Archive for Апрель 22nd, 2009
EATING DISORDERS: THE PROCESS OF FAMILY THERAPY
It’s hard enough for an individual to enter therapy. How does a whole family manage it?
Families’ needs, and thus their motivations, are different. Many families come because they have reached a point where therapy simply seems like «the thing to do.» They have struggled with the disorder for a long time, have handled it on their own, but now feel something more is needed. Sometimes, however, such families spend much of the session denying anything is wrong. They want to convince the therapist they are perfectly normal, and receive his or her blessing to go on living their lives as before. As Selvini-Palazzoli observes, such families go through the «ritual» of seeking help but have no real intention of changing.
Other families come because a crisis occurs that tips the balance. Often an older child is about to leave the family, perhaps because of an impending marriage or the start of school. The patient -the symptom-bearer – experiences a worsening of her illness in a desperate attempt to hold the family together and maintain the status quo.
Sometimes the family has grown so used to the patient’s ways that her starving or her bingeing fails to produce any emotional effect. She no longer gets the attention she once drew. As a result her symptoms may worsen, or she may become depressed. Sometimes it is this depression that brings the patient into treatment.
Another main reason for getting help is relentless pressure from other people. Oddly, many parents blind themselves to their daughter’s condition. Only when an outsider notices -»My God, Tricia has gotten so thin!» – does the ball start rolling.
How does the family select a therapist? The usual method is through a referral by a psychiatrist, pediatrician, or family doctor, or a recommendation from the local mental-health association. A few families let their fingers do the walking and look in the phone book.
It helps if the parents and the patient all attend the first session. Doing so provides a snapshot of how the family operates in each other’s presence, clues that will affect the course of therapy. It also prevents «splitting» – giving the patient the feeling that her parents have ganged up with the therapist against her, or that the patient and one parent have conspired against the other. It also gets all the therapeutic cards on the table: No one can accuse the others of telling tales behind his or her back.
*104/35/5*