Monte Nido RainRock Primary Therapist Carissa Surace, MFT shares some of her work with families in this week’s blog post. Carissa explains how she went through some trial and error to determine the best way to engage with families during their first session together. Read on to see what question Carissa uses to help begin the conversation…
“What’s it like to eat together?”
This is my favorite question to ask when it comes to family work at Monte Nido. It can be difficult to know where to start when a set of parents or a partner come to a session for the first time. Usually by the time the first family session comes up the client has been in program for a few days, and a rapport has already been built. Generally we as the therapist already have a lot of information on family dynamics from referral sources, collaboration with outpatient providers, introductory phone calls or emails with primary supports, family assessments, and of course, initial sessions with clients. With all of this upfront information, while necessary to gather, it’s important to also hold space for that loved one’s unique experience. Having a family member or partner with an eating disorder is scary, and it can be hard to know where to start or what questions to ask.
At the very beginning of my journey as a family therapist I would make the mistake of setting up initial family sessions as an open forum for questions and answers between the family members. For the more treatment savvy families this was okay, but for the less experienced families I quickly realized I was leaving too much space and not providing enough structure for the session. After some trial and error of asking very specific questions in an attempt to get the exact right flow of conversation (I’ve since learned that’s not a real thing) I realized that I could always bring it back to the food.
A common expression that we often tell clients and families is that the work “is about the food, and it isn’t about the food.” Since the food behaviors are usually what families notice and become the most nervous about before their loved ones enter treatment, it makes sense to start sessions there. As therapists, we know that there are many underlying issues when it comes to food behaviors, and that the stress and energy is taken out on the food. But this can be difficult for family members to understand or know what to do with. Oftentimes concern for a loved one will manifest in the statement, “I don’t understand why you can’t just eat” which results in frustration for both the client and her supports. Because the food behaviors are what is most obvious in someone with an eating disorder, I have found that it makes sense to start family sessions with questions about the food.
There are a lot of secrets when it comes to eating disorders, especially for loved ones, but what they do know is that eating with their person is challenging and stressful. Clients usually also know this, and have generally been open to talking about it because discussing the energy around the food feels safer than talking about the thoughts and feelings behind the behaviors. Moreover, it’s not uncommon for clients and families to be hesitant about doing any family work at all. Loved ones might be wanting to keep family secrets in the dark, and clients can often be protective of the family system, or worry that their fragile connections would be destroyed by letting a secret slip in front of a stranger, so talking about the food is a great way into the system to not only build trust, but to get a lot of good information.
I have yet to experience a room full of silence during a family session when I ask what it’s like to eat together. There is really no wrong way to answer, which sets all parties up for success and allows the therapist to pick up on important themes and patterns. For example, if I ask “What is it like to eat together?” the client might say “I get really anxious because I feel like I’m being watched all the time and my parents are policing me.” A parent or partner might respond with “I just want to her eat something and I’m afraid if I leave her alone she won’t eat anything all day.” This is a great way to jumpstart talking about ways in which to give support and go over different levels of responsibility for both the client and her family.
There are many ways to approach family sessions. Of course each family is different and there are an infinite number of ways to approach family issues, but taking it back to the food is a great way to invite everyone to participate while getting valuable information to help structure ongoing family work.