Mighty Blog

Collaborative caring in eating disorders

Pam Macdonald and Janet Treasure

Eating disorders have a profound impact on individuals, as well as the people who care for them.

Eating disorder symptoms have immense social and emotional ramifications for families and loved ones. Symptoms vary and can be frightening, intrusive, antisocial, anxiety provoking and frustrating. The behaviors involved in limiting calorie intake, increasing calorie expenditure, or uncontrolled calorie intake, take many forms. The physical consequences are alarming and distressing. All semblance of normality disappears, social life evaporates, future plans are put on hold and interactions around food increasingly dominate family relationships. It can feel akin to living within a maelstrom.

Promoting beliefs that sustain hope and empower families may be an important step in reducing caregivers’ feelings of helplessness and interrupt unhelpful interactions.

Researchers at King’s College London are equipping caregivers with tools aimed at reducing distress and boosting care-giving efficacy to support their loved ones on the road to recovery. Headed by world eating disorder specialist Dr. Janet Treasure, who will be speaking at Children’s Hospitals and Clinics of Minnesota on Monday, Aug. 4, the caregiver skills training is intended as an adjunct to the individual’s treatment program. The skills training program is the result of several empirical research studies and has been designed to provide caregivers with information on treatment goals, prognosis and maintenance factors to which they are entitled, without breaching patient confidentiality.

Utilizing a “dolphin-like” approach of warmth, gentle nudging and negotiation caregivers are taught how to listen to and analyze their emotional responses while reflecting upon what they might need to change in their own situation. Dr. Treasure’s interventions incorporate basic motivational interviewing techniques. The goal is for caregivers and professionals to work in partnership to promote the following:

  • Strengthen the caregivers’ belief in their own abilities to make change possible
  • Give caregivers the opportunity to express concerns about the cause and effects of the illness
  • Discuss the basic principles of behavior change
  • Teach good communication skills (the ability to express and process emotions)
  • Promote respect, satisfaction and a unified approach within the family (and extended family) unit
  • Learn the skills of problem solving
  • Maximize caregiver skills (warmth with limits and boundaries)
  • Highlight those factors which may be aggravating the problem
  • And, above all, encourage caregivers to practice self-care.

Are you a dolphin parent?

The skills training intervention uses a series of lighthearted animal analogies to encourage the caregiver to reflect upon his or her default caring style; for example, a kangaroo does everything to protect, keeps their loved one firmly in the pouch in an effort to avoid any upset or further stress, while the rhinoceros, fueled by stress, exhaustion and frustration, or simply one’s own temperament, attempts to persuade and convince by argument and confrontation. Emotional responses are captured with the help of the ostrich, who avoids talking and thinking about the problem, frequently due to the difficulty in coping with the distress of challenging eating disorder behaviors. The jellyfish becomes engulfed in intense emotional responses. These may include high levels of self-blame or perfectionist tendencies with regards to parenting skills or expectations of what it is to be a “good parent.” As illustrated above, the goal of the intervention is to promote a dolphin-like behavioral approach to caring and a St. Bernard emotional approach, responding consistently – reliable and dependable in all circumstances.

Dolphin parenting presentation

Children’s Center for the Treatment of Eating Disorders is sponsoring a short presentation by Dr. Treasure from 5:30-6:30 p.m. Monday, Aug. 4, at the John Nasseff Conference Center, 333 Smith Ave. N., in St. Paul. No registration or fee is required to attend.

The Center for the Treatment of Eating Disorders

The Center for the Treatment of Eating Disorders delivers the leading evidence-based treatments to patients of all ages and with all types of eating disorders. After a comprehensive assessment, the team develops an individualized approach for each patient. We offer customized inpatient and outpatient treatment for children, adolescents and adults. We use the latest evidence-based treatments, including: family-based therapy (FBT) and Cognitive Behavioral Therapy – Enhanced (CBT-E).

Everyone on the team — including psychiatrists, psychologists, hospitalists, dietitians and social workers — has special training in motivational strategies and the core treatments for helping children, adolescents and adults with anorexia, bulimia and other eating disorders. We offer inpatient treatments for young patients through college age at Children’s – Minneapolis, and for adults at Abbott Northwestern Hospital.

Janet Treasure, Ulrike Schmidt and Pam Macdonald co-edited “The Clinician’s Guide to Collaborative Caring in Eating Disorders.”


This free event series is open to parents, teachers, counselors, pediatricians and others interested in learning more about eating disorders and treatment options.