Working Backwards

I am always thinking about ways we can summarize and simplify the huge amounts of data that are being thrown at us every minute. The often conflicting data, the hundreds of inspirational quotations that we should follow, the reams of parenting advice……. and this is just on our twitter feed! Let alone books, research articles, and good old verbal advice. How do we make sense of all of this? How do we know what advice to follow when one finding looks as good as the next?

With these thoughts in mind, I was consulting the DSM-5, the “bible” for psychologists and people in the mental health field. It is our “map”, our way of trying to understand the complexity of human nature that often is presented in front of us. I was consulting the section on Personality Disorders to try and find some diagnostic clarity regarding a particularly challenging client, and I turned to the back of the book. There was a section on a proposed new way to classify and understand personality disorders which caught my attention. Instead of the current classification system, it proposes an overarching system of understanding personalty dysfunction: classifying if and how severely patients are struggling in four central areas of their lives: their overall sense of self, their ability to get things done, their sense of empathy, and the quality of relationships in their lives. Patients are classified along a continuum of mildly to severely impaired in these four areas. Pervasive dysfunction represents the most severe pathology.

I started thinking about the parents of my eating disordered patients and how we as a field are finally getting to the point of not blaming them for their child’s illness. I am very clear in my sessions that these parents have not caused the suffering in their child. This has been extremely helpful in the entire therapeutic process – alleviating guilt and allowing the parents to become empowered catalysts of change for their children. However, while we are moving on from blame and causal issues, we are still left with the fact that parents DO influence their children. They may not cause a particular illness, but they certainly leave an imprint on their child. In the world of eating disorder treatment, there are many times that the ED is lifted and the patient still struggles with some underlying personality dysfunction. The parents want to know – “What are we doing that is not helpful to our child?”. The child is now re-fed and their brain and body has come back to life. But the child continues to struggle. The parents continue to struggle. What next?

Instead of re-inventing the wheel each time wouldn’t it be nice if we could take what we know and work backwards. If we know that dysfunction in these four above mentioned areas can create ongoing issues, why not target these four issues? Why not help parents learn to parent better across these 4 domains? Why couldn’t we teach these (and all) parents to parent “better” in the areas that they struggle the most:

  • do they have good enough boundaries to create a child with a clear sense of self?
  • do they create enough structure (both consequences and reinforcements) to help the child manage the things they have to do, even if they don’t want to do them?
  • do they model compassion and empathy to the child through their relationship with their self and their child?
  • do they engage in truly reciprocal and mutually validating relationships with the child so that the child can take this model out into the world?

Helping a parent accomplish this on a consistent basis is extremely challenging in the world we live in. But how empowering it could be to give parents this map as well, to let them know what we know….and to show them that they can create health in their child not only by re-feeding them but also by supporting their emotional growth. Parents (and all of us) have a limited amount of energy to give – let’s help them figure out the most effective way to put this energy into action to best support their child.

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