Family Therapy and Eating Disorders
Clinicians have long believed that the family of the patient has an important role to play in a complete management plan for anorexia nervosa. During the early parts of the 20th century, psychological models of eating disorders were temporarily replaced by physical etiological models, but by the middle of the century, the tide had again changed and the patient’s family experiences were seen as having a pivotal role. Hilde Bruch, in proposing the importance of formative experiences in early mother–infant interactions, provided a major impetus for a family-based theory for anorexia nervosa. She suggested that, as a child, the anorexic patient’s needs received insufficient and inaccurate feedback from the mother. This led to poor development of the child’s interoceptive awareness, a distorted perception of self, and a pervasive sense of ineffectiveness.
Although these specific, clinically derived, theoretical conceptualizations have not been backed up by systematic research, a growing number of studies in the past 40 years support the general notion that family factors contribute importantly to the development and maintenance of eating disorders.
Accumulating clinical observations have been supplemented in a significant way by ideas and practice early in the evolution of family therapy. A number of influential figures in the family therapy field gave their attention to the treatment of eating disorders. Selvini-Palazzoli advocated a move from an individual therapy approach to whole-family intervention for anorexia nervosa, and Salvador Minuchin produced systematic clinical data to show the effectiveness of family therapy. The high level of prestige given to the observations of these two innovators gave great impetus to the application of family therapy to anorexia nervosa. This appeared to offer strong support to a specific belief about the etiology of anorexia nervosa in particular, and of eating disorders in general, a belief not confined to the adherents of the “family therapy movement”: The disorders were thought to originate in specific, pathogenic family processes. This was true despite the fact that Minuchin himself had drawn attention to a variety of factors other than the family processes that he had described as the etiological sources of anorexia nervosa.