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By: Elissa
Zelman, Psy.D., Director, Scarsdale Center
Experts in the eating disorders field often say
the treatment focus in not on the food, but on the underlying issues
within the individual, family, and cultural system.
Two of the common such issues that exist are expectation of
immediate gratification and being ill equipped to emotionally handle a
situation where this does not happen and frustration arises.
It is my belief that this is one of the cornerstone problems with
many eating disorder patients, as well as with people suffering from a
multitude of other issues. This
includes, but is not limited to violent behavior, depression/suicidality,
and identity instability.
From our experience at CEDaR, these
problems seem to be on the rise in today’s society. What explains for
such an increase in these issues? One of the main contributors to this
problem is the lack of parental availability to children.
This exists along all socio-economic strata – from the low-income
mother who works several jobs to feed and clothe her children, to the
upper-income families with two working parents.
In no way is this to blame families for trying to make ends meet. In my opinion, it is rather a societal issue where programs
are not in place to truly support the family environment.
Subsequently, parents are often left with
a difficult reality. They do
not have the time, or often the energy to teach children how to cope with
life. That sounds simplistic, but as most of us know, it takes a
tremendous amount of time, energy, patience, and comfort with our own
feelings to walk through the emotional minefields of childhood with our
children. Because parents are so overextended, they often speak of
looking for the “quick fix”, even when they do not theoretically
believe this is what the child needs.
This explains how children are often taught, from a young age, to
expect things to come easily to them.
It also starts to paint a picture of children learning how to use
their anger and frustration in a manipulative manner, rather than being
able to sit with frustration, while a supportive adult helps them cry,
scream, journal, relax or otherwise cope.
With eating disorders in particular, one often sees the food
metaphor play out through binge eating and purging, where the child does
not have internal limits to soothe themselves and looks for an immediate
escape from difficult emotional situations.
While these are only
two of many, underlying issues contributing to eating disorders, and other
mental health issues, I believe they are quite pervasive and influential
for our patients, as well as within our larger culture.
To remedy much of this, many of us work with children and families
to change the dynamics, so that the parents are better able to set limits
and tolerate the necessary emotional fallout for their child’s improved
emotional health. Additionally,
we teach the parents who often present with a seemingly martyrdom complex
that they are entitled, and in fact need to, better care for their own
needs. This means giving them
permission to not overextend themselves, to get support from
family/friends, and to teach themselves what they will ultimately teach
their children – they do not have to perfect and are doing the best that
they can.
On a more basic level, we can all do
seemingly small things to encourage our families to trust their ability to
feel frustration and anger without “falling apart”, to learn to slow
down, and to not expect such quick results.
Here are some examples that, I hope will span disciplines and
theoretical approaches.
- Encourage
children and parents to keep going when they do not receive expected
results in themselves or out of life.
They often have to re-learn that failing, or struggling, is a
necessary and integral part of being human and does not define them as
a human being. In fact,
it is the process of falling and getting back up that develops
confidence and mastery in one’s sense of self.
- Help
children and families find meaning in their life.
It is sometimes easier to persevere if there is a love of a
task, hobby, trait or goal.
- As
professionals, mind our own anxiety when the child gets angry and
demanding, so that we do not pacify the way the parent (s) may have
done. It is vitally
important for us to model how to cope with our own feelings when we
are doing something that is initially displeasing to someone else,
because we recognize it is for the long-term good of the child and
family. This will help parents to be less scared of the
unrealistic fallout they anticipate with their child (they will fall
apart, commit suicide, run away) if they set firm, consistent limits.
- Help
parents find supports so that they can have more energy and patience
to deal with saying “no” to their children.
The more the parents have a support network in place, the
greater the long-term change potential will be within the family.
- Remind
the family that these changes will not take place overnight! By
definition, this is teaching them to be patient with the process of
change, to have more realistic expectations of themselves and to
articulate their frustration in having to give these changes time.
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