Sunday, March 20, 2016

Family Values

My original reaction to the EDIC programme was negative. There appeared to be sessions about families but I wondered whether these would be in any way positive.

OK, Janet Treasure and a parent carer were giving a keynote but would this would be a tickbox gesture, a description of how you could herd the frightened parents into a pen like the rhinos and ostriches that they are and thus avoid the awkward business of having to deal with their unhelpful suggestions and complaints?

Much more worrying was the emphasis on "Attachment". Having seen that an author who has deliberately challenged modern thinking on the role of the family and hurled it right back into the dark ages, was presenting on attachment, I feared that the keynote on the subject would also be strong on  blame. It wasn't. In an engaging and amusing speech Dr Fonagy outlined the importance of attachment and argued that youngsters with poor "theory of mind" may use ED symptoms as a way of social regulation and that "Mentalisation" MIGHT be helpful with this but he deliberately avoided blame and made no boastful claims for his ideas over anyone else's.

Treasure and Langley's keynote couldn't have been used as an excuse to sideline parents away from the "main action" by any but the most dyed in the wool blamers. I heard that it was completely enlightening to some health economists who hadn't previously factored in the costs and benefits of family involvement. It concentrated on the isolation brought by the illness, especially as it became entrenched in longer term sufferers, and the need of families for practical skills. Langley brought up this point again in a question to Ivan Eisler on the third day. His talk on this history and development of family based treatments was part of a trio including news from France and Germany. His assertion that telling the parents "you know how to feed your child" and then leaving the parents to do it all alone isn't FBT was quite accurate, but it IS how all too many families in the UK experience it. By contrast parents in Germany are undoubtedly under-utilised, if not disempowered, by their system of automatic admission or day patient, but it is an immediately safer way of dealing with these life-threatening illnesses than some of the things that go on in the UK.  

I did hear criticism of parents, from patients that their illness was their business, from a counsellor that parents refused to acknowledge their children's illnesses, from a clinican that "parents get these ideas off the internet". These dangerous ideas turned out to be the NICE guidelines which in my mind couldn't be woollier if they were knitted from yarn, but the clinician had felt threatened when they had been used against him. However I didn't hear any of them during the attachment workshop. I expected to hate it and, as I put on my feedback form, my expectations were fully met, but it was billed as  teaching how to engage families in treatment, not "how to blame your mothers" and most (but not all) of those there seemed to be willing to swallow the theory in order to get to the practice. There was at least one other mother there, and apparently she loved it. I reluctantly have to conclude that perhaps parents are so desperate they will accept anything. I know I was when we went through our family therapy days. What can we do about that?

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