By: Adele Lafrance, PhD, Clinical Psychologist, CEDS/S, Co-developer of Emotion-Focused Family Therapy & Elizabeth Easton, PsyD, CEDS, Clinical Psychologist, Advanced EFFT Therapist and Supervisor
It’s dinner time. And not just any dinner – one in accordance with your child’s meal-plan which tonight also includes pasta – the dreaded ‘feared food’. Your child sits and stares at their plate for far too long, then starts pushing the noodles around, making comments about being full. You calmly remind them that they need to complete the meal. You reassure them that you believe in them, that you know they can do hard things, and that it’s all for their health. Your child isn’t swayed. As the tension rises and your child stutters into complete inaction, you do not have the energy for another fight. You remind them of the consequences: “You won’t be seeing your friends tonight or any other night this week if you don’t start eating. I’m serious. We’re not getting into this vicious cycle again.” You think to yourself: “that’s it – nice and firm…but wait… was that too firm?”, as you then get lost in your own thought-spiral, bracing yourself for what might come next.
Sound familiar? We clinicians have struggled too with trying out different meal-support strategies over the years – from no-pressure-dinner-talk to more coercive techniques in the name of health and healing. In fact, Emotion-Focused Family Therapy (EFFT), and in particular the module on Emotion Coaching, was developed over a decade ago in response to this very dilemma. Turns out that when it comes to meal support, practical suggestions, including setting limits, are equally important as validation and emotional support – but it’s the order of operations that seems to be the most critical (more on that later). Now, therapists, nurses and clinicians worldwide employ these strategies in eating disorder programs across levels of care and teach and empower parents and caregivers to do the same.
Emotion Coaching for Meal Support and Symptom Interruption
The first step in emotion coaching for meal support and symptom interruption is validation, and in this context, that means putting into words two or three reasons why your child is in fear-based resistance, like this:
I can understand you wouldn’t want to eat the pasta (1) because you’ve avoided carbs for a really long time now, and (2) because it probably feels like too much food and (3) because you might be worried about the intensity of the eating disorder thoughts later.
Notice any resistance of your own in approaching the situation in this manner? If so, it’s because doing so really goes against the cultural grain. We have been taught – and for generations – to respond to resistance with reassurance, prodding, pleading, even threats and consequences. Unfortunately, the most recent advances in neuroscience suggest that these old methods don’t work so well – especially when we lead with them.
Thanks to advances in brain research, what we now know is that when the external environment (parents or other caring adults) reflects a child’s inner thoughts and feelings with sincerity (like those because-statements above), it activates a chain of brain-based events that decreases the intensity of their emotional experience, including resistance – even if you don’t agree with their experience, and even if the bottom line is going to stay the same – finishing the meal. In other words, the verbal (because-statements) and nonverbal (stance of sincerity) signals that come with validating your child’s experience activates a release of brain-calming chemicals, including oxytocin, which travel to the limbic system, otherwise known as the emotional center of the brain, putting water on the fire. Once calmer, they will be more flexible, and more open to what you have to say next. Emphasis on the word more.
Which then leads to the next step in the two-step model – emotional and practical support. If you can relate to the example above, the truth is, the meal needs to be completed. And now that the brain is a bit more flexible, and more open to input, you can now offer your child some emotional support (e.g., encouragement) and practical support (e.g., a concrete suggestion to help your loved one get through the meal more easily) to keep nudging them along in the direction of the finish-line, like this:
Step 1 – Validation (to increase flexibility / openness):
I can understand you wouldn’t want to eat the pasta (1) because you’ve avoided carbs for a really long time now, and (2) because it probably feels like too much food and (3) because you might be worried about the intensity of the eating disorder thoughts later.
Step 2 – Support (to increase movement in the desired direction):
“I feel for you, sweetheart. I really do. And I believe in you. This won’t last forever, and I won’t leave you alone in this, not now, and not later. I know we can get through it together [emotional support]. Why don’t we listen to your favorite playlist and I’ll get a hot pack ready? And I’ll set up a movie to give you a break from those thoughts [practical support]”
When parents and caregivers lead with validating “because-statements”, followed by emotional support sentences, their efforts to support their child more practically will be met with less resistance, regardless of their age. That said, if you find yourself eager to try the approach but unable to find the words in the moment, we assure you this is completely normal. Being responsible for your child’s renourishment and symptom stabilization – even in part – can be emotionally excruciating at times. When the stakes are high – as they often are in these situations – emotions can run high as well. It’s not uncommon to freeze, or find yourself backing off as things intensify, or even roped into a fight. For this reason, we encourage you to 1. develop a few scripts ahead of time that can be useful across the most stressful of scenarios, 2. practice them with your partner, a friend or your therapist, and 3. try them out with your child, and seek feedback from your team in order to sharpen your skills. By doing so, you will soon develop what’s referred to as fluency, meaning that – even when you are stressed, you’ll be able to find the words, and with sincerity, which will help you to come back online and take charge of the situation in a way that feels aligned with your best intentions. We are the first to admit that it is not a perfect strategy or solution, but a valuable tool to include in any parent or caregiver’s toolkit, especially as you move from skill to stance.
Note: For more information on this technique and its application in the context of eating disorders, click here. You might also be interested in this book, which explains the science in support of the approach, in addition to providing several scripts of the framework in action across a range of scenarios.