Collaboration in Family-Based Care for an Eating Disorder

Being part of a group practice is an important part of my work at the Leggett Group because it provides me with a team of people who are there to support me and my work. This resounding idea that we often need the support of others to get through difficult times is one that continually appears in therapeutic frameworks, and a sentiment that is used over and over in the treatment of an eating disorder. Receiving the news that your child has an eating disorder is a terrifying realization, and often leaves caregivers feeling powerless and unsure of what the next steps may be. One answer that continues to gain more and more acclaim since it came to the United States from England in 1994 is Family-Based Treatment (FBT), also known as the Maudsley Method. FBT is a clinical framework used to treat eating disorders in children and adolescents that involves the whole family, and any other important adults in the adolescent’s life, as part of a plan to disrupt the eating disorder and return the child to their lives. The intervention can be thought of as a reset button in many ways, as the main characteristic involves the caregivers taking over all meal prep and presentation, and learning skills to help the child tolerate their distress and overcome their fears through exposure to food again. FBT is made up of three treatment phases that generally last over the period of a year; weight restoration, returning responsibility of food preparation and slowly moving towards increased autonomy, and the adolescent returning to establishing a healthy adolescent identity as is developmentally appropriate during this stage of their life.

During phase one, often caregivers feel as though they are caring for their adolescent as if they were a small child again because of the need to supervise them so closely and take back responsibility around food, which can feel developmentally inappropriate. Most caregivers are working to promote increased autonomy and self-reliance in their developing adolescent, so it can be difficult for both the adults and the adolescent. In some ways, because the eating disorder is controlling their behavior, the adolescent has regressed to behaving like a young child; the eating disorder is preventing them from safely caring for themselves and giving their body what it needs to survive. A helpful reminder is that this phase is temporary, and as the child begins to improve and challenge the eating disorder more regularly, they are ready to take on more responsibilities around food again.

Evidence-based studies show that FBT has a very high efficacy rate and the hard work and struggles are worth the effort when it means a family can return to their pre-eating disorder lives. When a caregiver feels ambivalent towards the treatment modality it can decrease the effectiveness of FBT, and the eating disorder may take advantage of any wavering on limits the caregiver has set. It can be extremely difficult for a caregiver to put all their trust in the FBT approach when it is new and they are feeling vulnerable and out of control, so it is important to communicate those concerns to the clinician the family is working with. If the caregiver can come to a decision on what limits they are comfortable enforcing, then the treatment can still be effective.  Lastly, another important aspect of FBT is working to remove blame within the family and focusing on how to move forward; the emphasis is less on what may have contributed to the development of the disorder and more on how to effectively cope and ultimately be in recovery. As a clinician who works with families going through such a tumultuous and frightening time, it is my role to be part of the team and to provide support, education, and ongoing feedback to help everyone involved learn to tolerate the distress of the experience in order to move forward towards recovery. If you or a loved one is struggling with an eating disorder, or you have concerns that they may be having symptoms related to disordered eating, please feel free to reach out for a consultation, or with any questions you may have about FBT!

Written by:  Nathalie Paquette, LICSW

Clinician Open House

Are you a clinician in the area?  We’d love to invite you to our upcoming Clinician Open House, at which you can get to know us and our services, and we can get to know you.  We’d love to collaborate, and always have a need for places to refer cases we can’t take.  We’re also inviting some very interesting guests:

 Representatives from the ClinciansUNITED unionizing effort will be here to discuss their efforts to break past the collective bargaining restrictions in our insurance contracts to actually advocate for higher reimbursements, as will State Senator Brian A. Joyce (D-Milton) , to discuss legislation he recently filed advocating for the right for a patient to sue an insurance company of they are denied mental health coverage at parity with a medical diagnosis.

This will be a fun and important event.  We hope you can join us!  Feel free to invite your friends and colleagues, and of course, please RSVP to Jen Leggett, or by calling 857.273.2123.

If you are unable to attend the Open House but would like to be in touch, please contact Jen as above with some information about your practice, and to find a time we might meet in person.  We are also very interested in working together as a mental health and healing community here to promote this area as one for self-care, and think we’d do that so much better if we worked together on this effort.

Hope to see you January 28th!  Here’s to a great 2014.

Happy New Year!

It’s a very exciting time for us here at The Leggett Group, as our providers are all coming online and we are very much open for business!  You may have just found us, or may have known one of our staff members from another location.  What is clear is this: The Leggett Group is a special, different place to come work on issues that trouble you.  We are passionate about providing therapy that works, that is compassionate, and that is respectful of the demands on your time.  We also know that change won’t start until you make a commitment to creating space for it in your life.  We’d like to be your partner in healing. We have so much to offer—just give us a call and we’ll help you take that first step towards feeling better in this New Year.

New Year—time to try something new—how about a Group?

The New Year brings with it the promise of new endeavors, new starts, and new energy.  However, if you bring into this new year issues or problems that you’d like to see left behind, it may be time to try something new.  We have developed a vast array of therapy groups that offer unique and different ways of addressing issues you struggle with, and are a great option as you consider therapy.  If you’ve never been a part of a therapy group—one that is a group of people that agrees to come each week and work together to address problems that haven’t been helped in other modalities—you truly have something wonderful to experience.  Many issues seem to truly lend themselves to being helped in a group in ways individual discussion just doesn’t address- so we hope you’ll check these out and give one a try- you’ll be glad you did!  Here is some information that might help you make the choice.

Group Therapy FAQs

What is Group Therapy?

Group therapy is a form of counseling in which a small number of people come together under the guidance of a professionally trained therapist to help themselves and one another, usually around a specific topic. This therapy has been widely used and has been a standard and effective treatment option for over 50 years. In group, not only do people receive tremendous understanding, support, and encouragement from others facing similar issues, but they also gain different perspectives, ideas, and viewpoints on those issues. Group therapy, like individual therapy, is a powerful vehicle for growth and change, and is intended to help people who would like to gain support, increase self-awareness, and learn new ways to cope with personal or interpersonal challenges.

Is Group Therapy as good as individual therapy?

Individual and group therapy have different benefits and help people in different ways.  Research studies have shown that group participants are equally if not more satisfied than people who participate in individual therapy.  While neither form is inherently better than the other, there are some struggles that are better suited for group interaction, such as developing communication skills, getting interpersonal feedback, obtaining social support, and understanding relationship patterns.

Will I be forced to speak in group therapy?

Participants are often encouraged by one another to share their observations, internal reactions and experiences of the group, but in a way that feels comfortable and supportive. Guidelines for the group are discussed at the beginning, and are mutually designed for your benefit and feeling of safety.  Difficult topics can be discussed in groups;  if a group member does not feel comfortable talking, they simply share this preference with the group and ask that the group trust them to speak when they are ready.  And, in listening to the insights and experiences of others, a group allows an individual to observe and reflect, which are powerful learning tools in and of themselves.

Will I be forced to share my deepest darkest secrets in group?

No one in group is forced to disclose anything that they are not comfortable with, and in fact some thoughts, feelings, or emotions are so personal that keeping them to oneself may be more beneficial than disclosing them to a group.  Group members learn to identify their personal boundaries and respectfully communicate those boundaries to one another.  They disclose personal information over time and in a way that feels comfortable.

Will your groups look like stereotypical groups I see in movies and on TV?

No.  Although there are plenty of stereotypes of a group member throwing something or getting angry and storming out of a room, this type of behavior rarely happens.  Group members are encouraged ahead of time to put their feelings into words instead of actions, so that they can help others to understand what they are going through, and to help themselves learn effective ways of managing difficult or intense emotion.  A strong group is a supportive, responsive entity like none other!