Collaborative care between professionals and non‐professionals in the management of eating disorders: a description of workshops focussed on interpersonal maintaining factors

Abstract

The aim of this paper is to describe the content and processes involved in a series of workshops for carers of people with an eating disorder. These workshops were designed to equip carers with the skills and knowledge needed to be a 'coach' and help the person with an eating disorder break free from the traps that block recovery. The first hurdle is to overcome the unhelpful patterns of interpersonal processes between the person with an eating disorder and their carers. In both naturalistic studies and randomised controlled trials (RCT), family factors have been implicated either as moderators or mediators of outcome. High levels of expressed emotion (EE), misattributions about the illness or unhelpful methods of engaging with the eating disorder symptoms contribute to this effect. These workshops aim to reduce EE such as over protection. Carers are introduced to the transtheoretical model of change and the principles of motivational interviewing so that they can help rather than hinder change. They learn how to use reflective listening to reduce confrontation and how to sidestep resistance. Carers learn what is needed to help their daughter change by reflecting on the processes involved in changing their own behaviours in relationship with the person with eating disorders. Once they recognise that they may need to change then they can use their skills, information and insight to help change eating disorder symptoms.

Minimizing and treating chronicity in the eating disorders: A clinical overview

“…For example, a significant de-emphasis on eliminating eating disorder symptoms, 20,24 a greater emphasis on social adaptation, 20,23,24 and the negotiations of issues of autonomy in relationship to family 17,18,20 are all themes that may be consistent with such a recovery model. Furthermore, the increasing attention paid to working with caregivers and family members of eating disorder patients 43,44 is consistent with such a burgeoning recovery oriented approach to mental health care.…”

Understanding how parents cope with living with someone with anorexia nervosa: Modelling the factors that are associated with carer distress

“…Educational and/or skills-based interventions for carers of people with ED can reduce parental distress, burden and EE. 21,27,[43][44][45][46] Whether such interventions can ameliorate adherence to and outcome of treatment requires further investigation.…”

“…6 It is clear from several studies that carers of people with ED have high levels of distress, associated in some cases with depression and anxiety 5,6,8,[17][18][19][20] and that their needs often go unmet, resulting in an impaired quality of life. 21,22 Mothers in particular have high levels of emotional distress. 19,23 Caregiver distress in ED has been compared with that of caregiving for someone with psychosis, 18 while Treasure et al 6 found higher distress and difficulties reported by carers in AN.…”

Family Climate and Recovery in Adolescent Onset Eating Disorders: A Prospective Study

“…We assume that Chaos is connected to the burden and parental stress of having a child with an eating disorder (Zabala et al, 2009). The effect of having a child with a long-term illness increases the burden (Ravi, Forsberg, Fitzpatrick, & Lock, 2009), and the difficulties may also maintain the symptoms (Treasure et al, 2007) and limit the family's ability to use adaptive mechanisms to help overcome this problem (Eisler, 2005). In comparison with 1073 nonclinical individuals of different ages (Söderlind & Johnsson, 2004), where the mean value for Closeness was 2.20, Distance 0.27 and Chaos 0.25, parents of R adolescents assessed their family climate more similar to nonclinical groups than parents of NR adolescents on Closeness and Chaos.…”