Family therapy when your child has an eating disorder

Family therapy when your child has an eating disorder may be the most important and the hardest thing you’ve ever done as a parent. Family therapy can help your family build belonging and resolve conflicts more easily. It can have a lifetime of benefits, including supporting eating disorder recovery.

But while therapy is ideally a safe space, when it’s family therapy, parents rarely feel safe. In fact, they usually feel uncomfortable at first. That’s because family therapy addresses family dynamics. And because you are the parent, and thus the head of the family, your behavior and parenting choices are naturally going to be evaluated and discussed. 

In family therapy, your child will get the lion’s share of talking time, for reasons I’ll explain shortly. This may make you feel shut down, shut out, disrespected and even furious. You want to be prepared for these feelings to show up. Because while they make perfect sense, they can get in the way of making progress. Family therapy is an opportunity to deepen your relationship with your child and support their recovery. It will be hard, but it will be worth it.

What is family therapy?

Family therapy is when family members are guided by a trained, licensed therapist to improve communication and resolve conflicts. Family therapy is different from family-based treatment (FBT), which is used for eating disorders. While FBT is about feeding, family therapy is about family dynamics. 

Family therapy is designed to help families:

• Increase empathy and understanding 
• Set and hold healthy boundaries
• Build belonging and communication
• Develop problem-solving and conflict resolution skills

If your child’s eating disorder treatment team has suggested family therapy, it’s best if you are informed and prepared. Here are the five steps you should take to prepare for family therapy: 

1. Set your goal

You want to go into family therapy with a clear goal. And while it may seem like the obvious family therapy goal is to fix your child’s eating disorder, that will not work. This is because family therapy is about working on your family dynamics, not solving a particular problem.

Family dynamics are the patterns of interactions among family members. It involves each person’s roles and relationships. Within families people adopt roles that can become fixed and unhealthy. And there are multiple dyads, triads, and other inter-relationships. These all need to be addressed individually and collectively. 

Family dynamics can either be supportive or a significant cause of stress. When we shift family dynamics from stressful to supportive, we can supercharge recovery. Thus, your goal in family therapy is to build more supportive family dynamics.  

2. Don’t expect equality

Family therapy is nothing like any other therapy you’ve experienced. If you’ve done individual therapy, you had 100% of the time to explain yourself and process your feelings. If you’ve done couples therapy, you had about 50% of the time. But in family therapy, your child’s experience of being a child in your family takes center stage.

You need to enter family therapy with a very clear understanding that this is not an equal playing field. While you may not realize it, you spent many years in a position of power over your child. That’s simply what it means to be a parent. Even if you felt powerless at times, the very nature of the parent-child dynamic is that you held tremendous power over them when they were a vulnerable infant, toddler, and child. This early dynamic shapes how they see you and relate to you, no matter how much things have changed since then.

In family therapy you and your child are not peers with equal perspectives. You will not get equal time. The therapist will encourage your child to express themselves and how they felt in the family. And that is where the healing begins. The more open you are to learning about your child’s perspective, the greater your success will be.

3. Don’t debate the “facts”

There is a good chance that your child will bring many stories and grievances to family therapy. They will have complaints about things you did and things you did not do. It is natural and normal to want to debate the facts of the situation. 

For example, if your child says you never cared about them, you will want to tell them all the ways you did care about them. If your child says you loved their sibling more, you will want to tell them the times you prioritized their feelings. 

But the facts are not the issue. And debating the facts will derail family therapy. Work on your own emotional regulation and prepare yourself to hear facts that you don’t agree with. Because you don’t have to agree with the facts. What you need to do is see the small vulnerable child who is asking you to witness the pain they experienced in childhood. What feels like criticism of you is actually a request for care from you. 

All children experience pain in childhood. No childhood is perfect. And you didn’t have to get things right in the past to be close with your child today. You just have to listen to their grievances with compassion and empathy and love them for who they are. The more you witness their pain with compassion and acceptance, the less they will suffer.

4. Don’t get defensive

It’s OK. You’re probably going to get defensive. It’s natural and normal to feel defensive when a child says something went wrong. But your goal is a deeper and more supportive relationship with your child. So you need to manage your defensiveness and not let it get between you and the vulnerable child who is asking you for emotional care.

Defensiveness sounds like this: 

• But I did all this for you …
• That’s not what happened
• But what I meant was …
• What I was trying to do was … 
• I can’t believe you would say that
• You’re wrong
• What else was I supposed to do?

These sorts of statements will want to tumble out of your mouth. But it’s best to manage your defensive impulses. Your goal in family therapy is to deepen your relationship with your child. And these defensive statements will not help and may even make things worse. Defensiveness from you will shut down the therapeutic process.

Work on your defense triggers in advance with a therapist or coach who can help you process your feelings with compassion and understanding. Practice managing your defensive impulses so you can hear about your child’s experience without getting defensive.

5. Listen & validate

Of course you want your child to understand you. But don’t start there. Healing begins when your child feels understood. When that happens, they will be able to see you in a new, softer light. But if you try to keep the focus on your feelings, a wall will remain between you. 

You’ll need to listen far more than you speak during family therapy. I don’t want you to repress your feelings. This is about managing your emotions during family therapy so that you’re able to hear what your child has to say. If sitting in family therapy is going to require strenuous repression, then it’s too soon for family therapy. Take more time with your own therapist or coach first so that your own feelings are well on their way to healing before you do family therapy with your child. 

During family therapy you mostly want to make validating statements. When your child speaks, they are opening a door to a relationship with you. They’re saying “can you see my pain?” And the correct answer to this is some version of “I believe you, and I’m sorry for your pain. I love you, and I will always love you.”

Practice validating your child’s feelings. As I said before, you’ll be tempted to focus on the facts and details, but instead focus on the feelings they are sharing with you. Listen for feelings like: 

• I felt sad when …
• I’m angry about …
• I wish you had … 
• I’m not sure that you love me …

Hearing your child have these feelings can be heartbreaking. Anticipate that your child has big feelings that will come out in therapy and practice responding to them with validating statements before you go.

I know that family therapy when your child has an eating disorder is hard. But there are tremendous benefits if you can do it. The best thing you can do is keep your goal in mind and be prepared. 

See Our Eating Disorder Treatment Guide For Parents