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Empowering Families

‘Skills for Carers Workshops’

Susan Ringwood

Chief Executive

Beat

Alpbach, October 2012

Overview of presentation

Beat

The New Maudsley Method

Parenting styles- the animal metaphors

Communication Skills

How Carers can cope

Carer & Sufferer comments

Discussion

Empowering Families


Beat

We believe that eating disorders will be beaten

Our aims are:

• to change the way everyone thinks and talks about

eating disorders

• to improve the ways services and treatment is provide

• to help anyone believe they can beat their eating

disorder


• Help-lines, email and text

• Website, forums and live chat

• Support groups

• Literature and publications

• Share perspectives with professionals

• Media work and campaigning

What we do


The Beat Team


Norwich- our fine city


...Ancient and modern


Empowering Families


Skills Workshops

Supporting Carers of Loved Ones with Eating Disorders

Beat in collaboration with the Maudsley Hospital

and King’s College, London

Material drawn directly from:

‘Skills-based Learning for Caring for a Loved One with an Eating Disorder.

The New Maudsley Method’(2007), Treasure, Smith and Crane

Thanks to Janet Treasure, Gill Todd and the Team.

Session outlines 1 understanding eating disorders

2 Maintaining factors, personality & animals

3 Stages of change & communication skills

4 Motivational interviewing

5 Challenging Behaviours

6 Problem eating

7 Supporting yourself

8 Review and planning ahead


Understanding Eating

Disorders


Exact cause of Eating Disorders unknown – but many

different risk factors...

NO evidence family are the cause of Eating Disorders

Why Skills Training?

The Collaborative Care Ethos


• Caring for a loved one with an eating disorder

• Impact on family and friends

• Family involvement in treatment

•Family members lack information and skills for

this role

•Collaborative Care ethos sees carers as a

Valuable Resource

Collaborative Care Ethos

•Curious

•Caring

•Consistent

•Compassionate

•Coaching

•Calm

• Perfectionism

‘black and white thinking’

- Missing the ‘Oh Sod It!’ Gene

• Rigidity - Difficulty in changing thinking. Rules learnt are difficult to shift.

• Detail vs Global bias ‘Not seeing the wood for the trees’

Shared Personality traits of Eating

disordered individuals and Carers

Nothing All polarised thinking

Flexible Focused

Global Detailed


Maintaining Factors


Interpersonal Biological

Social Environmental

Animal Analogies

Just enough

direction & support Too much sympathy

& micromanagement

Too much criticism

& hostility

Style of Involvement

Emotional Response

Too little emotion

‘Head in the sand’

Too much emotion

Can’t cope: ‘Sad & Mad’

Just enough calmness,

compassion & consistency

Expressed Emotion: Overprotection

Anxious about Edi

Fear of death

Fear of saying the

wrong thing

Worsen Problems No opportunity to master challenges

Gives message world is a threat

Stifles and frustrates. Suffocating

Emotionally draining for both

Worsen how they feel

Unhelpful behaviours Become “overly”

supportive

Don’t allow any space/

personal responsibility

The Vicious Cycle of Kangaroo Care


Expressed Emotion: Over-directedness

Anxious about her/

fear of her death

Want to take control/

sort things out

Make her see reason

Worsen Problems Edi feels rejected/unloved - no trust

Anger/upset: I won’t give in!

Emotionally draining for all

Worsen how they feel Unhelpful behaviours

Shout/try to control

“Ban” from going out

Argue and try to “win”

The Vicious Cycle of Rhinoceros Care


The Balance of Direction

Too much sympathy &

micro-management

Too much control

& direction Just enough

Subtle direction


Think about your loved one-

What are their personality traits?

Have any of them appeared or increased

since they’ve developed an eating

disorder?


So what are the perceived

benefits of an eating disorder

for someone with these

personality traits?


The Stages of Change Model

Pre-

contemplation

Contemplation

Preparation Action

Maintenance

Relapse

Exit through

Maintenance

to

Recovery


Motivational Interviewing

Aesop – The Battle of Wind and Sun



Discover tools to:

• Express yourself in a way your loved

one can understand

• Understand what your loved one is

trying to communicate

• Improve your relationships




Listen –skills build trust & mutual respect

Empathise – understand what is really going on

Share – non-eating disorder activities

Support – create a safe and calm atmosphere

is More

Reflective Listening

“It sounds to me like…”

“So you’re saying…”

“From your point of view…”

“Let me check I’ve understood.

“…you’re feeling…”


Roadblocks to Listening

Dis/approving

Arguing

Reassuring

Judging

Feeling upset

Dis/agreeing

Being distracted

Suggesting

Too much

Empathising

Rehearsing


Antecedents for Challenging

Behaviours Intense negative thoughts about self and world

The Hidden emotions

Low self-worth

Teenage hormones

Starved (/unbalanced) brain

High Expressed Emotion environment

Carer refuses to Accommodate/Enable

Fear about change/leaving ‘safety’ of Eating

Disorder behaviour.

A Antecedent

B

Behaviour C

Consequence

Addressing Challenging Behaviour

with ABC

What was their

behaviour?

What was your response?

Understanding the

underlying causes for

their behaviour, & the

vicious cycles that

maintain them, how

could your response be

different in the future?

What were the

emotions and

illness-based

reasons underlying

the behaviour?

Carer Coping

‘Good Enough Caring’

Mistakes are a treasure!

Oxygen mask


‘What did you find most useful

about the workshops?’

‘Just telling us over and over again that

we need some breaks and time for

ourselves, as we always feel guilty if

we do take some time off...’

‘I have learned to give myself my life

back’


Carer Comments

“I think it is absolutely essential for carers of loved ones with eating

disorders, the sooner the better”

“...it made me hopeful that I could do something useful”

“Our relationship has improved massively”

“I know that we’re just at the beginning of a really difficult road of

recovery but for the first time feel like it’s going to be OK”

“I strongly recommend to any family facing a similar problem, please

do attend the workshops if you can, both parents if possible”

“I really can’t recommend the workshops highly enough, I almost feel

like a different person now”


Sufferers Comments If she hadn’t had the teaching and support and stuff like that then I

might not have got better as well or as quickly as I have”

“I feel it really helped and the main thing that helped was her staying

calm…it really, really helped...when she stays calm, I sort of stayed

calm myself and just got over it”

“She recognises that I have AN, it’s not just my personality…and it’s

the AN she hates... I like that she sees it as separate in one way

because it makes me know that she doesn’t hate me”

“I think mainly the confidence thing…before they felt panicked; they

didn’t know what to do...”


Further Information:

‘Skills-based Learning

for Caring For a

Loved One with an

Eating Disorder.

The New Maudsley

Method’

Janet Treasure, Grainne Smith,

Anna Crane

2007, Routledge



Thank you

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Empowering Families - Netzwerk Essstö · PDF fileEmpowering Families ... 4 Motivational interviewing ... Share – non-eating disorder activities Support – create a safe and calm