The Family System
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Cults \u0026 the Family System (1 of 2)
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It is primarily delivered in outpatient settings , although there are some residential and partial hospitalization PHP programs that incorporate FBT. While FBT may not be for every family, research shows that it is highly effective and faster to act than many other treatments. It should therefore usually be considered as a first-line approach to treatment for children , adolescents, and some young adults with eating disorders. FBT represents a radical departure from more traditional treatments. Mothers were believed to be the primary cause of the eating disorders of their children, as they were in the case of schizophrenia and autism.
The typical treatment instructed parents to step aside and turn their children with anorexia over to individual treatment or residential treatment centers—an approach we now know to have been, in many cases, detrimental to both the families and the patients. Recent research has debunked the theory of parental causation of eating disorders, just as it has for schizophrenia and autism. The literature has rediscovered older starvation studies demonstrating that a number of characteristic behaviors of anorexia are actually the result of malnutrition that accompanies anorexia. It is also believed that many clinicians made a basic selection bias error: observing the dynamics of families as they were seeking treatment, clinicians naturally saw families locked in a life-and-death struggle over food.
This struggle is, however, a symptom of the disorder, not a cause—in the years preceding the eating disorder, their dynamics likely looked no different than other families. Acknowledging that the weight of evidence had shifted, in , the Academy for Eating Disorders published a position paper specifically refuting the idea that family factors are a primary mechanism in the development of an eating disorder.
FBT should not be confused with the similarly-named but potentially fundamentally different approaches under the umbrella of family therapy. Traditional family therapy often takes the view that the child with an eating disorder is expressing a family problem. It focuses on identifying and solving that problem in order to cure the eating disorder. This approach has not been supported by research and is challenged by the AED position paper. In the s and early s, the clinicians at the Maudsley Hospital in London, England, conceived a very different form of family therapy, treating parents as a resource, not a source of harm.
The Maudsley team has continued to develop and teach the approach, which they do not refer to as the Maudsley approach, but as anorexia-focused family therapy. Meanwhile Drs. The FBT approach is rooted in aspects of behavioral therapy, narrative therapy, and structural family therapy. FBT takes an agnostic view of the eating disorder, meaning therapists do not try to analyze why the eating disorder developed. FBT does not blame families for the disorder. On the contrary, it presumes the powerful bond between parents and children and empowers the parents to use their love to help their child. In FBT, parents are viewed as experts on their child, an essential part of the solution, and members of the treatment team.
In FBT, the eating disorder is viewed as an external force that is possessing the child. Parents are asked to join with the healthy part of the child against the eating disorder which is threatening to take their child away. Full nutrition is viewed as a critical first step in recovery; the role of parents is to provide this nutrition by actively feeding their child. This gives the therapist an opportunity to observe the behaviors of different family members during a meal and to coach the parents to help their child eat. Because patients with eating disorders may present with medical complications , they should be monitored by a physician during the course of treatment. Brain starvation can cause anosognosia , a lack of awareness that one is ill.
As a result, there can be a long time lag before the minds of adolescents in recovery are capable of the motivation or insight to maintain their own recovery. According to Bowen, a family is a system in which each member had a role to play and rules to respect. Members of the system are expected to respond to each other in a certain way according to their role, which is determined by relationship agreements. Within the boundaries of the system, patterns develop as certain family member's behavior is caused by and causes other family member's behaviors in predictable ways. Maintaining the same pattern of behaviors within a system may lead to balance in the family system, but also to dysfunction.
For example, if a husband is depressive and cannot pull himself together, the wife may need to take up more responsibilities to pick up the slack. And we practiced communication skills because they had not learned how to talk about their problems in a constructive way. The result? This family learned to express their feelings honestly but in a nonjudgmental way. They learned to listen to one another without being defensive, to discuss issues rationally, and to find resolutions.
Today they are a happier, more harmonious family. The rituals are set in stone. The food is elaborate. The decorations are perfect. The times have changed, but the rules have not. The result is that holidays have become drudgery for the siblings and their families. Most family rules are not written down, but everyone knows what they are. And they know they are not subject to discussion. When a system is static and fixed, it prevents families from evolving, and it becomes destructive to personal growth. Families that are flexible are much more likely to succeed over time. Both Jessie and her older brother were becoming adults, but their parents were unable to go with the flow of natural maturation. They were frozen in place, not wanting to acknowledge how things were.
They kicked her out of the house, not even willing to talk with her about her options. Fortunately, she found a foster home until she was old enough to be on her own. Sandy experienced a similar situation when her teenage daughter announced she had gotten pregnant by a guy she had met on a European trip that summer. Both families had to cope with an unexpected change. Only one family faced the change in a healthy way. By embracing the concept of change and understanding that changes will come into your family — whether you want them to or not — you will be better prepared to deal with them in a way that brings your family together instead of tearing it apart.
Closed families circle their wagons and try to maintain the status quo. They consider life risky and dangerous. Healthy, open families are growth-oriented, creative, and hopeful for the future. They view life as an adventure. They realize that each new person they add will shift the dynamic of their family. They look forward to the new perspectives of incoming spouses and the enrichment of a growing family. They embrace new relationships, new ways of thinking, and new challenges in the future.
Adopt an attitude of acceptance. Teach everyone in your family that differences are not a threat, but an opportunity for increased tolerance, understanding, and wisdom. Take time to get to know every member of your family more intimately — including spouses and grandchildren. Learn about their interests, talents, ideas, and dreams. Let them know that you value them just the way they are, even though they may be different from you. Spend time building relationships among family members.
Plan activities that put different generations together and make extended family members feel as important as nuclear family members. Be flexible in changing old traditions, rituals, and rules that have become outdated.