Emotion
Focused Family Therapy for Eating Disorders (EFFT)

EFFT seems to be the new buzzword in the BC
eating disorders field, but let me assure you it is more than a trend. Initially
hearing about it at the 2013 NEDIC conference, something about Dr. Adele
Lafrance Robinson’s presentation caught my heart. Any therapy that believes in
the healing power of parents as monumental for change wins my vote.

Developed as an adjunct to care and
specifically for treatment resistant cases, EFFT views low self-efficacy and
emotion avoidance as foundational culprits in the development and ongoing
struggle with eating disorders. As presented in the below example, eating
disorder symptoms are maintained as an attempt to quiet emotion, and
individuals who lack the ability to fully express and have their emotional
needs met, will continuously find themselves in a state of overwhelm. 

Imagine functioning in the realm of extreme emotion.
Feeling another’s sadness, anger, fear or shame before they even express it.
Believing you need to be the one to reduce the burden because tolerating it
feels like too much. Each time someone looks at you the wrong way means they are
thinking the worst – not to mention your whole existence is wrong; therefore,
your actions are driven with a desire to avoid further shame. The sub-theme to
your existence is about repaying a debt to humanity.

Now, imagine finding a way to dull that emotional
intensity. Realizing that you can trade the discomfort and cocoon yourself
behind a protective layer – much like the quieting of a busy city during the
peaceful dark of a snowy night. You know the chaos still exists, but have found
a refuge that feels unfaltering. Even if for a moment, hiding in this place promises
a form of relief.

Then, imagine everyone in your life franticly
demanding you come out from behind that protective fortress. People insisting
your hiding space is bad. That you must stop, and change, and shatter the very
thing that has promised you escape…

How do you convince someone to give up the
one thing that helps them feel safe?

The short answer: you don’t. The long
answer: you help them find a new definition for safety.

Super-feelers are highly sensitive to the
emotions of others’, have an extreme degree of emotion perception, and
experience their own emotions very intensely. Combine super-feeler status with
the various known contributors to the development of eating disorders
(genetics, cultural, social, life stressors, coping style) and you have the
perfect storm. No wonder eating disorders develop.

Viewing the eating disorder as an adaptive
way to manage emotion has transformed my clinical practice. I increasingly find
myself saying, “that makes so much sense!” and no longer struggle to outwit or
outsmart a seemingly relentless opponent.

This model values individuals as doing
their absolute best, and challenges a deeper look whenever motivation is in
question. Your child adamantly demands you stay out of her care? I can almost
guarantee that she is really saying “I
desperately want you involved, but am so worried it won’t go well, so I feel
safer pushing you away.” Your client is convinced she is not ready to
recover? I wonder if she is really admitting, “I am so scared and don’t know how to do this.”

The
Role of Carers

So where do carers come in? EFFT teaches
carers (any loved one who is in a caregiving role) to become their loved ones recovery
coach and emotion coach, invites family members to participate in relationship
repair, as well as offers an opportunity for carers to work through their own
fears related to offering support.

Previously avoiding the word good in any therapeutic conversation, I
have recently found myself saying good
and very good more regularly. Why? Because each time we
uncover the fear behind a behaviour – also known as speaking the unspoken – we
have found a clue:

If I
give her too much support she may never become independent.

Now we understand why you are not loving
this approach. Good. We can work
through that.

If I make
her eat she may run away or kill herself.

 So now we know why
you freeze each time she complains about meal support. Good. We can work
through that.

Anyone can be taken hostage by emotion,
especially fear, and EFFT invites carers (and therapists) to work through their
fears in order to become more grounded in the recovery process. EFFT views care
as “going back to get on track” and highly values a carers ability to soothe
their child. How much more are we able to soothe when we don’t have the devil
whispering core fears in our ear?

Recovery
Coaching

Family members are taught how to support
re-feeding and symptom interruption. Strategies for various situations are
taught and practiced (including meal supervision, coaching phrases, asking
direct questions, and even how to support someone through text message).

Emotion
Coaching

Family members are also taught skills to
support the processing of emotion, specifically around targeting bodily felt
sense, emotional needs, and action tendencies.

SADNESS:

Feels- heavy and slow

Needs- comfort

Action Tendency- reach out for a hug

Each emotion has a need, and it is by
experiencing the full follow through of emotion that individuals come to rely
less on the eating disorder symptoms. Emotion coaching supports the child to
internalize emotion regulation skills and helps re-shape their experience of
previously overwhelming feelings. It also enhances relationships.

Where
to go from here?

EFFT balances empathy and compassion with
firm limits that support symptom interruption, behavioural change, and an
overall transformative experience of emotion. With preliminary data showing
significant positive changes, this approach offers carers tangible skills in
order to fully engage in and support their child’s recovery process.

1) Pay attention to how you and your child
express and process emotion. Does it always feel safe to “go there”? Do you
find yourself walking on eggshells for fear of something “worse” happening?

2) Check out www.emotionfocusedfamilytherapy.org

3) Consider attending the EFFT Carers
Workshops in April. Carers, as well as clinicians (as observers) are invited to
register:

About Natasha: