Relational containment: exploring the effect of family-based treatment for anorexia on familial relationships

Abstract

BackgroundThe aim of this research was to investigate the process of familial relationship change for adolescents with anorexia nervosa and their parents, who participated in Family-Based Treatment (FBT).MethodA Constructionist grounded theory design was employed with purposive sampling. Sixteen young people between 12 and 18 years with a good outcome in FBT and twenty-eight of their parents participated. Young people and their parents took part in separate interviews at the end of treatment. Each interview was transcribed and analysed to identify a unifying phenomenon across the data to elicit a theory that explained the data and then integrated into existing theory.ResultsPrior to treatment families’ experienced significant conflict, disconnection and isolation. The FBT structure, therapist direction, and the specialist medical setting created a process of relational containment. This enabled parents to trust the process of FBT and develop confidence in their executive role in the family. In turn this allowed the adolescent with anorexia nervosa to trust their parents, feel more secure and gradually engage in the treatment process themselves. Improvements in closeness, communication and adolescent sense of self were reported after FBT.ConclusionsThese findings illuminate a possible mechanism of change in FBT. It underscores the importance of parental management of eating disorder symptoms at the commencement of treatment to enable increased parental confidence. Meaningful changes occurred for the adolescents’ that aided normal developmental and relational processes, an important aspect of recovery.Trial registration Australian Clinical Trials Register number: ACTRN012607000009415

Predictors of early response in conjoint and separated models of family‐based treatment for adolescent anorexia nervosa

“…In previous research, we have shown that greater attendance by fathers predicts better patient outcomes (Hughes, Burton, Le Grange, & Sawyer, ). This may be in part due to fathers' involvement contributing to greater relational containment whereby treatment enhances parental confidence and the parent–child relationship, leading the adolescent to feel more secure and to engage more readily in the therapeutic process (Wallis et al, ). Taken together, the results suggest that the father's relationships with their child and the therapist, as well as his participation in treatment, can have a significant impact on treatment progress.…”

Are family relations connected to the quality of the outcome in adolescent anorexia nervosa? An observational study with the Lausanne Trilogue Play

“…Family therapies, such as the family‐based therapy or the Maudsley family therapy (Le Grange & Eisler, ; Murray & Le Grange, ), have their roots in the systemic approach (Minuchin et al, ; Selvini Palazzoli, ) along with the behavioural one; they have shown high levels of efficacy in the treatment of anorexia nervosa and in particular of adolescents (Couturier, Kimber, & Szatmari, ; Fisher, Hetrick, & Rushford, ). Early studies (Wallis, Rhodes, et al, ) investigating the therapeutic process and the changing mechanisms in family‐based therapy showed that relational containment and parental confidence may play a pivotal role in enhancing the adolescent physiological individuation and autonomy process. Moreover, there is preliminary evidence that supports also therapeutic methods coming from different theoretical approaches, such as the systemic family therapy (Agras et al, ) or the dynamic family therapy of the Montsuris (Paris)‐based group (Godart et al, ).…”

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

“…For example, we can see that uniting the parents in managing the re‐feeding can provide ‘relational containment,’ and when that is achieved the parents are available to help the young person regulate their distress, as Wallis et al. () describe. Initially that distress arises in relation to eating, weight, and shape issues.…”

“…Wallis et al. () report a qualitative study of changes in family relationships resulting from FBT. They drew their observations from interviews with members of 33 families successfully treated (emphasis added).…”

“…This helps parents take a less critical stance. Then, ‘Providing time in sessions to help adolescents’ articulate their experience, and supporting parents to listen in a validating way may be an important way to help the adolescent engage and seek support …’ (Wallis et al., , p. 9).…”