Emotion-Focused Family Therapy and Eating Disorders
By: Tiffany Phillips, M.A., LMFT, CEDS
Tiffany is a therapist in private practice in Nashville, TN. She is an iaedp certified eating disorder specialist and the current Nashville iaedp Membership Chair.
The Nashville iaedp chapter has spent the last several months focused on eating disorders and
its relationship with family members. As a family therapist and an iaedp certified eating
disorder specialist, I often get questions about working with families. The most common one I
hear is “Do you have room to see a family who needs support, because I am not sure how best
to help?” The purpose of this blog is to create a one degree effect for professionals treating
eating disorders by introducing them to a resource that can harness change and move their
clients toward health and recovery.
EFFT and EDs
In years past, eating disorders were often conceptualized as stemming from poor family dynamics with blame placed upon the parents. Because of this, family members were excluded at the detriment of the client. Today, we understand that there is not one typical family style that can predict the development of an eating disorder and including family support can become our biggest ally in treatment. Thanks to Janet Treasure, James Lock, and Daniel Le Grange, Family Based Treatment (FBT) is now regarded as the best treatment for eating disorders in children and adolescents. Adele Lafrance and Janet Dolhanty’s model of Emotion-Focused Family Treatment (EFFT) enhances FBT by providing family members with the tools to become vital members of the treatment team and lead their loved ones to recovery.
EFFT utilizes the client’s loved ones to facilitate change through behavior and emotional skill building. It is a transdiagnostic model that is experiential in nature. The goal is to equip loved-ones with a set of advanced care-giving skills that can enhance the client’s ability to turn toward support rather than toward their eating disorder when struggling. It is not limited to children and adolescents and can be used with clients of all ages involving caregivers such as parents, partners/spouses, and friends.
The Six Pillars of EFFT
1) Caregivers become active agents of healing: EFFT uses the power of the client and caregivers’ emotional attachment because it is neurologically more powerful than the bond with the clinician.
2) Problematic emotional processing, including emotional avoidance, plays a key role of maintenance of eating disorder behaviors.
3) Skill-building through experiential practice helps develop new ways of responding to the eating disorder.
4) No-Blame: loved-ones cannot become part of the solution if they believe they caused the problem. We know that the development of eating disorders, and all mental illnesses, is complex. EFFT utilizes compassion to explore any self-imposed blame.
5) Collaboration and Transparency: the clinician and the caregiver collaborate to create the treatment plan and make decisions. EFFT believes that the caregiver knows and understands the client best, where the clinician is an expert in mental health issues.
6) The One-Degree Effect: referring to the concept that if a plane’s navigation is off course by even one degree in flight will change its entire trajectory. The EFFT clinician engages the caregiver as much as possible, believing that even small changes can be the beginning of significant change over time.
EFFT Modules
Emotion Coaching: Emotion coaching, developed by Gottman, shows that children who are coached on how to attend to emotions can better regulate their emotional states and engage in self soothing. Whereas the eating disorder may have been an attempt at emotional regulation, now the relationship with the caregiver can serve to meet that need. The skills taught in emotion coaching include:
Understanding of emotion basics
Learning to attend, label, validate and meet the underlying emotional need
Problem solving
Behavior Coaching: Food is medicine and nutrition helps reduce or eliminate medical complications while improving cognitive and emotional capability. The skills taught in behavior coaching include:
Meal support
Symptom interruption
The Therapeutic Apology: Lead by the clinician, the therapeutic apology is an intervention used to reduce caregiver blame, help the client share their burdens, and strengthen the overall caregiver-client relationship. This includes:
Labeling difficult events, including stating their specific impact
Validating painful emotions
Communicating sincere apologies
Addressing what will change
Validating the response/reaction
Overcoming Blocks: EFFT understands that caregivers may have emotional blocks that need to be addressed. These may include fears of worsening the situation, such as “If I encourage her to eat, she may become suicidal.” EFFT overcomes these blocks through:
Psychoeducation
Experiential practice
Learning through metaphors
Chair work
For more information and training, EFFT is readily accessible to clinicians through books, websites, and video series.
