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atdt31_US

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Hi All -- not sure we even have a provider locally who would have the experience needed, but can someone tell me what family therapy looks like?  And, I guess, if I am correct that family therapy is, ideally, part of FBT.

While there is no doubt our little family of four (h,w,d,d) has issues that do not generate from the one d's eating issues, that would certainly be the catalyst to get us to Family Therapy (if I understand it right).  Stress in the house about what to serve, how well or quickly it is eaten, role of h, w, and sister, brainstorming ways/methods of restoring/preserving peace and normalcy in light of years of this dysfunction that has no end in sight.  Some version of that is what I envision Family Therapy would entail -- 

a. am I correct that is what it would look like?  would it be a part of addressing non-eater-d's anxiety?

b. If yes to a, it seems like non-eater-d would feel very ganged up on and blameworthy, which would not be accurate and would be very hurtful.

Any insight into this would be helpful as we continue to try to navigate giving the girls a normal childhood and happy home despite the daily drama over amount of intake/speed of intake/need to ingest certain medications, anxiety, etc.  

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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
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Reply with quote  #2 
I hate to be the Voice of Doom, but in my small experience, Family Therapy tends to be old-school talk therapy that blames the mom / mum for all problems and colludes with ED by telling everyone that we need to stop being the Food Police.  So, I would encourage you to choose carefully and ask lots of questions before allowing your d to participate in something like this.

Hopefully there are some good and enlightening ones out there somewhere.  xx

-Torie

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tina72

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Reply with quote  #3 
Hi,
here in Europe Family Therapy is something totally different to FBT so I cannot give you a really good advice on that.
Family Therapy is here what Torie said: Old fashioned seeking for causes and blaming parents. Telling you your kid needs more freedom and that you are overprotecting, not to be the food police etc.

FBT therapists do something else in phase 3: you talk about what problems every family member has left, what you need to get into normal life again. How you can cope with all the things that are still there after surviving ED. What you as a sufferer can do to avoid relapses and how your family can help you with that. What triggers ED and how you can avoid these triggers. Something like that.
The big question is what you want to achieve with that. If you need some help to get into a normal life again, seek for a FBT therapist or come here [biggrin].
Anyway, talk to a candidate before and alone and ask how much he knows about ED. Be careful.
Tina72
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Reply with quote  #4 
I think you are referring to family therapy as a way to help the family reduce and manage all the tension "around" the ED, not to treat the ED, right?

But still, I wouldn't do this. WAY too much opportunity for a non-ED specialist to talk about food-related stress in ways that would undermine you, the parents.

If non-ED-d has stress, maybe she can get her own therapist. We did this for our non-ed kid, just so he could have a place for dealing with his stuff. And likewise parents could have a marital therapist, to talk about how to maintain the relationship as well as possible during this awful time. 

But I would not expose an ED kid to any therapist who is not FBT or some other approach to ED I approve of.
atdt31_US

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Reply with quote  #5 
hmmm. I see what you are all saying and it is in keeping with my concerns.  So ... what is the family therapy at the UCSD 1 week intensive program -- it is involving the family and ed kid in dealing with the eating issues (well before phase 3 of FBT?), I thought,  and finding ways for the parents and siblings to also be heard/guided in going forward in a way to help the household as well as the kid with the eating issues.  I feel like I am blurring some things together I guess.
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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
atdt31_US

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Reply with quote  #6 
Quote:
Originally Posted by EC_Mom
I think you are referring to family therapy as a way to help the family reduce and manage all the tension "around" the ED, not to treat the ED, right?
.


Maybe.  I thought they would go together I guess, but one goal is certainly to reduce the stress in the household for all four of us, that comes from the daily eating issues as well as anxiety and daily resistance to taking the required constipation medication.  
 

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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
mjkz

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Reply with quote  #7 
I guess we've been very lucky because I've done family therapy on just those kinds of issues with my daughter and it has been very effective.  We actually saw my daughter's therapist who specializes in trauma and has a very solid background in eating issues too although she did get more training on that when she accepted my daughter as a patient.

I would look for someone who knows how to treat EDs and trauma both and make the goals going into therapy very clear.  I made it very clear going in that we were not there to deal with what started my daughter's ED or even to uncover those but to deal with issues arising from treatment of the ED, ways that we could help reduce the emotional tone of meals and deal with communication issues, etc.  Our therapist is very skill oriented, does DBT and CBT as well as treating PTSD, trauma issues (which every single family who has ever had a kid with an ED has if not going in then stemming from treatment).  We did very short courses and then went out and put the skills learned to the test.  We then met back to discuss what worked, what didn't work, etc.  She has been a true livesaver!!
atdt31_US

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Reply with quote  #8 
Yes, you are correct, I should add PTSD to the litany of things that we would like a magic want to address ... except that the Post part is wishful thinking - still very much in the traumatic stress part.  I live in a metro area and there is literally NO therapist that claims to be FBT in my city.  There is ONE about an hour away (and I am still waiting for the call back from her from about three months ago when we had a lengthy conversation and she was going to look into something and get back to me).  But since we are in all likelihood not RAN, but possibly ARFID, I was wondering if a normal "family therapist" would suffice -- looks like that answer is "probably not" and/or "only if you find a really good one who will get educated on Eds."   
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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
runmum

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Reply with quote  #9 
For those in the UK reading this, I would say ours was not old fashioned or blaming parents. I didn't find it a lot of help as I had read such a lot, but I imagine some families may find it more useful.
Tali97

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Reply with quote  #10 
We found our therapist by identifying what we wanted from a therapist and asking therapists for recommendations of people in the business that they thought would be able to help. It took a few phone calls, but we ended up with a therapist who has worked wonders but was not someone I would have gone to without the recommendations that we received. I will also say that around here that the therapist you want is the one with the long waiting list.
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18 year old boy (Gluten Free/Dairy Free 2005)
 IP - March/April 2014.  ARFID.
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AUSSIEedfamily

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Reply with quote  #11 
Dear atdt31_US,

I believe the 5 day UCSD program you are discussing is the NEW FED TR program that is a collaboration between UCSD and the Centre For Balance Living.

Read the attached research report on the NEW FED TR program program.

Eating Disorders Families Australia (www.edfa.org.au) is working and planning on getting Dr Laura Hill & Stephanie Knazt Peck to Australia and possibly New Zealand in the southern hemisphere spring of 2018

This program is explained in one of Laura Collins Lyster Mench's New Plates Podcast.

http://www.circummensam.com/new-plates-podcast.html

http://www.circummensam.com/episode-4-new-fed-tr-at-ucsd-and-cbl.html

Episode 4 - Treat To The Trait: a NEW approach to adult eating disorder treatment


 
Attached Files
pdf Outcome data NEW FED TR Oct 28 2016-1.pdf (285.11 KB, 11 views)


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harri

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Reply with quote  #12 
Hi all,

We are UK based and our daughter has been in hospital for six weeks now. I cannot compare family therapy to other countries, but for us it has been a life saviour and I call it personally a "sanity hour" of the week. No shaming or blaming at all, although our therapist can be pretty strict, too. But it was her who got our daughter back to normal eating. After a "lecture" what NG tubes etc. will cause, our daughter went to see her dietitian herself and asked to get back to full meals and we haven't had a problem ever since.

Based on group sessions with other parents, it looks like family therapy works very well for some families and not so well for others. I would advise to get some recommendations before starting with anyone.
atdt31_US

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Reply with quote  #13 
Quote:
Originally Posted by mjkz
Our therapist is very skill oriented, does DBT and CBT as well as treating PTSD, trauma issues (which every single family who has ever had a kid with an ED has if not going in then stemming from treatment).  We did very short courses and then went out and put the skills learned to the test.  We then met back to discuss what worked, what didn't work, etc.  She has been a true livesaver!!


Thanks for this input -- do you mind telling me how old your Ed Child was when you started the family therapy with DBT and CBT?  

My Ed-D has been with same therapist on and off for years (mostly before a name was put on diagnosis, but same issues throughout) and most recently, about nine months of once weekly appointments -- we are not feeling like there has been much done to address anxiety and what therapist says is ocd (we don't see this manifested outwardly at home) and what appears to be newly emerging symptoms of depression (one day episodes, if that is possible ...).  



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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
atdt31_US

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Reply with quote  #14 
Quote:
Originally Posted by AUSSIEedfamily
Dear atdt31_US,

I believe the 5 day UCSD program you are discussing is the NEW FED TR program that is a collaboration between UCSD and the Centre For Balance Living.

Read the attached research report on the NEW FED TR program program.

Eating Disorders Families Australia (www.edfa.org.au) is working and planning on getting Dr Laura Hill & Stephanie Knazt Peck to Australia and possibly New Zealand in the southern hemisphere spring of 2018

This program is explained in one of Laura Collins Lyster Mench's New Plates Podcast.

http://www.circummensam.com/new-plates-podcast.html

http://www.circummensam.com/episode-4-new-fed-tr-at-ucsd-and-cbl.html

Episode 4 - Treat To The Trait: a NEW approach to adult eating disorder treatment





I am not sure what this program is, but I was referring to the One Week Intensive Family Program at UCSD ... my understanding is they want both parents and all siblings and they educate all the family members, discuss roles of each in treatments, etc.  I think my non-Ed-D needs the ED explained and perhaps gain some understanding to why we are, in her eyes, ignoring punishable conduct by ED-d.  Non-Ed-D and ED-D are twins and are at each other's throats for the last few weeks -- partly because they have had a lot of together time this summer and the main focus has been refeeding -- so maybe school starting in a week will magically bring back some peace.  But in the meantime Non-Ed-D is suffering some terrible treatment by ED-D (although it definitely flows both ways at times) and it is hard to explain to her why confronting it at a time that will lose me a meal is less important than getting the meal in and addressing the conduct later with ED-D ...  I am unsure what is appropriate to try to explain to Non-Ed-D.  

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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
toothfairy

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Reply with quote  #15 
I love this


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Food is the medicine. Recovery is possible.
atdt31_US

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Reply with quote  #16 
. (from a different thread)

Interesting.  I sure don't have a crystal ball, and my twins are at a vulnerable age in terms of ED, so I am not going to look for trouble, but I would be very surprised if my NON-ED-D developed an ED.  They are fraternal, from IVF, and are incredibly different in terms of body type (in ways that have nothing to do with weight), and very different personalities.    Also, I somewhat wonder if the genetic component is the same in RAN as in the sort of ARFID my d has -- present and symptomatic since birth.

I definitely need to Educate NON-ED-D but how to do it effectively has been slow-going.  She alternately says and does stuff that begs for an understanding of it, but when I try to talk about it she shuts down pretty quickly and changes the topic -- essentially suggesting her sister should just eat, and having zero ability/willingness to entertain the idea that some of ED-D's behavior is properly ignored (or not punished in the moment) even though if NON-ED-D did the same thing it would be dealt with differently.

If you don't mind me asking, toothfairy, in what way did you EDucate your Twin2? I have seen this video you posted in this thread, and while it is fine, I do not think it would resonate much with my NON-ED-D -- in part, ED-D is not anorexic and a lot of what is assumed about the ED child in the video is not our reality.  I am not sure what, in the podcast, would be triggering for NON-ED-D or why showing the video versus the podcast is safer.  But I will heed the advice and not show it at this point.  


e
diting to say I have no clue why this is showing up underlined and in this color.  tried to fix it but could not figure it out - sorry. 


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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
Foodsupport_AUS

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Reply with quote  #17 
atdt31 it is nothing you have done. There is a bit of a glitch at times when you add a hyperlink the whole thing keeps on typing as a hyperlink. To stop this happening at the time, I normally start a new line of text, sometimes having to delete and restart again before it starts typing normally again. I can edit it out for you if you like but I don't think it really matters. 
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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
mjkz

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Reply with quote  #18 
Quote:
Thanks for this input -- do you mind telling me how old your Ed Child was when you started the family therapy with DBT and CBT?  


Around 14-15 for DBT but there was always some form of CBT right from early on.

Quote:
My Ed-D has been with same therapist on and off for years (mostly before a name was put on diagnosis, but same issues throughout) and most recently, about nine months of once weekly appointments -- we are not feeling like there has been much done to address anxiety and what therapist says is ocd (we don't see this manifested outwardly at home) and what appears to be newly emerging symptoms of depression (one day episodes, if that is possible ...). 


My daughter was in much more intensive therapy.  She started out at 2 sessions a week alone and one with me.  She is still at two a week but is looking at transitioning to one a week. She still sees a psychiatrist once a month for an hour, twice or more during depressive episodes and a GP once every 3-6 months now.  She has been in physical therapy off and on for problems with hypermobile joints due to being so underweight for years and herniated disks in her back.  She sees a chiropractor as needed too.  She sees a gastroenterologist for mild gastroparesis and takes meds for it but all things considered for how long she was sick and how emaciated she was most of her life, she is doing really well.
atdt31_US

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Reply with quote  #19 
Quote:
Originally Posted by mjkz

My daughter was in much more intensive therapy.  She started out at 2 sessions a week alone and one with me.  She is still at two a week but is looking at transitioning to one a week. She still sees a psychiatrist once a month for an hour, twice or more during depressive episodes and a GP once every 3-6 months now.  She has been in physical therapy off and on for problems with hypermobile joints due to being so underweight for years and herniated disks in her back.  She sees a chiropractor as needed too.  She sees a gastroenterologist for mild gastroparesis and takes meds for it but all things considered for how long she was sick and how emaciated she was most of her life, she is doing really well.



Thanks mjz.  This is enlightening -- I had absolutely no idea there was such intense psych treatment options.  They have always given us an appt every two weeks and then when we hit what seemed like a crisis period with Ed-D, I asked if we could come once per week and I guess I just assumed that was the most frequent they allowed.  I am hoping to talk with the therapist soon without Ed-D to see if the therapist thinks there has been some improvement because, truly, I don't see it, and worse, my ED-D wants to quit going because she says she is not getting help with her anxiety/difficulties with socializing and public speaking type school assignments and says therapist always just wants to talk about food and eating "and I don't have any anxiety about that."  

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Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth. FWIW ED-D is a fraternal twin and we have no other kids.
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