Increasing parental self-efficacy with emotion-focused family therapy for eating disorders: a process model

ABSTRACT

A process model was tested whereby parental fear and self-blame were targeted in order to enhance parental self-efficacy and supportive efforts in the context of emotion-focused family therapy (EFFT) for eating disorders (ED). A 2-day EFFT group intervention was delivered to parents of adolescent and adult children with ED. Data were collected from eight treatment sites (N = 124). Data were analyzed using t-tests, regression analyses and structural equation modeling. The findings supported the proposed process model. Through the processing of parents’ maladaptive fear and self-blame, parents felt more empowered to support their child’s recovery. This increase in self-efficacy led to an increase in parents’ intentions to engage in recovery-focused behaviors. This study is the first to test a method for clinicians to increase supportive efforts by targeting and enhancing caregiver self-efficacy via the processing of emotion.

Elterliche Selbstwirksamkeit mit Emotionsfokussierter Familien-Therapie bei Essstörungen. Ein Prozessmodell

Ein Prozessmodell im Rahmen von Emotionsfokussierter Familien-Therapie (EFFT) wurde getestet: Elterliche Angst und Selbstvorwürfe wurden bearbeitet, um elterliche Selbstwirksamkeit und unterstützende Bemühungen bei Essstörungen (ES) zu erhöhen. Eltern von adoleszenten und erwachsenen Kindern mit ES bekamen eine zweitägige EFFT Gruppenintervention. Von acht Behandlungsorten wurden Daten erhoben (N=124). Die Daten wurden mit T-Tests, Regressionsanalysen und strukturellen Gleichungsmodellen analysiert. Die Befunde unterstützten das hier skizzierte Prozess-Modell. Durch das Prozessieren ihrer elterlichen maladaptive Angst und ihrer Selbstvorwürfe fühlten sich die Eltern gestärkt, die Rekonvaleszenz ihres Kindes zu unterstützen. Diese Zunahme an Selbstwirksamkeit führte zu einer größeren Bereitschaft der Eltern, Verhalten an den Tag zu legen, das auf die Genesung fokussiert war. Diese Studie ist die erste, die eine Methode für Kliniker testet, wie man unterstützende Bemühungen verstärken kann, indem man die Selbst-Wirksamkeit der Bezugspersonen erhöht, indem man Emotionen prozessiert.

Aumento de la Auto-Eficacia Parental con la Terapia Familiar enfocada en la Emoción para Trastornos de la Alimentación: Un Modelo de Proceso

Se ensayó un modelo de proceso en el que se buscó el miedo de los padres y la culpa de sí mismos para mejorar la autoeficacia de los padres y los esfuerzos de apoyo en el contexto de la terapia familiar enfocada en la emoción (EFFT, por sus siglas en inglés). Se administró una intervención de grupo de dos días de EFFT a padres de niños adolescentes y adultos con ED. Se recogieron datos de ocho centros de tratamiento (N = 124). Los datos se analizaron mediante pruebas t, análisis de regresión y modelización de ecuaciones estructurales. Los hallazgos apoyaron el modelo de proceso propuesto. A través del procesamiento del temor inadaptado de los padres y de su auto-culpa, los padres se sentían más capacitados para apoyar la recuperación de su hijo. Este aumento en la autoeficacia condujo a un aumento en las intenciones de los padres de participar en comportamientos centrados en la recuperación. Este estudio es el primero en probar un método para que los médicos aumenten los esfuerzos de apoyo dirigiendo y mejorando la autoeficacia del cuidador a través del procesamiento de la emoción.

Augmenter l’auto-efficacité parentale par la thérapie centrée sur l’émotion dans les cas de troubles de l’alimentation : un modèle de processus

Dans le modèle de processus qui a été testé, la peur et l’auto-culpabilité des parents ont été ciblées en vue d’améliorer l’auto-efficacité parentale et les efforts de soutien dans le contexte de la thérapie familiale centrée sur les émotions (TFCE) dans des cas de troubles de l’alimentation. Une intervention de groupe TFCE d’une durée de deux jours a été dispensée à des parents d’adolescents et d’enfants adultes ayant un trouble de l’alimentation. Les données issues de huit sources (N=124) ont été collectées. Elles ont été analysées en utilisant le t-test, l’analyse de régression et le modèle d’équations structurales. Les résultats étayent le modèle de processus proposé. A travers la transformation des peurs et de l’auto-culpabilité inadéquates des parents, ceux-ci se sentent davantage en capacité de soutenir le rétablissement de leurs enfants. Cet accroissement de l’auto-efficacité engendre une augmentation des intentions des parents de développer des comportements centrés sur le rétablissement. Cette étude est la première qui teste une méthode destinée aux cliniciens pour intensifier les efforts de soutien en ciblant et en améliorant l’auto-efficacité des aidants via le traitement des émotions.

Auto-eficácia Parental Crescente através da Terapia Familiar Focada na Emoção no tratamento de Doenças do Comportamento Alimentar: um modelo de processo

Foi testado um modelo de processo dirigido ao medo e à culpa parental, de modo a incrementar a autoeficácia parental e os esforços de apoio às perturbações do comportamento alimentar (PCA), no contexto da Terapia Familiar Focada na Emoção (TFFE). Os pais de adolescentes e jovens adultos com PCA foram sujeitos a dois dias de intervenção em grupo de TFFE. Os dados de oito tratamentos foram recolhidos (N=124). Os mesmos dados foram analisados com recurso a testes-t, análises de regressão e modelos de equação estrutural. Os resultados apoiaram o modelo de processo proposto. Ao processarem o seu medo e o seu sentimento culpa disfuncionais, os pais sentiam-se mais aptos a apoiarem a recuperação dos seus filhos. Este incremento de autoeficácia conduziu a um aumento nas intenções dos pais em se envolverem em comportamentos focados na recuperação. Este é o primeiro estudo que testa um método no qual os clínicos aumentam os esforços de apoio ao se dirigirem e melhorarem à autoeficácia do prestador de cuidados, através do processamento das suas emoções.

KEYWORDS:

• Eating disorders
• self-efficacy
• emotion-focused family therapy
• process model

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Services included independent counseling, unspecified outpatient services and psychological treatment for another mental illness.

2. The items that make up the Carer Fear and Blame Scales are derived from the Parents Traps Scale (PTS, Lafrance Robinson et al., 2014).

Additional information

Notes on contributors

Erin J. Strahan

Erin J. Strahan, PhD is a faculty member in the Psychology Department of Wilfrid Laurier University. She is active in body image research with a focus on process models.

Amanda Stillar

Amanda Stillar, MA is a doctoral student in Counselling Psychology at the University of Alberta. She is active in eating disorder research with a focus on emotion-focused family therapy (EFFT) and the role of parental emotions.

Natasha Files

Natasha Files, MSW, RSW is a family therapist in private practice and at the Looking Glass Residence for Eating Disorders (ED) in Vancouver, BC. She is also a sessional instructor in Social Work at the University of the Fraser Valley.

Patricia Nash

Patricia Nash, M.Ed, C.C.C is the Counselor and Program Facilitator at the Eating Disorder Foundation of Newfoundland and Labrador in St. John’s, NL. She is also a Mom with lived experience who is passionate about helping families struggling with EDs.

Jennifer Scarborough

Jennifer Scarborough, MSW, RSW, is a clinician in the ED program at Canadian Mental Health Association in Waterloo, Ontario. She is currently completing her PhD at Wilfrid Laurier University with a focus on pediatric ED and parental emotions.

Laura Connors

Laura Connors, Ph.D., is a registered psychologist employed at the IWK Health Centre in Halifax, Nova Scotia, Canada. She is involved in ongoing research evaluating the use of EFFT for ED and general mental health.

Joanne Gusella

Joanne Gusella, PhD is a clinical psychologist in Private Practice in Halifax, N.S., and an Assistant Professor in the Department of Psychiatry at Dalhousie University. She specializes in treating youth and adults with ED and in researching treatment approaches.

Katherine Henderson

Katherine Henderson, Ph.D., C.Psych is codirector and cofounder of Anchor Psychological Services in Ottawa, Canada, where she specializes in ED and EFFT. She is an adjunct research professor in the Department of Psychology at Carleton University.

Shari Mayman

Shari Mayman, Ph.D., C.Psych is the cofounder and codirector of Anchor Psychological Services, a private practice in Ottawa, ON. She is active in the research and delivery of the EFFT model as well as in the training of other professionals.

Patricia Marchand

Patricia Marchand, MSW, RSW is the team leader and coordinator of the child and adolescent eating disorder clinic at hotel Dieu hospital in Kingston Ontario.

Emily S. Orr

Emily S. Orr, PhD, is a clinical psychologist with the Eating Disorders Clinic at Cape Breton Regional Hospital. She also maintains a private practice in the Sydney, NS area.

Joanne Dolhanty

Joanne Dolhanty, PhD, C.Psych is a Psychologist at the Mount Pleasant Therapy Centre in Toronto, Ontario. She codeveloped EFFT for Eating Disorders and supervises clinicians and teams from organizations across Canada and Europe.

Adèle Lafrance

Adèle Lafrance, PhD, C.Psych is an Associate Professor in the Psychology Department at Laurentian University. She is a Psychologist and codeveloper of EFFT. She supervises clinicians and teams from organizations across Canada and Europe.