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Interventions & Eating Disorders: Part 2, Taking Action

By Monica Bracht, MA, LADAC
Reprinted from Eating Disorders Today
Winter 2008 Volume 6, Number 1
©2008 Gürze Books

Part one of this article focused on understanding the principles and successful application of the intervention process to eating disorders. It pointed out the two most important goals: 1) to get the individual suffering from an eating disorder into the appropriate level of treatment. 2) To help move the family out of crisis. This article will address the advantages of using a professional when planning an intervention. It will show how the process, as applied to eating disorders, actually works. It will also answer some frequently asked questions.

Taking Action
The most important thing a family or concerned person can do when facing a possible eating disorder is to objectively assess changes in behavior or eating patterns. If you suspect there is a problem it is important to act quickly, but not without a plan. All interventions begin with an expression of concern or a request for change. Very few people who attempt to intervene, however, have a complete action plan that addresses all possible outcomes. Remember, recovery from an eating disorder is a long, involved process. It is not a one-time event.

Why work with a professional?
The job of the interventionist is to work with family and friends to make sure everyone is on the same page about the intended outcome prior to confronting the eating disordered individual. It is also the professional’s job to help determine, with those involved, the right approach in each situation. Working with a professional, as opposed to going at it alone, provides the family with an independent advocate and a well-conceived, long-term action plan. Many good intentions to intervene have gone awry as soon as a family sits down together to confront the situation. The “family meeting” gets diverted due to the eating disordered individual’s ability to change the subject or diminish the urgency of the situation as a whole.

A professional will objectively guide the intervention process. By keeping antagonism in check and managing the lines of communication, the desired outcome is more likely achieved. The professional should direct, intervene, support, and challenge underlying motives, agendas, or manipulations. He or she must also be able to handle any unforeseen emergencies or contingencies.

How do you find an interventionist and what are the qualifications?
Currently there is no professional licensing for interventionists. Typically interventionists are mental health professionals (i.e. therapists, psychologists, alcohol and drug counselors, clergy or recovering individuals with proven experience doing interventions). Eating disorders are complex illnesses; therefore it is important that the professional you choose has specific experience working with eating disorder sufferers and their families.

Treatment facilities may work with interventionists so getting names from a reputable eating disorder treatment facility is one good way to start. Searching the Internet, asking friends, colleagues, therapists, clergy, or your doctor are other options. Once you have a name, check references. Make sure you feel comfortable with the person, the process, and the length of time that the professional will work with your family. You can also contact Addiction Intervention Resources (AIR) for more information, with questions, or to help with resources.

How does the process work?
Let’s look at a case study: a family that sought help for their daughter, Sara, a young professional struggling with anorexia nervosa. While desperately worried about their daughter, there were tensions within the family about how to best confront the situation. The family had witnessed Sara actively engage in anorexic behaviors for years, but when they had tried to discuss the problem, Sara either denied her behaviors or minimized and cut off discussion by saying she had everything under control. Given the evidence of Sara’s anorexia, her father and brother wanted to address it without question and make certain the demand for treatment. Her mother and sister sought to allow Sara to take some ownership by acknowledging her problem and having some say about treatment.

For this family, the intervention or “family meeting” took place without Sara’s advanced knowledge. (In some cases, the correct approach is to invite the person to the meeting.) Prepared letters were read to her by each concerned family member addressing their perspective of the situation, what they had actually witnessed in terms of her behaviors, and the negative impact on Sara. They next shared their own concerns, the impact of her illness, as well as the reality of what would happen to the relationship between themselves and Sara if she did not choose to get help.

What happens after an intervention?
Family members are often concerned about the consequences of an intervention. They don’t want to cut a family member off completely or act drastically, although in some cases families have been through so many trials and so much pain that they are willing to make the consequences fairly steep. When deciding on consequences, the motto should always be “no idle threats.” Follow-through can determine the level of success.

It is also important to note that subtle emotional consequences can often be the most powerful: a mother telling her daughter that she cannot continue to speak with her on the phone without confronting the illness and asking if she is ready to get help, a father who states he could no longer handle the pain of watching his daughter waste away. These statements can have a more profound effect than taking away the car or no longer paying the rent.

Most people struggling with an eating disorder know on some level that there is a problem. The point of the intervention is to allow the person to feel the impact of the illness on self as well as on everyone concerned. The goal is neither to educate the individual about the illness nor to convince him or her intellectually about the need for change. Rather, it is to break the conspiracy of silence, to point out the pain that everyone has been experiencing, and to help establish a new set of operating conditions for the whole family.

In the case of Sara, help was offered in a way that respected her intelligence and her autonomy. As a result of this process, Sara was able to accept the help that she desperately needed.

Is an intervention an overreaction?
Remember that early intervention and treatment is the key to successful recovery. Addressing an eating problem early on is far better than waiting until the situation is dire. An experienced professional can assess the level of severity and appropriate level of care. In the case where an eating disorder is not present, the professional can arrange for additional medical, psychiatric, or other evaluations to determine the underlying problem or cause of symptoms.

What if the person refuses help?
This is where the ability to followthrough with consequences is especially important. Sometimes the identified individual will test the resolve of friends and family by refusing help at the time of the intervention. The following weeks are another opportunity for the individual to change his or her mind, especially if he or she knows that the family isn’t bluffing; that those involved are unified in their decision and have made their expectations clear; and that they have begun to set healthy boundaries for themselves.

Remember, a successful intervention should not be defined solely by whether the individual goes to treatment, but also by whether family and friends are in a better place as a result.

Monica M. Bracht, MA, LADAC, is a licensed alcohol and drug counselor currently working on her MSW degree. She is the director of Eating Disorder Services for AIR, a national consulting, intervention and recovery management company based in St. Paul, MN. For more information on eating disorders and interventions, visit www. intervene.com or contact Monica directly at monica@Intervene.com.

Additional Resources:
Far-Reaching Effects of Sexual Abuse
Fat is NOT JUST a Feminist Issue Anymore
Father Hunger
Fathers: A Potential Antidote to the "If Only I Were Skinny" Fantasy
Finding the Needle in the Haystack of Eating Disorders Care-Providers