The Anorectic Family
Blueprints for Treatment
Therapist Role and Scope
Characteristics of the Anorectic System
Psychodynamic
- Energy paradigm:
- "Total personality and psychological growth"
- Symptom remission is a byproduct of personality restoration
- Therapist interested in historical reconstruction of patients inner life
- Transference is healing
- Add Communication paradigm (Bruch):
- Emphasis on respecting patients present reality and subjective experience
- Still, meetings with system are seen as management, not therapy
- Excludes parents from therapeutic focus
Behavioral
1. Child has grown up in an enmeshed system
- Interpersonal contact and proximity define their reality
2. Family is child-oriented
- Overprotective and hyper-vigilant
- Child develops vigilance over their own actions
- Perfection and people pleasing
3. Guilt and Shame for violating family expectations
- Autonomy curtailed-- denial of self due to concern for family
- The what not the why
- Therapist is outside of the system
- Objective scientist
Systems
- A member of the system, and must participate in order to modify system
- IP behavior both is programmed by and programs family behavior
- Change means new family structures
Change
Family Functioning in a Healthy System
Paradigm Shifts
The Process of Change
Characteristics of the Anorectic System, Cont.
The Locus of Pathology
- Disequilibrium occurs when family members grow and system cannot adjust
- Family's job is to maintain continuity while also responding for demands for change
- Rigidity = dysfunction
- The family is a closed system
Psychodynamic
- Individual identity depends on validation of self by reference group (family)
- "Family transactional patterns form the matrix of psychological health"
- Expanded self, incorporation of repressed parts of reality
- Psychodynamic therapists choose linear treatment--hospitalizing anorexic girls and working with them out of context
- Intensifies the symptom label-- isolation
- "Collage" of Levenson's paradigms
- Palazzoli
- Mechanistic and communication paradigms are complementary
- Mistrust of body signals spring from both internal identification of body with bad object, and mothers inability to meet child's needs
- Investigators POV/governing concept is their blueprint for selecting "relevant" information and methods
- Systems orientation to anorexia only since the 1950s
- Systems vs. Linear models
- Important to look at development of paradigms and how they have built off one another
- Medical model --> Psychosomatic approach-->Systems
Behavioral
4. Family can't cope with transitions/shifting needs of members-- adolescence causes a crisis
- Development is stunted by child's over involvement with family, delays individuation
5. Cross-generational coalitions common-- triangulation to maintain family harmony, which is overemphasized
6. Focus on bodily functions
- This is how over-involvement can play out
- Any symptom quickly becomes embedded in the system as family members respond to bodily signals
- Feeling that someone else owns your body
- Man is an animal who learns
- Contingencies encourage adaptive behavior
- Focus on weight gain
- Despite improvement, gains not maintained after treatment-- IP has not generalized responses outside therapeutic environment
- Like psychodynamics, views locus of pathology as internal
- Focus on overcoming unadaptive habits
- Treatment kept at a symptom level
Systems
Levenson
Systems
- Chance can only occur with system transformation
- Alternative ways of relating so that adaptive patterns can be created and maintained
- Change occurs in the here and now-- significant parts of the past are contained in the present
The Communication Paradigm
The Organismic Paradigm
The Energy Paradigm
- Psychodynamics and behaviorism are both part of the answer
- However, CURRENT CONTEXT is missing
- Expressions of pathology change according to context
- Dysfunctional sequences and how the system uses the symptom
- First significant shift in psychoanalytic thinking
- Cybernetics
- Shifting patterns, never the same twice
- "The electronic machine"
- Biological, not physical
- Bertanffly
- Man as active personality system involved in a web of relationships with his environment
- "Organization"
- Freud: Man as Machine
- Mind can stop (fixation), or go backward (regression)
- Time oriented perspective, forward and backward mechanistically
- "The work machine"
Subsystems and Boundaries
The Unit of Intervention
Conclusions
- Spouse
- Dysfunction at this level reverberates through family
- Models nature of intimate relationships for child
- Parental
- Can include non-nuclear family. Can also include child
- Provides nurturence, guidance and control
- Child learns basic patterns of relating in situations of unequal power
- Learns to manage wants needs and expectations
- Develops a general concept of authority
- Sibling
- First peer group
- Practices isolation, teaching, scapegoating
- Child learns patterns for negotiation, cooperation, and competition
- Haley- Unit of intervention imposes different theoretical constructs
- Contradicts Levenson, who says concepts of cause and intervention are not coinciding
- Both are true and we just aren't doing logically consistent work?
- Bowen and Laing
- Argues that true systems thinking always intervenes at the level of subsystems-- always wholistic
- Individual reality is complex and not captured by linear models
- Epistemological error of western thought-- the myth of unilateral individual control
Boundaries = Rules that define subsystems, who participates in transactions and how. They protect necessary differentiation for each sub system to carry out its function