Emotionally focused family therapy for bulimia: Changing attachment patterns.

Abstract

This article provides an overview of an emotionally focused family therapy intervention for bulimic adolescents referred to an outpatient hospital clinic. The article attempts to integrate theory, practice, and preliminary research results. Bulimia is viewed from the theoretical perspective of attachment theory as described by Bowlby (1969). The emotionally focused approach to creating more secure attachment in families is described, outcome on a small number of adolescents is noted, and the implications of these theoretical and empirical points are discussed. Although there have been numerous systemic formulations of bulimia nervosa (Roberto, 1986; Root, Fallen, & Friedrich, 1986) and systemic interventions have become established as an important part of treatment of eating disorders (Gurman, Kniskem, & Pinsof, 1986), the treatment of bulimia with outpatient family therapy is still in an early phase of development. Influential authors have popularized the use of family interventions for eating disorders in general (Minuchin, Roseman, & Baker, 1978; Selvini-Palazzoli, 1978), and there are some empirical data on the effectiveness of family therapy for anorexia nervosa (Dare, Eisler, Russell, & Szmukler, 1990). Although a few descriptions of family therapy for

Outcome research in family therapy

“…Garner, 1994;Fishman, 1996;Johnson et al, 1998), there is at present little convincing evidence for its efficacy. In a study (n = 30) conducted by Schwartz et al (1985), two-thirds of the patients were rated at the end of treatment and on follow-up (18 months) as being 'nearly always in control', with no more than one bulimic episode per month.…”

Emotionally Focused Family Therapy and Play Therapy Techniques

“…The maladaptive behaviors found within these negative interaction patterns can be viewed as attachment dilemmas resulting in separation distress. The way an individual's attachment needs for security, protection, and contact are enacted, constrained, or denied can be problematic (Johnson, Maddeaux, & Blouin, 1998). Securely attached individuals tend to turn to attachment figures for comfort and are independent and confident.…”

Helping Families with Defiant Adolescents

“…Although she focuses primarily on the marital dyad, Susan Johnson (1996) describes the process of softening, whereby a careful process of questioning and reflection by the therapist helps to shift the hostile tone of interaction between the partners to one in which more vulnerable feelings are brought to the fore. Johnson and Lee (2000) have expanded this model to work with families. Howard Liddle's model of working with adolescent substance abusers includes interventions to shift the tone of the interaction between the parents and adolescent from one in which the parent is critical or demanding to one in which the parent is more nurturing and supportive of the adolescent (Diamond & Liddle, 1999;Liddle, 1999).…”