Family Therapy for Eating Disorders

F amily therapy was first described as a primary psychotherapeutic modality for anorexia nervosa by Minuchin in 1970 [1]. In that description and subsequent work, Minuchin and colleagues have identified dysfunctional aspects of family interaction in families with anorectic members and formulated specific family-centered interventions to respond to symptoms of the anorexia and alter family behavior [112]. Minuchin's work was highlighted by a strong therapeutic presence, specific attention to family behavior within therapeutic sessions, and the creation and assignment of tasks that would help change family relationships and establish control over the symptoms of the anorexia. Family therapy for anorexia, as described by Minuchin, was based on structural family therapy that he had originated and described [13,14]. Minuchin's therapeutic efforts for anorexia include (1) establishing parental hierarchy within the family, (2) clarifying and resolving conflict between parental figures, (3) establishing boundaries between family subsystems and between individual family members to reduce parental overinvolvement with the anorectic patient, and finally (4) involving the entire family to enhance the development of the young person with anorexia while she achieves autonomy appropriate for her age and developmental level. Liebman and colleagues, while working with Minuchin, amplified the techniques of family therapy for anorexia by integrating a behavioral paradigm for weight gain within the family therapy [2,3,8,15]. Rosman [6] has described lunch sessions in which the anorectic patient and her family have a meal with the therapist. During these sessions, the cycle of family interaction concerning food is made apparent and directly altered. Minuchin, Rosman, and colleagues also reviewed the treatment of a cohort of 53 patients with anorexia nervosa followed for at least five years after completion of family therapy for the anorexia. They found the treatment to be effective in inducing resolution of the anorectic symptoms and improvement in psychosocial functioning in 83% of the cases [4,5,7,9]. Sargent and colleagues have recently described the entire course of family therapy for anorexia including an outline of the integration of family treatment into hospitalization [16]. Sargent and Liebman have also recently reviewed a family-oriented approach to outpatient therapy [17] as well as family treatment for both anorexia and bulimia [18]. Other descriptions of family therapy for anorexia have included (1) a description of the role of hospitalization in catalyzing and supporting family therapy [19], (2) an elucidation of the family ties of loyalty across three generations in families of anorectic members, with specific interventions aimed at diluting and altering the impact of loyalty conflicts and trans-generational coalitions [20]. and (3) Selvini-Palazzoli's work in identifying family patterns of control and the influence of the larger culture upon the family with an anorectic member at