Relationships are important. Lots of reasons, unique and specific to my nature and how I was nurtured, led me to be a care giver, provider, nurturer. I have a high threshold for other peoples’ pain and generally tolerate a lot from an individual before I come to accept that I cannot do the work for someone else or accept responsibility for someone who is unwilling to take responsibility for their own behavior, feelings or unsatisfying life. I have learned most from my children and patients about change through allowing them to struggle with their own angst and pain. I can only hope that their trust of me during their varied past and current struggles is maintained by knowing that my respect and compassion never wavers. How lucky am I to continue to have this privilege as a mother and therapist.
In this regard, I have come to know that issues, symptoms, self-defeating or destructive behaviors and problems arise for a multitude of reasons and stem from a variety of sources. Eating Disorders are multi-causational. We increasingly learn through research and treatment about how symptoms function and how they are responses to internal and relational stressors. We continue to search for genes that contribute to disorders that are self destructive like Eating Disorders, Cutting, Substance Abuse.
We know that anxiety and depression tend to run in families and can offer some insight as to how these conditions are precursors to eating disorders and addictions. We continue, however, to search for understanding as to ‘why’ anxiety and depression run in families. Are anxiety and depression genetic? Are they learned behaviors by children who grow up in families where one or more members is depressed or anxious? Are anxiety and/or depression the net result of familial stressors, psychological conflicts in an individual or collectively in the family, repressed emotions, traumatic events, repetitive familial behaviors and dynamics repeated through generations? The development of an eating disorder then makes sense as a response.
What I have come to understand in my own life, my child rearing practices and clinical treatment of my patients is that no matter what the cause of the problem or issue, the relationship between my children and me or between my patients and me matter. Whether a patient’s eating disorders symptoms were caused by a predisposing anxiety whereby the symptoms of the eating disorder soothed or stifled the anxiety or the eating disorder was a direct result of growing up in a home where the child was physically, sexually or emotionally traumatized and the eating disorder was an attempt to distract, cope, adapt, or repeat the trauma through the harshness of symptoms, knowing that someone is there now to rely upon who is kind, supportive and non-judgmental is critical to growth and change. Honesty, whether it be on the part of a developing child or patient in treatment, is only possible when the person feels safe and does not fear criticism, shame, anger or withdrawal.
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Parents and therapists have a similar role.
When genuine respect, empathy, and compassion are present overall, a feeling of safety is created and the child or patient develops a reliable perspective about relationships in general. Honesty and guidance on the part of the parents or therapist— without control, manipulation, or judgment — allow for the development of trust in the individual. When a child or patient is given the right to have her/his own voice and opinion, self-doubt diminishes. As a result, she/he learns over time to trust her/his intuition — that deeply knowing internal voice that guides us throughout life in decision making and assessment of people.
Identifying, discussing, and tolerating emotions among family members, particularly negative ones, creates self-awareness in the developing child. The ability to know, tolerate, and integrate all emotions is then made possible.
How does therapy help families heal?
Healing is a process; its first step is to help family members learn not be afraid of each other. They discover what it means to feel safe in confronting and expressing emotion, solid in their belief that their relationships are safe, and to welcome this kind of honesty. As families learn and begin to integrate a new language of emotions into their lives, the veneer of anger, blame, defensiveness, criticism, shame, and guilt slowly falls away. Family members truly begin to understand and accept what it means to openly love each other. They learn how to relate to each other empathetically and share responsibility for their individual contributions in the development of their loved one’s eating disorder — and in all aspects of their family life. In time, after the sorrow passes, forgiveness comes and, ultimately, acceptance dawns — each begins to embrace the others’ humanity with all its imperfections and contradictions. This beautiful outcome is possible; I have seen it happen in my practice many times.
Whether a solid infrastructure of safety, trust and respect is built in a child from the get go or a person seeks out therapy later in life in response to growing up not feeling safe, trusting and nurtured and consequently or coincidentally develops an eating disorder, the message is the same. Building or rebuilding the infrastructure is possible. Recovery from an eating disorder is possible when the commitment to the work, the acceptance of responsibility and the depth of trust are present. Families who are engaged in this process whether they are physically present or not in a family member’s treatment is irrelevant if they can see the benefit and beauty of shared responsibility and the depth and breath of what honesty and trust provide to growth and healing.
