during the conference.  It was interesting to learn that, once research is parsed though, FBT actually only has about a 40% cure rate.  But it is seen as the frontrunner in terms of therapeutic options because indeed when it does work, it is significantly cheaper than any other treatment around (one therapist, seen 20 times yearly, with big insurance backing for the expenditures). The finances, if nothing else, make this treatment extremely compelling.

That being said, I have many families who could never take the time off from work to sit with their son or daughter through months of meals.  That would be more costly than any possible treatment solution.  Hiring a full time nurse or aide is a possibility—again, finances would have to be assessed.

The problem for me is not that FBT isn’t effective.  I think research certainly has demonstrated that it CAN be—in certain specific situations.  Certainly, FBT has addressed one of the most significant gaps in the treatment arena—that is, how parents can be of support in the therapeutic process.  What concerns me though is that clinical experience with eating-disordered patients has shown that other kinds of parental involvement can result in symptom reduction, abatement and change.  I’m talking about a treatment in which parents don’t directly re-feed their kids but are involved in other ways.  Here, a nutritionist, therapist and physician determine how much weight the patient needs to gain each week (in the case of anorexics) and the parents are supporting these efforts. often by unemotionally insisting on consequences if the weight is not gained (i.e., withdrawal from sports, withdrawal from school, etc).  Exploration of family and individual dynamics at this point can help families deal with issues such as  1)coping with the intense frustration that is inevitable at this stage of treatment, 2) expressing anger constructively and 3)fine tuning the best ways for parental involvement.

Parents and clinicians alike would benefit from studies in which FBT is compared to studies in which FBT is compared to other family involvements even when parents don’t specifically feed their child.

We have much to learn from each other.  Take a look at Treatment of Eating Disorders: Bridging the research-practice gap (Maine, McGilley and Bunnell, 2010).  It’s challenging and thought provoking place to start. As clinicians, we had better get going in documenting effective treatment practices. As researchers, let’s pay attention to what we aren’t documenting but may be proving despite ourselves (i.e., that parental involvement is critical, but it may be unclear just what about the involvement is helpful).  What we do know is that parents need to be our therapeutic partners.  Just how that should be remains the question at hand.   jb

You've Got Mail! "I'm Worried about my Daughter..."

One of the most important  things Ive learned in working with families is how crucial it is to be respectful, empathic and connected to every member of the family--.which isn't always as easy as that might seem. Sometimes an alliance with a parent can threaten a teen, and equally as often, an alliance with a teen can leave a parent feeling left out of the loop with no support.  Ihad seen Ilana, a  20 year old college student, four times when I opened my inbox to find this e-mail from her father, Joe:
 
 Dear Dr. Rabinor

I'm really worried about Ilana and since I know you are seeing her this afternoon I thought I would let you know what’s going on. I see she's been struggling, especially the last two days - there was some evidence of purging this morning in the toilet.  Can you give me some direction:what should I do when I see this?

Dear Jane, Your BMI is high!

Parents have a lot to worry about these days. In that spirit, we’ve been paying attention to Michele Obama’s "Let’s Move" anti-obesity campaign which has gotten off to (dare I say) a running start. This program is vast, for the most part intelligent and multi-directional.  But it seems that no one, except the eating disorder community, is worried about the real possibility that this focus on fat will result in more eating disorders (think bulimia and anorexia), not less.