As a family therapist, I found this book presented interesting theoretical and practical approaches to the dilemma of working with adolescents and their families around the issue of anorexia nervosa. The book offers a structured approach to working with these families, which could be followed as prescribed, but only if one works as part of a team who could and wanted to work in concert with this theoretical model. The model clearly advocates putting parents in charge of the adolescent’s eating behaviours and giving them the responsibility of the re-feeding process. For those family therapists working alone or with a team who may not share these authors’ approach to anorexia, there are both theoretical and practical examples that are worthy of implementing into one’s own practice with anorexic families.
The authors clearly present three phases of the family treatment of anorexia, moving from the initial phase of re-invigorating the parents to be able to take on the task of re-feeding their adolescent, to the second phase of the adolescent and parents negotiating a new pattern of relationships, to the last phase in which adolescent issues are examined in the context of the absence of anorexic symptomatology. The authors explain the theoretical model behind this approach clearly and outline the steps one would take to follow this path with actual process interviews, in order that the therapist can get a feel as to how this model is put into practice. A cornerstone of this model is the observation of a family meal, which is provided by the parents and brought to the therapist’s office. Care is given to the discussion about what foods the parents thought were appropriate to re-nourish their daughter and examples of how the parents were coached to persuade their daughter to eat more than she had planned. Examples of how families may collude with the anorexic symptoms and the therapeutic response to this collusion are given.
The authors give excellent examples of the use of circular questioning in bringing about the participation of siblings in the family sessions. They present transcribed interviews showing how they involve the siblings with the goal being their empathic support to the patient as she struggles with the need to gain weight. Sibs are instructed not to assist the parents in their role of not letting their sister starve herself. Examples are also given to encourage parents in separating the eating disorder from the patient so that a co-operative alliance can be established between parent and adolescent regarding weight gain. The authors help the therapist to see the importance of focusing on the anorexic symptomatology and need for vigilance in insisting upon continued weight gain, which is particularly difficult for parents once the immediate medical crisis is over as the adolescent regains some weight. The authors site research around the poor prognostic implications of negative parental criticism toward their anorexic adolescent. They recommend choosing parental counselling rather than conjoint family therapy if it appears that conjoint sessions will exacerbate these negative qualities.
The emphasis on parental control over the eating disorder illustrates one side of the dimension between those who advocate this approach and others whose theoretical model leans more toward the motivational approach, relying more heavily upon the adolescent’s own decision to work towards recovery. For me this book provides a valuable tool to help the clinician working with adolescents and their families in programs whose theoretical framework follows either of those models. I highly recommend it for any therapist who has struggled with the difficult task of trying to keep a family focused on the arduous task of re-nourishing their adolescent to health. It gives a step by step approach to the therapist which will help her keep the focus on the initial presenting problem, and not become side-tracked with secondary albeit compelling problems, as the illness of anorexia will invariably do to both therapist and family alike.