By Harriet Frew, Highly Specialised Eating Disorder Counselling Practitioner at
Cambridgeshire and Peterborough NHS Foundation Trust
When someone you care about develops an eating disorder, it should not be under-estimated how stressful it can be.
You might feel hopeless, scared and upset, wanting desperately to help, whilst feeling unequipped to do so. Maybe you have already tried to help, but found that your input has not been welcomed by your loved one.
In the Adult Eating Disorder Service (AEDS) at CPFT, we support carers using the New Maudsley Model developed by Professor Janet Treasure and colleagues.
This model works to support and include carers in treatment, acknowledging the value carers bring and the potential to affect positive outcomes in recovery.
The method is underpinned by Motivational Interviewing, where the person with the eating disorder is encouraged to take full charge of their recovery and to develop skills to maintain this.
Carers learn the tools to support their loved one in this process. It contrasts with child and adolescent services, where carers are encouraged to take active control of recovery.
If you have a young person transitioning from child to adult services, the change in approach can feel unsettling initially.
As you try to support your loved one, you might be unintentionally drawn to help, in ways that could potentially exacerbate the eating disorder.
Professor Treasure has developed ‘animal metaphors’ as a way of communicating communication styles, that families can often relate to more easily than complex, psychological jargon.
The Rhino: Faced with your ill loved one, it makes sense that you might want to fix the problem, by offering practical advice and logical solutions. The tricky fact is that someone with an eating disorder is often ambivalent about change. Therefore, a perfectly good-intentioned rhino will often unwittingly drive the person with the illness, to argue back or push against the advice. The sufferer may feel controlled and become extremely rebellious, then holding onto the eating disorder with greater tenacity.
The Kangaroo: An eating disorder often renders a person more childlike and helpless, particularly if they have lost significant weight. Understandably, as a carer, you might feel drawn in to rescuing and protecting them, taking on their responsibilities. Although this approach is tempting and feels reasonable, it is actually not helpful to do this, as your loved one may likely regress and lose confidence. A part of them may even begin to welcome this care and attention; the illness then offering a benefit, you would wish to avoid.
The Dolphin (the one to aim for): The Dolphin moves alongside their loved one, being supportive, kind and attentive through active listening. The Dolphin can stand in someone else’s shoes, showing empathy and understanding of a different perspective. The Dolphin is validating and affirming (noticing the mini steps forward and championing these), so helping to raise self-esteem. Simultaneously, the Dolphin is not a walk-over, having protective boundaries in place.
It can be hard to be a Dolphin in the midst of the stress and anguish of the eating disorder. Sometimes, Dolphin behaviour can feel as if you are not doing anything. However, the Dolphin’s impact is subtle but powerful, creating a motivational back-drop for change to happen.
The Jellyfish: If your loved one is unwell, you will understandably feel anxious and overwhelmed. You might find it challenging to control these feelings, finding them dominating and seeping-out on a daily basis. The Jellyfish can be tearful or feel guilty for what is happening. Unfortunately, the Jellyfish unintentionally creates more stress and upheaval, being overcome with emotion. This results in the sufferer protecting their carer by not expressing true feelings, due to a fear of creating further upset. When you are in Jellyfish mode, this is the time to seek out support for yourself with a good friend or through counselling.
The Ostrich: The Ostrich feels frightened by the illness and buries their head in the sand. They pretend that there isn’t a problem and may withdraw from their loved one. This can result in the sufferer feeling isolated and possibly colluding with the idea that the eating disorder isn’t an issue.
The Saint Bernard (the response to aim for): The Saint Bernard is kind, caring and consistent in their emotional response. They avoid arguments and roll with the resistance, by listening and empathising. The Saint Bernard provides warmth and companionship towards their loved one, as they embark on the recovery road. They remain self-compassionate and take care of themselves too.
A carer’s story: Rachel
“Supporting someone through an eating disorder is a marathon not a sprint so you need to make sure you are supported and looking after your own wellbeing.
“Make sure you give yourself time to self care whether that’s doing some exercise, meeting friends or taking time to do a hobby you enjoy. It’s not easy and try to remember that you can’t ‘fix’ someone, only be there to support them through their own recovery.”
In AEDS , we understand how tough it can be for carers when someone is unwell with an eating disorder. This is why we teach carers motivational tools and skills, which help support their loved one towards recovery.
Carer’s work can include:
• Carers Group – meeting monthly in Cambridge
• Individual family work
• Three-day multi-family workshop
Eating disorder charity Beat has information for carers here.
Book recommendation: Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method 1st Edition by Janet Treasure