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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

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