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NZ Eating Disorder Specialists has opened its private clinic in Auckland to help people and their families overcome eating disorders such as anorexia and bulimia. The clinic has 30 years of expertise and is the only clinic in New Zealand using the family therapy approach of Intensive Structural Therapy.
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“We can’t solve problems by using the same kind of thinking we used when we created them.”
Albert Einstein
“Two things are infinite: the universe and human stupidity; and I’m not sure about the universe.”
Albert Einstein
A Pew survey revealed that Osama bin Laden’s popularity rating was more than 40 points higher than George Bush’s in Jordan, Morocco and Pakistan (Walt, 2005).
Family Therapy is a keen and powerful treatment for micro-systems and valuable for treating families in various configurations. When one considers the international drama played out between nations and social movements, we, as therapists, are certainly not at the table. Nevertheless, some of the classic thinking of Family Therapy tenets of Gregory Bateson, one of the fathers of cybernetics and information theory, becomes increasingly relevant; the ideas may indeed have significance, providing a more effective way of addressing increasingly dire international situation.
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Adolescence is a strange wondrous stage, both for the young person as well as the family. No-one can deny that, just as a tadpole becomes a frog, there are biological changes in children in terms of physical and, somewhat slower, emotional maturity. The family, along with the peers and other social force help shape the emerging adult. Certain tips for parents can facilitate and make this voyage easier, in my experience.
Note: These are just tips – they should not replace going to a competent professional.
I believe that one of the most useful assessment tools available to the family therapist is the concept of the homeostatic maintainer, the individuals or social forces that are maintaining a given problem and must therefore be included in the treatment.
The term homeostatic maintainer derives from the word homeostasis or same state. As used in biology or physiology, homeostatis refers to a process of maintaining sameness by restoring a system to a state from which it periodically departs. A classic example of a homeostatic mechanism is the thermotactic system in the human body. This system acts like a regulator to maintain body heat at a constant temperature to maximize efficiency both in cell reproduction and in interaction with the environment. As we know, however, there are times of crisis, such as infection or injury, when the critical function of the thermotactic system is to raise body temperature. During these periods, increased temperatures act to enhance the production of white blood cells and to destroy infecting agents. While the overall goal of the higher temperature is to improve bodily protection, if this excess heat is maintained for too long a period – if it becomes a new status quo – there can be deleterious side-effects. The homeostatic system, then, can prove either a positive or a negative force.
With a family crisis, there can be forces at work that act to maintain the status quo in a way that is detrimental to the system, by keeping the system from changing in the face of developmental pressures. It is this negative characteristic of homeostasis that makes it an important concept for family therapy. Like the body, the family system can include forces that keep it in a steady state that proves harmful because it prevents the family from adapting to developmental changes. The system either cannot allow a necessary increase in social “temperature” to deal with crisis, or it persists in crisis and cannot return to “normal” – to an everyday productive functioning.
A few years ago, the newspapers reported a story of a nineteen-year old man who had committed an armed robbery in a rural community. When his court-appointed attorney went to see him, the man pulled a knife and held the young woman prisoner for three days. Finally the man was apprehended and had his day in court. When, just before sentencing, the judge asked, “Is there anything you would like to say in your own behalf?” the man remained silent but gestured to his mother. The middle-aged mother then stood, pointed to the judge, and said, “How dare you treat my son like this! It’s not fair. He’s done nothing wrong.”
With just this brief story to go on, one can only guess about the true nature of the forces in the young man’s life that had buffered him from facing the consequences of his actions. But it is clear that even at this eleventh hour, in the face of overwhelming evidence of culpability , the mother refused to hold her son responsible and instead acted to maintain the status quo. This was a family system held fast in negative homeostatis, where productive change had not been allowed and where terrible dysfunction had come to be accepted as the norm.
The family therapist uses the concept of the homeostatic maintainer by attempting to render ineffective the family’s stereotyped, stable ways of responding. The first step for the therapist is to discover what is maintaining the problem – that is, the person or persons, who are encouraging the homeostasis – then distinguish a therapeutic unit that includes the homeostatic maintainer. The therapist must obviously demarcate the extent of the forces to be worked with – mother, father, grandparents, neighbours, teachers. As Francisco Varela (1976) points out, family systems can be like Chinese boxes: individuals are part of a family, which is part of an extended family, which is part of a community, and so forth. The job of the therapist is to identify and focus on the “box” that may hold the homeostatic maintainer and then treat this unit as the family system. The second step in the treatment process is for the therapist to disrupt the system and observe who attempts to return the system to its status quo. That person or social force is the homeostatic maintainer.
A very clear example of a family member functioning as a homeostatic maintainer is the father described in the chapter on delinquency in the book Treating Troubled Adolescents. Early in the session, when his wife was confronting their delinquent youngster (who had been caught the night before with some of her jewellery and an empty vial of cocaine), the father, by his passivity and solicitous concern for his son , continually undermined his wife’s efforts to have the boy respond to parental authority. He sat passively and stared at his son while his wife confronted the adolescent. By not joining with his wife in the confrontation, the father was implying approval and thus maintaining the dysfunctional pattern of the boy’s illegal behaviour.
Intensive Structural family therapy is an affective tool for transforming systemic issues of eating disorders suffers. A major question for all successful treatment is how long will the positive changes be maintained. Will there be regression?
An analysis of cases followed after, in some cases, 20 years after treatment, found the following characteristic at the end of therapy to increase the probability that the changes will be stable:
Based on the data of my qualitative follow-up survey, I am advocating a different position of the therapist from what is customary. Treatment characteristically ends when the problem is resolved and the client and family are satisfied. In this alternative perspective the therapist sees his or her jurisdiction as continuing until the family changes are supported by the broader social system.
While this is a new position for clinicians it is by no means not logical. The broader the support for a system be it social movement or ship that is built so that every system has an identical duplicate in case of failure only increases the odds of stability. So it is with family systems that are often buffed by development and social changes that the broader their supports, the more stable they will remain in the face of these pressures.
I believe that this is an important perspective. There is considerable follow-up literature that supports the effectiveness of family therapy, especially with adolescent anorectics. This finding specially pin points what the clinician should do to increase the odds of long term success. And what families and sufferers should expect from their treatment!
