Reflections on Communication - Family Week

I’ve participated in Family Weeks at several eating disorder residential treatment facilities.  These programs are usually scheduled towards the end of a person’s stay when they are healthier nutritionally (and this is another topic I want to expand on having read Dr. Julie O’Toole’s Give Food a Chance and now am reading Answers to Anorexia by James M. Greenblatt, MD) and have made substantial progress therapeutically.   Sometimes the week is a long weekend; other times it’s a full week.  Sometimes, depending on financial ability, the entire family travels to participate; others, just one person.   It’s hard work, no doubt about it, and I’ve witnessed a lot of progress among family members, myself included.

Family Week also provides up-to-date information about eating disorders.  Sometimes, it's the first time family members have actually had a chance to sit down, discuss, and digest what's going on because life has focused on getting one's loved on into treatment.  I have inevitably found it to be a good experience.

Early on, Family Week left me feeling like I had been beaten up and was to blame for the illness.  I certainly had made decisions that I know added to the anxiety and stress felt/experienced in the family; so had others.  But some families haven’t experienced turmoil and still a family member develops an eating disorder.  What then?  This discussion in response to a post by Judy Scheel, Ph.D., LCSW titled "Linking Early Attachments to Eating Disorders" (11/1/2011) illuminates my and others' discomfort and partially explains why I wrote this post about communication and family week.

Parents can understandably be very reluctant to participate especially, as Dr. Janet Treasure notes in her book Skills-Based Learning for Caring for a Loved One with an Eating Disorder, since these illnesses cause great strife in the family unit and can tear it apart without appropriate support and guidance through family counseling.  Now, though, science and research are catching up.   We know that genetics as well as environment play a large part.  We know that people – whether parents or their children – are different; even identical twins.  So traits become an important factor as is behavior.  Communication – nonverbal as well as verbal – is very important.  Mirroring is a major factor.  We know we can still learn new ways of doing things.

Over the past six years especially the content of Family Week has improved, at least where I’ve gone to participate.  Family members are more likely to be included in the team, recognizing that once the person leaves the facility and especially if s/he is not yet an adult, s/he is going to go back to the home.  So, the question is, how can everyone help make the situation better for the person who is in recovery and who is still pretty raw from a lot of introspection as well as adaptation to new behaviors to replace old, maladaptive ones?

I need to say this another way.  When one becomes accustomed to doing things a certain way, one needs to consciously work on doing things another way.  When a person  has been ill with an eating disorder, they have developed behaviors and thought patterns that need to be changed.  Nutrition alone is not going to change this fact.  Nutrition and then behavior modification is.  That's why, even with the new Maudsley Method, family and individual therapy are very important to help the person in recovery really get into recovery.  Since at least 60 percent of those who develop eating disorders have struggled with anxiety disorders including OCD, these disorders need to be addressed.  Since fifty percent (according to the latest study) of people do not respond to the Maudsley Method (and it will be interesting to pick the results apart to understand why fifty percent do not, assuming that therapy is part of the picture to help people learn new ways of thinking and doing and responding), there still is work to be done.

I’ve already mentioned LEAP, the wonderful communication theory developed by Dr. Xavier Amador and expanded upon in two of his books:  I Am Not Sick, I Don’t Need Help and I’m Right, You’re Wrong, Now What.  Seminars have been held across the United States and there’s a website with more information.  I have found this theory of communication to be very helpful.  The goal is to help your loved one believe not only that you’re listening, but also that you’re understanding.  S/he wants to be heard.  There’s a great on-line primer.  I try to review it often.

Another is to create a safe, loving household where everyone is treated with love, respect and dignity while the parent(s) or partner remain as calm, cool and collected as possible.  In this context, how does one express love?

One of the Family Week exercises I truly found eye-opening and very helpful is based on work by Gary Chapman about what he calls The Five Love Languages.  I happened to see one of his books on display in a local bookstore this past weekend and remembered how this exercise had affected our family.  Basically, because of our own “stew”, each of us has a different “love language” not only in terms of how we hope to have love expressed to us or put in another way how we interpret someone else’s love for us, but also how we express love to others.  Chapman believes that there are five categories of love, which are:   things done for you, physical touch, time spent, talking/conversation, and gifts.

Each family member in our group was asked to independently order, from most important to least important,  these categories not only for themselves, but also what we all believed was the order of importance for other members in our family and then share, while guided by the family therapist.

So, for example, a person may believe that the most important way they can show love for a family member is by providing material things including gifts.  This belief usually means that the person needs to work long hours away from home to earn the money to do this.  On the other hand, the child or the spouse/partner may instead believe that time spent with them or in conversation is much more important. 

If your child came into the world being ultra-sensitive to touch, light and noise, then it would help her/him if the family would go easy with the bear hugs, rowdiness and the tickling.  Changing behavior to recognize this sensitivity can be interpreted as love.  On the other hand, some parents grew up in homes where hugs were few and far between but their child loves and even craves to be touched.  Touching stimulates the release of the hormone oxytocin, about which I’ve posted here earlier.  Maybe touching is one of the keys to recovery. 

 

The bottom line is that if a person isn’t getting what they need, what they believe is love, or s/he is struggling with his/her disruptive feelings and emotions and not getting the right kind of help from their parent(s) or other family members for them, they may feel neglected and unloved.  Notice that I highlighted the words “may” and “feel.”   It's important to reflect on this. 

Where does this fit in?  First, it’s important to recognize that this is not a “blaming” exercise.  Rather, it’s a “getting to know you better” exercise for the entire family.   There are other helpful exercises, as well.  Going back to LEAP, if a person really thinks they are being heard and understood, this belief provides a base for progress.

Unless a home is truly dysfunctional and abusive, most family members really do want to create a loving environment for their children and for each other.    If the family knows that eating disorders, depression and anxiety are prevalent in the family tree or that these or other brain disorders are already appearing, then the family’s goal is to make the home a safe haven for their children where they can learn effective coping mechanisms when confronted with situations that might trigger anxiety, for example.   If anxiety is quieted so that the person does not turn or return to an eating disorder as a coping mechanism but rather to a positive mechanism, then the person is making progress.  Having a safe, loving environment in these situations is very important.  Knowing a person’s love language can be useful on the path to recovery.