Family Involvement in Mental Health Treatment: Q&A with Allison K. Chase, PhD, CEDS

The ERC/Pathlight family of programs acknowledge the importance of family involvement in treatment for eating, mood and anxiety disorders. Below, Dr. Chase outlines the role of families in fostering sustainable recovery.
 
Q: Can you explain the role of family involvement in recovery for individuals with behavioral health concerns?
 
A: Families touched by eating disorders and mood and anxiety disorders are in crisis. Family members need the support and guidance of a knowledgeable treatment team in this uncertain, stressful period of life. At the same time, their loved ones who are struggling with the disorder need meaningful participation from their families to help them achieve lasting recovery. Regardless of the patient’s age, engaging loved ones in assessment, education, family therapy and discharge planning is so valuable. 
 
My training and background is in pediatric and adolescent care specifically. In this population, families are closely involved as they are tasked with managing re-feeding (for patients with eating disorders) and supporting recovery skills until their young loved ones are developmentally ready to assume these responsibilities themselves. In children and adolescents, family involvement generally refers to participation of parents/guardians, and involves family therapy, multifamily education and group therapy sessions. 
 
Family support is equally important in adult patients, although involvement can be a bit more complicated. “Family” is more loosely defined for adults — family can mean a spouse, significant other, adult child (if appropriate/clinically indicated), parent(s) or even a trusted friend. Because adults have different kinds of meaningful relationships, the basic criteria for participation in the treatment process is consent/willingness, and a commitment to be involved in their loved one’s recovery. Regardless of the age of the patient, a treatment approach that engages, educates and encourages families is so important to empower them to do whatever is needed to support the patient in the areas they are struggling. 
 
Honestly, this is hard work—involving loved ones in a productive recovery effort entails looking at each person’s own issues, beliefs, questions and dynamics, which requires vulnerability and commitment. However, when family work is done in a supportive, compassionate way, it can rally whole families in the march toward recovery.
 
Q: What are the key aspects of family involvement in treatment?
 
A: Because eating, mood and anxiety disorders can be so powerful, families tend to end up functioning around their loved one’s illness, and as a result they often struggle to conceive of a life without the disorder. When we talk about family involvement in treatment, we’re not just talking about family therapy and mending connections, but also educating families about these complex illnesses and their role in the treatment process, as well as engaging them in both the assessment and discharge planning phases of treatment.
 
Education
Some families come into treatment knowing very little about these behavioral health disorders, while others know a great deal (much of which can be inaccurate or counterproductive information). At a fundamental level, families want to know what has happened to their loved one, what to expect moving forward and how they can help. They also want to know “why” their loved one is struggling with these issues, be it eating disorders, depressed mood, crippling anxiety, co-occurring substance abuse or other conditions. 
 
As clinicians, we should carefully avoid the notion of blame—after all, this collaborative stance is a foundation of family-based work. It is essential for the treatment team to reiterate that there is no single cause of these disorders and to educate families about the complex interplay of factors that contribute to the development of these mental health concerns — biological, genetic, personality/temperament, developmental functioning, environmental pressures (family, school, peer and sociocultural pressures). When combined with a developmental transition, life event or traumatic experience, these factors can trigger troubling symptoms and behaviors. 
 
In addition to providing accurate eating disorder information and teaching skills to help families support recovery, clinicians should explain the treatment process and honestly address potential pitfalls they may encounter as recovery progresses. This education helps families remain hopeful and have realistic expectations about the road ahead. 
 
While in treatment, potential pitfalls include:

• Patient is not successfully completing meals and weight has dropped; or weight gain has halted (for patients with eating disorders)
• Parents/families are ready to “throw in towel”
• Parental and/or family conflict has significantly increased
• Patients and/or parents are “done with this monitoring stuff” and/or “done with family therapy” 

Following discharge, potential pitfalls include:

• Patient’s weight drops, eating disordered behaviors begin to resurface or body image disturbances continue (for patients with eating disorders)
• Parents struggle with normative adolescent behaviors in their child
• Family dynamic issues are surfacing, and parents/families are resistant to addressing them

 
The most likely pitfalls generally depend on the age of the patient and the family’s unique recovery challenges but outlining common barriers to recovery can minimize the sense of crisis and hopelessness when obstacles emerge. Remind loved ones that recovery is hard—for the patient and family alike—and that it is normal for participants to feel frustrated, discouraged or exhausted. When facing challenges, the role of the treatment team is to empower the entire family to be proud of their progress and successes, to problem-solve with them and to encourage them as they continue to implement recovery skills.
 
Thorough Assessment
In addition to reviewing information from referring providers, gathering physical data (height, weight, BMI, etc.) and assessing medical stability and dietary needs, families bring valuable Pathlight in the preliminary assessment. Invite parents and loved ones to share their interpretation of their loved one’s behaviors, developmental issues, family history (including psychiatric), the marital relationship and life stressors. Perhaps most importantly, a family interview helps to establish a therapeutic alliance. Talking to parents and participating loved ones honestly about recovery and setting expectations for the therapeutic relationship—while being realistic and encouraging—helps to foster trust and buy-in. In conjunction with an interview of the patient (their interpretation of their behaviors and their thoughts about treatment), the family’s unique recovery needs become more clear and this information informs the development of an individualized treatment plan.
 
Discharge Planning
We know that preparation and planning with known variables goes a long way in supporting lasting recovery. In addition to collaboration with community and referring providers, involving families in the transition out of treatment can benefit all parties involved. After all, these supportive networks play an ongoing role in sustaining recovery in addition to the patient’s continued outpatient therapy. Early on, initiate a discussion of how the patient and family are working towards health and how to support success after leaving treatment. These conversations ensure that patients and families are working toward a common goal and know what to expect in terms of decreasing frequency of sessions, developing a relapse prevention strategy and other treatment referrals should new issues arise that need addressing.
 
Q: How are families involved in treatment at ERC and Pathlight?
 
A: In general, families are involved in family therapy sessions and multi-family education groups. These groups bring multiple patients and families together in a supportive therapeutic environment for education, sharing of experiences and fostering support and connection. Additionally, parent groups explore meaningful topics related to recovery, supported family meals provide opportunities to apply skills in a “real world” context and assessment and discharge planning phases of treatment also engage families for Pathlight as appropriate. 
 
At ERC/Pathlight, our multidisciplinary treatment team is committed to the idea that eating, mood and anxiety disorders can truly be treated. We take every opportunity to encourage families to have hope and prepare them for the challenging yet rewarding work of healing and restoring health in their loved ones and in their families. 
 
Allison Chase, PhD, CEDS, has been working in the field of eating disorder treatment for over 20 years and is currently a Regional Managing Clinical Director of Eating Recovery Center and Pathlight Behavioral Health Center locations in Texas. Dr. Chase’s areas of clinical specialization include child and adolescent mental health issues, the treatment of eating disorders, parental training and education, and family- or team-based therapy.
 
In addition to serving her patients, Dr. Chase enjoys helping others on a mass scale through presentations and media interviews. Dr. Chase has taught undergraduate psychology courses at The University of Texas at Austin since 2001 and has a faculty appointment as an Assistant Clinical Professor, where she trains and supervises graduate students.

Dr. Chase earned her bachelor’s degree in psychology at the University of California at San Diego. She earned her Ph.D. in clinical psychology at The University of Texas at Austin and completed residency training in Chicago at Rush University Medical Center, in both the departments of psychology and pediatrics. Dr. Chase completed a post-doctoral fellowship at Austin Child Guidance Center as well.