Wednesday, March 5, 2014

Emotion Focused Family Therapy for Eating Disorders (EFFT), by Natasha Files

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.

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?

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

About Natasha:
Natasha Files, MSW, RSW
Natasha holds a Master of Social Work (Clinical Specialization) from the University of Calgary, is a Registered Social Worker, and has specialized training in Dialectical Behaviour Therapy, Narrative Therapy, and more recently, Emotion Focused Family Therapy. Currently working in private practice, as well as being the Transitional Care Coordinator and an Individual and Family Therapist at Woodstone Residence, Natasha is passionate about facilitating a therapeutic experience that is both tangible and sustainable. 

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