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Doctor Kevin
Doctor Kevin, Ph.D.
Category: Mental Health
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Experience:  25 years in private practice
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What is the advantages and disadvantages in the proposal to

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What is the advantages and disadvantages in the proposal to make family therapy compulsory in the treatment of those with an eating disorder.

Dr.Kappler :

Thank you for choosing this website. My approach is mental health not mental illness. You present an interesting question in suggesting that family therapy be compulsory in the treatment of those with an eating disorder. You would like specifically to know the advantages and disadvantages of such a proposal

Dr.Kappler :

As you may know and eating disorder is considered one of the last defenses of an individual when they are faced with what they perceive to be a hostile support system. They typically describe their ability to control their intake of food as a last resort in their capacity to maintain control over anything in their lives. As a result there's an incredible amount of animosity which is usually generated towards individual with the eating disorder and their family or support system. Passive aggressiveness anger drug abuse suicidal ideation and negative personal interactions all form the arsenal of behaviors that person with an eating disorder has in being able to express their frustration at being dominated by their support system.

Dr.Kappler :

Usually the support system is characterized by significant psychological naïveté. Typically they will say that they have done everything they can and the person still continues to withdraw and refuse food. food becomes a weapon in the interaction between the person with the eating disorder and their support system. Many times the support system is simply the nor the eating disorder until it becomes obvious to other people or authorities. Simple statements like "we provide all the food she wants." other statements like "piece of touchy about his body image and constantly thinks he's fat even though we tell him over and over again that that's not the case."

Dr.Kappler :

Most people with an eating disorder usually and treatments by two major routes. They are forced into compulsory treatment because they have reached a life-threatening level of self starvation. This includes other behaviors that are self-destructive like cutting and suicidal ideation. The second route is when the individual finally faces the fact that they're terribly depressed extremely angry and are taking it out on themselves. These individuals are relatively rare in comparison.

Dr.Kappler :

The first problem with any treatment is that involves cooperation from someone who is not cooperative. This sets off a whole series of minor psychological squabbles involving hiding food regurgitating and using food as a power issue. The disadvantages are clear. Compulsory treatment usually does not work and tends to reinforce and hardened defenses. Compulsory treatment also locks the person into a power struggle which results in an incredible amount of resistance. Hospitals have often had to resort to force feeding in order to break the will a person with eating disorder. Therapy involving the family or support system will work only when the person with the eating disorder is engaged in treatment.

Dr.Kappler :

The advantages of compulsory treatment are that they force that person to face their support system. In turn the support system is forced be educated something that is ignored and denied for so long. With a skilled therapist him out of passive aggressive anger, rage and unresolved power issues quickly come to the surface. The disadvantage is that it may destroy the support system altogether. The advantage is that it puts the need for change clearly back in the role of the person with the eating disorder and makes their support system responsible.

Dr.Kappler :

I see that your currently off-line and I hope I have provided sufficient information for you. If you would like any more explanation of any aspect of what I had said please let me know before you rate me.


This has opened my line of thought and helped me look at the bigger picture. Thank you.

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Helen Jones I hope my answer helped. In the future if you want me to answer a question put for "Doctor Kevin" on it and I will get it

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