Our knowledge of eating disorders and the presentation of these illnesses is growing but remains complex. Eating disorder illnesses bring about an affect change to individual social spheres and relationships are unavoidably impacted. This relationship impact extends to the experience of the carers, including family, friends, and other figures of support for an individual. If relationships are impacted, whether it be positively or negatively, recovery too can be impacted.
Maintaining Hope in the Face of Despair
The idea of hope being fundamental to a person’s capacity in believing that their own recovery is possible is essential. Thus, engaging with the whole person can help to serve as a reminder that there is life beyond the problem currently being faced. Maintaining that connection with hope and belief in the person is like helping to keep a fire burning. Stoking it with the dry wood it needs to flourish. It is fundamental to sparking the possibility for change.
The work of people like Michael White and David Epston, whose narrative therapy theories have helped form new understandings, provide a framework for how to effectively communicate, maintain, and grow social relationships with those suffering from an eating disorder. Using narrative approaches, people with eating disorders can share and be understood as spate to their problem. Problem stories must be understood as being separate to the person rather than part of them for conversations and courses of action to begin.
Gaining Perspective via Non-Judgemental Engagement
Collaborative and non-judgemental engagement is essential for creating safe spaces for people to share their stories. Understanding problem stories from an individual’s perspective enables conversations that look to find moments of hope within the problem story. This helps the individual move away from their negative thinking and move towards a thinking pattern that has positive outlook and a hopeful focus.
In the instance of eating disorders, not only is this important for the person who has an eating disorder, but it is also important for those caring. The intensity of a caring role can mean that the focus can easily become directed onto the problem and
so the person who is ill and a problem can begin to be seen as one. This is simply not the case. For clinicians whose job it is to be experts in a problem area and who have deep knowledge on problem topics, the role can act in juxtaposition to movement towards healing. As such, clinicians must hold space for a person whilst they are thinking and working in with the patient on their problem.
Families, clinicians, and non-clinical support involved in recovery each have distinct yet interdependent roles and as such the role of carers is an emerging area of focus. Carers’ roles, as with other roles, can often lead to focus on the illness and consequently the relationship between parent and child, sibling, friend, or significant other can be diminished or clouded. The mindful acknowledgment of the whole person whether it be by the clinician, friend, or carer is imperative as the eating disorder itself can mask, hide, or push the other areas of an individual’s life to the side as time and effort is spent in appointments and in therapy. The person who is ill therefore becomes further isolated and dehumanized.
Focus on the Unique Individual
The fundamental principle that patients are still unique individuals who have other interests, opinions, thoughts, and attitudes must be at the heart of any interaction. Helping them to maintain meaningful social relationships will assist individuals in integrating back into a full and quality life once they are able to resume normal activities. This means that focus on the wellness of a person as well as their illness is crucial from the get-go.
During eating disorder recovery, it is possible for a person’s personality traits to receive diminished attention or focus. This can be a dehumanizing and isolating experience. While much of the focus is understandably on the recovery process, the people recovering are still just that - people. People who deserve to be celebrated for the things that make them who they are. It is vital to not allow those things to take a complete backseat during recovery. According to researchers such as Brochu (2018), the quality of interactions with close others, mainly parents, may have a direct impact on symptom severity in individuals with an eating disorder.
There has been a large body of research coming from the UK and the endeavours of people like Jenny Langley who herself was a carer of a child with an eating disorder. Her work has led to evidence-based practices including innovations such as collaborative carer skills workshops. This method of intervention, commonly known as the Maudsley method, is used to support families. In particular, it is used by parents of adolescents with eating disorders in the management and coping ability for their role as long-term carer. In these workshops, the metaphor of the blue balloon and red balloon as used by the CCSW (2015) workshop, is a great example of how to visualize the parts of a person who has an eating disorder and one’s relationship with that. With the blue balloon representing the well side of a person’s life, the more that carers ‘inflate’ or give time to those parts of life the less space there is for eating disorder thinking otherwise known as thick red balloon thinking. By deepening connections to a person’s other interests and focuses on skills we can connect back to hope and possibility. In narrative therapy terms this is called a glimmer of hope. These glimmers of hope are vital for progress.
Tackling the Challenges of Carer Demands
The role of carer demands that attention be given to recovery goals such as weight/meal plans/etc and thus is also time sensitive. The sense of urgency and the knowledge of illness severity can lead to heightened fear resulting in the whole person being lost as carers get caught in the problem story leading to sense of being overwhelmed and hopeless.
These challenges can result with carers becoming despondent, disheartened, and even hopeless themselves. Acutely aware of how each little comment or social interaction within the relationship can be misconstrued or undermined by the eating disorder, carers and supporters often find themselves stuck and unable to differentiate between the illness and the person in front of them. This experience can be taken on board by those working in the eating disorder field as health professionals. By understanding the difficulties faced by those closest to an individual, the clinician can find new meaning and understanding of how they might enhance their own relationship in their patients’ recovery journeys.
Research is emerging that highlights the importance of the whole person, and a body of evidence is forming. However often knowledge and findings are anecdotal and unique. It is the very premise that each of us is unique that can help researchers focus on the relevance and importance of carers’ perspectives in the hope for development of effective services and better relationships between all involved in the field. The concept of the whole person therefore connects across all involved in an individual’s recovery. Carers’ deep knowledge of their loved one can be leveraged to help advances in knowledge and approaches to engagement.
Using Collaboration as a Powerful Tool
The idea that wellness is as important as illness has come through very effectively. If patients are being asked to have a curious and flexible approach to interventions presented to them for their illness, then we as the carers or the clinicians as providers need also to have a curious and flexible approach as well. By taking on these approaches, power structures are also addressed, and dominant dynamics are challenged thus creating a collaborative approach with implicit trust and explicit compassion.
Ideas for Further Research
It would be interesting to undertake further research into an initial diagnosis, pathology, and intake system that values the holistic person. If screening and diagnosis involved the clinician deepening an understanding of the strengths a person has and therefore tapping into the whole person, then there would be a clearer picture of how to intervene and engage with the person who is ill. Potential for further research in this area could include exploring different ways of approaching initial consultation to include a more collaborative approach that aims to discover not only the difficulties the ill person has but also the strengths they have which may help them tackle their recovery journey with hope and positivity.
The sense of self efficacy as an approach could prove valuable in shortening timeframes. In this complex area of health, let us look to build on the knowledge we have and, so deep in our connection and our relationships with those recovering from eating disorders, to enhance the chance of integrating back into the full daily lives as speedily and effectively as possible.
Jade Pelletier Brochu, Dominique Meilleur, Giuseppina DiMeglio, Danielle Taddeo, Eric Lavoie, Julius Erdstein, Robert Pauzé, Caroline Pesant, Isabelle Thibault & Jean-Yves Frappier (2018) Adolescents’ perceptions of the quality of interpersonal relationships and eating disorder symptom severity: The mediating role of low self-esteem and negative mood, Eating Disorders, 26:4, 388-406, DOI: 10.1080/10640266.2018.1454806
Treasure, J., Rhind, C., Macdonald, P., & Todd, G. (2015). Collaborative Care: The New Maudsley Model. Eating disorders, 23(4), 366–376. https://doi.org/10.1080/10640266.2015.1044351