Dispelling the Toxic Family

"The older point of view was that families of anorexic girls were in some way toxic," says Robin. It's true that family problems often contribute to anorexia, Robin says, but it's also true that parents can become a therapist's best allies. Indeed, Ivan Eisler, PhD, a London University psychologist who is leading the training workshop in New York this week, says girls whose parents are directly involved in therapy "in many cases may require no more than a few sessions to achieve good results."

One reason parents can become so effective is that they're with their daughter for hours each day. When properly trained, they can monitor and guide the eating process, says Amy Baker Dennis, PhD, an assistant professor at Wayne State University Medical School, and director of training and education for the Academy for Eating Disorders. Also, parents intimately know their daughter and her social life. When a truce is called in the battle for control, they can help her solve problems and surmount the hurdles she faces. Moreover, the new style of treatment doesn't prevent a family from using therapy to work on issues that may have contributed to the eating disorder.

Dennis cautions that this approach won't work for all families. Girls whose parents have serious problems of their own -- substance abuse or mental illness -- are still best treated individually, she says.

Dinner Wins a Trip to the Mall

When Megan's family walked through the doors of Children's Hospital, Megan was a high-school senior who had lost 50 pounds in six months. Siegel first reassured the girl's parents that they were not to blame for her illness. "This approach neutralizes the parents' sense of guilt and engages them," she says.

Then Siegel placed Claire and Bob in charge of preparing meals planned by a dietitian. They never forced Megan to eat. "That was Megan's one responsibility," Siegel says. Instead, Siegel trained the Donovans in how to use behavioral incentives to subtly encourage Megan to eat. For instance, when Megan refused food, her parents required her to rest quietly to conserve her energy. When she ate, they gave her both small and large rewards. Eating a healthy dinner could earn her a trip to the mall with her friends. And when the scale showed Megan weighed 100 pounds -- a difficult mark for her to achieve -- they took her to Chicago to shop for a prom dress.

The first several months of treatment were not easy. Megan, who said she looked and felt great at 85 pounds, was often hostile and deceptive. She would hide food in a napkin to avoid eating, or put coins in her panties before she was weighed. Siegel coached the Donovans on how to hang tough. "The therapist needs to convey to the parents that he or she will see them through this and keep them in control of their daughter," Siegel says.

Parents Learn to Let Go

Once Megan had achieved her target weight of 115 pounds, the focus of therapy shifted gears. Siegel began to concentrate on family issues that would keep Megan healthy. For years an avid dancer who spent many hours each week practicing, Megan now wanted to enjoy a more relaxed teenage life. Claire, proud of her role as a "dance parent," realized that she had unconsciously pressured Megan to stick with her dancing. "Megan wanted more time with her peer group but had never known how to tell her parents that," Siegel says.