I received so much positive feedback regarding my last “Top 10 List” that I thought I would attempt another, shorter list with my thoughts on what could be helpful for parents of ED children. There are many suggestions or lists to parents who have recently had their child diagnosed. What to do, what type of therapist to look for, how to get the child to eat. I thought I could add something new to this information by offering my thoughts on what I would like parents to know who are currently already in some type of family therapy with their child, helping them to fight this illness. I hope this is helpful!
1. Guilt (in you)- A lot is now being said about the fact that finally, many (but not all) professionals are “getting it” that you, the parent did not cause your child’s eating disorder. This is highly important and has been a long time coming. But that being said, even though I do not blame the parent for the ED, I do try to educate them on how to be the most supportive they can be during the recovery process. This interaction can feel like I am blaming them, criticizing them, or invalidating what they are doing to help their child already. It is a very delicate balance of evaluating the present dynamic in the family, and seeing what everyone can do differently to minimize the impact of this deadly disorder. As much as I try to offer this information in a non-critical manner, many parents end up feeling “blamed” for something they are “doing wrong”. They then often generalize this to thinking “I just caused the whole problem, it is all my fault”. This process of the parent being overwhelmed by their own guilt is not only bad for them but it is unhelpful to the whole therapy process.
My best advice: Do not allow yourself to mistakenly buy into something that is not real. You did not know this ED was there, you did the best to get your child help as soon as you knew, you are trying your hardest now. The fact that you are showing up in therapy means everything. Just that alone is a tremendous gift to your child. Guilt makes you paralyzed. It doesn’t allow you to move forward. Instead of swimming in guilt, trade it in for anger. Anger at the ED for wanting to destroy your child and the life of your family. Anger will motivate you. Anger will move you. Guilt will imprison you and make you ineffective in trying to be the best parent when your child needs you the most, when they are sick.
2. Frustration (in your child). One of the primary beliefs of the family based work is that “the ED is not your child”. This is very clear in practice, but again like I spoke of above with guilt, in the therapy room it can be more messy than that. We all believe that the ED is a separate entity from your child and thus are clear that we want to “punish” the ED while we support and love your child. But, the reality is when we are trying to “kill off” the ED, we are still affecting your child. Many, many children will say to me “When you get mad at the ED, you are getting mad at me too!”. This is a common occurrence, especially at the beginning of treatment. It is very hard on the children who are bewildered and confused most of the time. They never meant to fall down this rabbit hole. They just wanted to lose weight or “become healthy”. They certainly didn’t want or expect to have to meet with all these annoying therapists and they certainly didn’t want their families to become so upset. It just happened and they feel lost and powerless and often hide behind the defiant, strong facade of the anorexia. So, knowing how their child is sad, lost, and anxious most parents are extremely reluctant to upset them anymore. This is totally understandable. However, this thinking needs to be challenged. Yes, the child who is hosting the ED will get upset when they are “made to eat”, yes they will cry when they lose privileges because they are not sticking to the meal plan. Yes, they will initially experience the therapy as horrible and “only wanting to make them fat”. But…..this is ALL O.K.
It seems counter intuitive to parents to “further frustrate their child” with this type of treatment. But, they must. I am NOT saying to be abusive, shaming, or to terrify the child. These things traumatize the child. They leave an imprint on the psyche and on the developing brain. We never want to do that. But, parents who are strong, unwavering, and yes, sometimes frustrating to the child are what is needed. Time and again, after the storm passes and the ED is gone I process the child/parent relationship. It is very common that the child acknowledges then that they need the parent’s strength, they needed it all along. They were dying, unable to fight this illness. They couldn’t ask for help. They just needed the parent and treatment team to “get rid of it for them”. This process of the child being frustrated with limits or consequences or firmness from the parent in an appropriate manner has NEVER led to a worse relationship. In fact, it has only led to more openness, more trust, and more connection.
My best advice: Be confident in yourself that you would never abuse your child. You are only doing what is needed to pull them from the depths of this hole where they are failing in their attempts to fight this illness. Being firm, consistent, strong, and more insistent than the voice in their head is not only important, it is crucial to their full recovery.
Please let me know your thoughts and if this is helpful I would be happy to continue this series….Take care. Dr. Davis