When most people think of interventions, they have an example in their minds from a television show, most often related to someone with a substance use disorder. Although interventions are used frequently to help convince persons with addictions to begin treatment, it is my belief (thanks to my experience tracking and staffing cases for a large eating disorder organization) that it is quite rare for people with eating disorders to have a formal intervention. This realization, then, begs the questions: Can an intervention be done for patients with eating disorders? And if so, why are they not used more frequently?
Below, I discuss some points to consider when answering these questions:
First, we must look at the difference in temperament and presentation of eating disorders versus substance use disorder.​​​​​

• As my mentor Craig Johnson used to say, “Eating disorders thrive in secrecy and isolation.” Oftentimes, families have no clue what their loved one is hiding behind closed doors. Plus, it’s difficult to recognize an eating disorder in a culture that glamorizes dieting and exercise. It can be confusing to know when behaviors have crossed the line into  being disordered.
• Temperaments of persons with eating disorders, across diagnoses, tend to be “harm avoidant,” meaning they follow the rules, pay attention to details, and generally know how to stay out of trouble. They often don’t have the legal troubles that frequently initiate the alarm bells of families who have loved ones with addictions.
• Individuals with eating disorders also struggle to believe that they are sick enough to warrant care. They are fearful of accepting treatment because they think they don’t look as sick as others. They can make very convincing arguments to professionals and families about why “it’s not that bad.” They often convince their loved ones that they can get things under control without outside help. 

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Persons with eating disorders and their families do not have the same access to support groups as addictions.

• One positive outcome from the COVID-19 pandemic is that it has opened the door for more virtual support groups for eating disordered patients and their families. Still, compared to the thousands of meetings available every single day to those with addiction struggles, the disparity in the number of support group offerings for eating disorders is chilling.
  Family members of individuals with eating disorders will often tell you that they don’t have anyone to talk to or that, when they do reach out, others just don’t understand their experiences. One of the beautiful things about support groups is the finding of common ground, including the discussion of topics like successful family involvement and interventions. Unfortunately, when there is limited access to support, these conversations are less likely to happen.

In the eating disorder community, many individuals are worried about interventions being too confrontational.

• Some intervention models use a “surprise” approach when meeting with the individual of concern. In general, due to the temperament of those with eating disorders (as explained above in 1b and 1c), this population doesn’t do well with surprises. They may shut down and become more stubborn or anxious. Persons with eating disorders also like to be thoughtful about details and planning and are less likely to begin a treatment plan without a thorough review. Additionally, families will tell you that the idea of an eating disorder intervention “scares them.”
• ​The ARISE® Comprehensive Care with Intervention model takes a different spin on intervention that is a nice fit for persons with eating disorders. The individual is invited to become part of the family network and part of the first meeting -- meaning there are no surprises or ambushes. The ARISE® facilitator collects family history and develops a recovery message with the family in order to reduce shame and blame and increase healing and health for the whole family over the course of the recovery journey. An intervention, if needed, is just one piece of the plan that can be implemented to help individuals stay engaged with treatment and ultimately reach their treatment goals. 

Eating disorder treatment programs may require specialized admission procedures.

• Persons with eating disorders may have very serious physical and medical complications that need careful vetting with an admissions team. Eating disorder programs must screen for things like appropriateness, travel considerations, and level of care needs, which means that they often cannot have the quick turn-around time of a substance abuse program. 
• In addition, programs may have wait lists that are several days or weeks long. This complication calls for an adjustment to the typical practice of packing your bags and going to treatment immediately following the intervention. The eating disorder interventionist needs to help the family manage the time between the person agreeing to treatment and the actual admissions date.

With mindfulness to the considerations above, I believe that persons struggling with eating disorders can benefit from intervention services. It is imperative for the family network to have support from others to help navigate the road to recovery while their loved one is in treatment and once they return home.  
If you are interested in learning more about eating disorder interventions, please visit my website (EatingDisorderIntervention.com) and reach out to me via my contact page. I offer free, 30-minute consultations to new clients.

Most parents of children who are now adults will tell you that parenting doesn’t magically stop at age 18.  We are connected to our children and loved ones through our neurobiology throughout our lives.  As the saying goes in Emotion Focused Family Therapy (EFFT), developed by Adele Lafrance and Joanne Dolhanty “once connected, always affected”. 
It is completely normal for us to hold in one hand the desire to help our loved ones when they are struggling and in the other hand a desire to see them work through their problems and gain independence.  However, when mental health challenges such as eating disorders, addictions and mood disorders start to affect areas of daily functioning, relationships, ability to engage in school or work and safety is at risk, the person affected needs help and support to get back on track.  Parents and other caregivers such as partners, spouses, extended family and friends have the neurobiological power to be very effective healing agents of change, even more so than clinicians! 
Plus, family involvement and support is endorsed by national organizations such as The Substance Abuse and Mental Health Services Administration (SAMHSA) and The National Alliance on Mental Illness (NAMI).

So why do we question our involvement?
As a parent who has been there and as a clinician who has seen it in action, I can say that in general we question ourselves because we have difficulty seeing how our efforts may be helpful.  EFFT describes this as the experience of caregiver burden.  The feeling of burden does not depend on how much time you spend on the situation or the resources you have committed to it, rather it is the sense that what you have to offer isn’t helping, the situation isn’t changing or the worry that you may make it worse.  It can show up in all kinds of ways.  For example, here are a few more common thoughts I’ve heard parents and caregivers express:

• My child is an “adult”, I’ve done all I can do and they need to learn how to take care of themselves.
• My adult child is refusing to involve me and won’t allow treatment providers to talk to me.  I guess there’s nothing I can do.
• I might make things worse.
• I can’t help because I have my own struggles with mental health or addictive behaviors.
• I’m so exhausted and burned out, I don’t know how to be helpful.

 
All these thoughts and more may be true.  And, with EFFT as our guide, we also know that:

• Parent and caregiver efforts are more neurobiologically powerful than professionals.  When your brain is wired to another, even if the relationship isn’t perfect, is cut off or restricted or in conflict, you can be more effective and efficient than any therapist!  While a therapist may have deep regard and respect for the human they treat, they don’t love them like a family member.
• Adults remain connected to their families after age 18.  Many are still on their parents’ insurance policies, cell phone plans, gym memberships, etc.  In many major cities, the cost of real estate is so high it makes more sense for your adult child to live at home. And even if your child has launched, you continue to remain connected through that neurobiological wiring for life.  A family member or caregiver has the opportunity for better eyes into the day to day struggle than a therapist in this sense, and, an opportunity to use interventions and skills in the moment.
• Inclusion of parents and caregivers in their loved ones’ treatment can increase their feelings of empowerment and effectiveness.  Our mental health systems often exclude or even blame family members which increases a sense of burnout and can lead to relationship conflict and an increase in our loved one’s behavioral symptoms. 
• The therapist/client relationship, while a healing one, is also a business relationship that may be limited by access, availability and location issues.  Therapists may move practices, change directions in their careers, etc and clients may terminate therapy due to resource constraints, frustration, scheduling issues, etc.  The family network is the best equipped to support when the external system weakens.

EFFT harnesses the incredible healing power of families, across diagnoses and the lifespan.  A core principle of EFFT is that persons struggling with mental health challenges, addictions and eating disorders may require “advanced caregiver skills”.  These are skills that you don’t normally need in regular situations and skills that are taught to clinicians that can also be taught to you.   You are not to blame for the lack of these skills or for the development of your loved one’s struggles.  Even one degree of change in a parent or caregiver’s attitudes or behavior can have a significant impact on their loved one over time.[i]
 
What can I do to be involved?

1.  Let your adult child know you see they are struggling and ask how you can help.  Sometimes just acknowledging the issues can open the door.  If they are already in treatment, offer to join a session or talk to a provider. *hint: even if a provider can’t confirm or deny that they are treating your loved one, you are not violating confidentiality laws by reaching out to them to let them know you exist and want to help.
2. Get your own support.
   1. Having a family member struggling with mental challenges can be stressful and worrisome.  One positive development during our pandemic is that virtual support groups are more widely available.  You can find some quick links on my Resource page 
3. Watch Adele LaFrance’s video on “Why We Want You” 
4. Enroll in an EFFT webinar or workshop
   1. Bonnie Brennan Counseling and Education, LLC will be offering 2 day Parent/Caregiver workshops very soon.  Please check back for updates on the next date available.
   2. You can also register for webinars and events through Mental Health Foundations 
5. Hire a professional
   1. Family support can come in the form of family therapy, family consultation or intervention and continuing care services.  
   2. Click here for an overview of services available at Bonnie Brennan Counseling and Education, LLC or call me at 720-663-8699 for a 30 min free consultation.

In closing, please know that being involved in the treatment or support of your adult child struggling with mental health challenges, addictions or eating disorders may be the very thing that makes a difference.  You can absolutely be part of the solution.  Human beings are social creatures and we need each other in order to thrive.  I very much appreciate you for loving your person struggling and being willing to consider, even if you don’t know what will happen, the possibility that change can happen and that you can be part of that change.
 
 


[i] Lafrance, A., Henderson, K. A., & Mayman, S. (2020). Emotion-focused family therapy: A transdiagnostic model for caregiver-focused interventions. American Psychological Association. https://doi.org/10.1037/0000166-000