Registered: Oct 16, 2012
Posts: 23
| Posted Yesterday at 03:41 AM | Reply with quote?#1? |
| CAMHS has offered us some family therapy but neither our ED D nor her brother are at all keen on the idea and my h is skeptical. Just wondering whether anyone has done it and whether they found it helpful? Also, we have been refeeding for the last two weeks and our d is really struggling to cope with school now; not academically but emotionally, having to cope with supervised eating at school,?with 'pretending to be OK' when she is clearly feeling very fragile, and just the whole social side of school. I told her that she could stay home if she feels this would be better for her, but my h thinks it would only make it harder to go back and she is in her GCSE year now. I suggested that part-time school attendance might be a compromise and she quite likes the idea. I suppose this would mean letting all the teachers know and getting work sent home by email. At the moment only the deputy head, her house leader and head of support services know. What has other people's experience been with school? | |
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Registered: Sept 17, 2011
Posts: 609
| Posted Yesterday at 03:53 AM | Reply with quote?#2? |
| Hi MamaJ, Re familytherapy, I started a thread on it a while ago, if you click on my user name you'll be able to find it. It totally depends on who does it if you ask me. Re school, refeeding is exhausting, being undernourished is exhausting. School burns up energy. I think the part time option, if you can arrange it, sounds good. If she copes with it. If she has to retake this year, surely that's not the end of the world either. My D is redoing year 12 at the moment, no way could she have done it safely last year. We've also tried to reduce the academic pressure somewhat by her dropping a subject, this has taken some pressure of and she coping better now. Some mums on here have totally home schooled as well. The teachers should all know I think, for Ds safety and support. Red has got a bril letter, which I've adjusted to Ds situation and used with Reds permission, and emailed to the school. Asked school to email it to all adults involved with D. Am sure she won't mind you having a copy. Hope this helps. | |
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Registered: June 20, 2012
Posts: 41
| Posted Yesterday at 04:06 AM | Reply with quote?#3? |
| MamaJ
Our AN D was in school full time from Jan to June of this year during refeeding. I often questioned whether she should be from a physical and emotional health point of view, but school was her motivation to eat every meal. Plus, it gave her and me space between eating episodes.
Regarding family therapy. We did FBT for 6 months which I loved because it exposed the anorexia and gave everyone a forum to speak about any issues and seek resolution. Our AN D hated it, presumably because her ED was exposed and she felt very vulnerable. H, who is naturally very private, found it useful too. Our younger 2 daughters didn't like it and stopped attending after 3 months with everyone's agreement. Since Ds discharge from IP in the summer, we have had a couple of sessions of family therapy, which I'm not convinced are useful. I don't feel we have the same support as with FBT, but we are persevering as this can change and take various forms.
Xxx | |
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Registered: Oct 16, 2012
Posts: 23
| Posted Yesterday at 04:22 AM | Reply with quote?#4? |
| Referee: 'Our D is a high achiever and school means a lot to her, so we have been able to use it to motivate her to keep going.' This is exactly how we felt and this is what motivated her during half-term. She is desperate to get the high grades she is predicted and was horrified at the idea of missing out on school. That's why I am so surprised that she is?now saying she is finding it extremely hard to cope at school. Thursday she asked us mid-morning to get her and she stayed home on Friday. She went in today but was really not looking forward to it. She said it takes a HUGE amount of energy to cope at the moment. She babysat for friends Friday night, something she normally really enjoys but she said she found even that extremely difficult to cope with. | |
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Moderator
Registered: March 14, 2008
Posts: 1,228
| Posted Yesterday at 09:29 AM | Reply with quote?#5? |
| MamaJ, re family therapy, we tried it for a while - just me, h and d, not the whole family - family therapy not FBT - and everyone was sceptical about it to begin with.? I was prepared to give it the benefit of the doubt once I checked that it was not looking to find fault and how do we fix it kind of therapy but more problem solving in public but everyone else said, once I had made an appointment, that they weren't coming (and, to paint a more graphic picture of our dysfunction at the time, while I was on the phone making the appointment in my best "we are a family in crisis but strong together" kind of voice, d and h were having a lively exchange of raised voices in the background!).? I decided I would go on my own if necessary but, on the day, they all showed up and it did us a lot of good.? We sat around and talked to each other with the therapist (who was great) acting as a kind of interested bystander/faciliator/safety net keeping us civil (just by being there) and we took turns and listened to each other and had our say and problem-solved, out loud, and I would recommend it if you can find a good therapist. Re school - we did part-time schooling for the tail end of GCSE year and much of AS level year and it worked out fine.? D was able to sign in and out of school pretty much as she needed, the teachers provided work for her when necessary and the pressure was off.? The school even suggested ways of making it easier on her (applying for uni post results, sitting some exams in Jan instead of the summer) but she managed to keep up, did well, went to the uni of her choice to study the subject of her choice at the same time as her peer group.? She says now that, although she fought tooth and nail at the time to be left to be 'normal', it was a huge relief when she was told she wasn't well enough to be at school full time because, the truth was, she knew that she wasn't either. | |
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Moderator
Registered: Nov 20, 2010
Posts: 2,774
| Posted Yesterday at 02:33 PM | Reply with quote?#6? |
| I would be careful about the purpose of family therapy - is it to support you as a family, or *discover* the *underlying issues* that *caused* the illness? | |
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Registered: June 20, 2012
Posts: 41
| Posted Yesterday at 03:00 PM | Reply with quote?#7? |
| MamaJ It sounds like your D s much more tuned into her body and it's limits than our D. Our D keeps taking on more and more after school activities, lunchtime activities, joining committees, volunteering etc etc. At her review last Thursday her doctor has said she can go to school tour and a half days, but must reduce her other activities. D, H and I have sat down twice now to give her the opportunity to choose what she drops. Both times she has walked away unwilling to make the choice, and doesn't see why she needs to. She thinks she has to be hillwalking or at the gym to be using energy. So it looks like we will have to make those choices for her, and get the school involved to ensure they don't happen. Not what I want as it will bring more resentment but hey ho! If things deteriorate we will not hesitate in pulling D out of school. Her health takes priority over exams etc. Red, regarding family therapy,i agree that it most definitely should not be about finding the root cause of the ED, but to provide support for the whole family in dealing with it. | |
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Registered: May 15, 2011
Posts: 321
| Posted Yesterday at 03:52 PM | Reply with quote?#8? |
| It's great to hear that some people have found Family Therapy useful, but we decided against it and have not regretted the decision. Our local ED unit urged us to attend Family Therapy because all their advice was predicated on the belief that we were a dysfunctional family with unacknowledged problems. I really struggled to satisfy myself that my antipathy to the therapy was based on sound judgement rather than an emotional and defensive reaction and it caused me a lot of stress that I could be refusing something that we really needed. Looking back now, I'm convinced we did the right thing. We didnt need it. We weren't dysfunctional and the people advocating it were the ones who needed to educate themsleves and change their thinking.... does that sound defensive? Probably, but Im still cross about it! | |
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Registered: March 30, 2009
Posts: 901
| Posted Yesterday at 06:20 PM | Reply with quote?#9? |
| We were offered family therapy when AN d was 15. I did feel that there could have been some value to it - if done well. However our experiences with the ED service we were under at that time had already made me feel that they were only playing lipservice to the notion that families do not cause eating disorders, and they had already proved themselves incapable of treating my older?(nonAN) daughter, who was very vulnerable, with the care and respect that she needed. I felt that they did not have the sensitivity or skill required to conduct/facilitate useful family therapy in a situation with two girls suffering from different mental health difficulties. H was strongly anti, and so was ANd.?So we declined. Like Emily,?I wasted energy trying to mentally double check that I wasn't hiding from some unpalatable truths about the causes of the illnesses in our family. The sort of facilitated open conversation EB describes is exactly what we could have found useful, but sadly I do not believe that was what we would have got - I think there was an agenda to find a cause for the younger d's?AN in my other daughter's difficulties. And tbh I can figure out for myself that the stress caused in the family by one d's illness made life harder for the other, but with all the hindsight in the world I have never been able to figure how we could have handled things differently, and I can't see that allocating blame would help anybody. Sometimes life is just a bit pants, and you do the best you can. If you feel confident that it is solution focused, forward looking family therapy aiming to help every member of the family to express themselves in a refereed space, then I would say go for it, but if it feels at all like it would be an exercise in trying to uncover whatever "trauma" or "problem" or "control issues" caused or triggered the eating disorder, personally I would not bother. Also for me it would depend upon it being offered at the appropriate stage in d's recovery. | |
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Mentor
Registered: Oct 18, 2007
Posts: 358
| Posted Yesterday at 08:49 PM | Reply with quote?#10? |
The phrase "family therapy" in connection with treatment for anorexia nervosa has several different meanings, and the kind of family therapy offered?varies widely from system to system and from one treatment provider to the next. One common type, known as "family systems therapy," assumes that?the family of the patient is fundamentally dysfunctional. It is?hypothesized that the family members?were significantly?involved in causing?the sufferer to develop anorexia nervosa in the first instance, as well as in the perpetuation?and maintenance of the disorder. This type of family therapy, therefore, attempts to change the way the family members relate to and communicate with one another. Common features of this?model of family therapy involve the development of a therapeutic alliance between the therapist and the family, the?identification of?areas of individual responsibility and clarification of?inter-generational boundaries, the enabling of?appropriate expression and management of conflict, and the?development of?the patient's sense of autonomy from the family. An experiment was conducted to determine whether this type of family therapy is effective in treating adolescents who suffer from anorexia. In the experiment, the parents?of the patients were specifically told by the therapists to leave decisions about food to the adolescent. The therapy sessions focused instead?on the familial dynamic as a whole and did not address eating behaviors directly. Eating behaviors were addressed not by the parents but?by a psychiatrist who met separately with the adolescent. The results of the experiment can be read at A couple years ago, researchers systematically analyzed all studies?in which?family therapy was?used to treat anorexia nervosa. The conclusion of the analysis was that family systems therapy showed "little advantage."? http://www.ncbi.nlm.nih.gov/pubmed/20393940? A completely different kind of "family therapy," however, known as Family Based Treatment, does not assume family dysfunction, and it specifically absolves family members?of responsibility for causing their loved-one to develop anorexia.?Instead, FBT views the parents and family as a resource to help the young person recover. The basic approach of FBT is optimistic and results-oriented. Unlike family systems therapy, FBT enlists the parents as the key agents to help the child recover. Rather than focusing on "family dynamics," FBT focuses on food and eating. In FBT, unlike family systems therapy, families are encouraged to work out for themselves how best to help restore the weight of the child with anorexia, and then to help her or him re-establish normal eating patterns. The empirical data from the available?FBT experiments shows, in my? opinion,?that FBT is far superior to family systems therapy. In the most recent clinical trial, for example,?49% of the adolescent patients treated with FBT?had an excellent outcome?within 24 months. This is far superior to the 22%-31% who experienced?merely a?good or intermediate outcome with family systems therapy. Only 15% of the kids treated with?FBT needed to be hospitalized during treatment as a result of medical instability, compared to 46.7% of the patients?who received?family systems therapy. FBT is recommended by the leading professional organizations. The?American Academy of Pediatrics, for example, revised its treatment guideline in 2010 to recommend FBT.? http://pediatrics.aappublications.org/content/early/2010/11/29/peds.2010-2821.abstract? ?Family systems therapy is not recommended by the AAP. The NICE guidelines in the U.K. are much older than the AAP guideline and are considered by many to be out of date. ?Although the NICE guidelines don't?mention FBT specifically, several experts are predicting that when the NICE?guidelines are next revised, perhaps in a few years,?they will finally?recommend FBT specifically for the treatment of anorexia nervosa in adolescent patients.? The basic principles of FBT were developed at the Maudsley hospital in London. MamaJ, I would want to ask CAMHS, therefore,?what kind of "family therapy" it is offering to you, and why. Is it FBT or is it family systems therapy, or something else? | |
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