Power dynamics in the therapy of anorexia and bulimia: from constraint to resource?

Author/s Valeria Ugazio, Lisa Chiara Fellin
Publishing Year 2022 Issue 2022/128
Language Italian Pages 24 P. 31-54 File size 664 KB
DOI 10.3280/TF2022-128003
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This article presents the alternating pathways, a systemic therapeutic strategy for adolescent anorexia and bulimia developed by Ugazio (2010; 2013; 2019). It is a planned therapeutic path, articulated in four phases, which alternate family formats with individual sessions with the patient. This approach is based on the family semantic polarities theory (Ugazio, 1998; 2012; 2018), according to which the semantic of power prevails in the conversation of and with these families. Through the discussion of a clinical case, we illustrate how this strategy helps to overcome the dilemmas, related to the dynamics of power, so characteristic of psychotherapies with eating disorders and also maximizes the therapeutic alliance with the family and especially with the patient.

Keywords: Eating disorders, anorexia nervosa, bulimia nervosa, systemic family therapy individual, systmic therapy, therapeutic alliance.

  1. Aradas J., Sales D., Rhodes P. et al. (2019). “As long as they eat”? Therapist experiences, dilemmas and identity negotiations of Maudsley and family-based therapy for anorexia nervosa. Journal of Eating Disorders, 7: 26.
  2. Astrachan-Fletcher E., Accurso E.C., Rossman S., McClanahan S.F., Dimitropoulos G. & Le Grange D. (2018). An exploratory study of challenges and successes in implementing adapted family-based treatment in a community setting. Journal of Eating Disorders, 6: 44.
  3. Berger P. & Luckmann T. (1966). The social construction of reality: A treatise in the sociology of knowledge. New York: Anchor Books.
  4. Bruch H. (1962). Treatment of Anorexia nervosa in Current psychiatry therapy. New York: Grune & Stratton.
  5. Bruch H. (1973). Eating disorders: Obesity, anorexia and the person within. New York: Basic Books (trad. it. Patologia del comportamento alimentare. Obesità, anoressia mentale e personalità. Milano: Feltrinelli, 1982). Bruch H. (1978). The golden cage. New York: Vintage (trad. it. La gabbia d’oro. L’enigma dell’anoressia mentale. Milano: Feltrinelli, 1989). Carr A. (2018a). Family therapy and systemic interventions for child‐focused problems: the current evidence base. Journal of Family Therapy, 41(2): 153-213. DOI: 10.1111/1467-6427.12226
  6. Carr A. (2018b). Couple therapy, family therapy and systemic interventions for adult‐focused problems: the current evidence base. Journal of Family Therapy, 41(4): 492-536. DOI: 10.1111/1467-6427.12225
  7. Eisler I., Lock J. & le Grange D. (2010). Family-based treatments for adolescents with anorexia nervosa: Single-family and multifamily approaches. In: Grilo C.M. & Mitchell J.E., eds., The treatment of eating disorders: A clinical handbook (pp. 150-174). New York: Guilford Press.
  8. Guidano V.F. (1987). Complexity of the Self. New York: Guilford Press.
  9. Guidano V.F. (1991). The Self in process: toward a post-rationalist cognitive therapy. New York: Guilford Press.
  10. Hay P.J., Claudino A.M., Touyz S. & Abd Elbaky G. (2015). Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev, 7.
  11. Hilbert A., Hoek H.W. & Schmidt R. (2017). Evidence-based clinical guidelines for eating disorders: international comparison. Current Opinions in Psychiatry, 30: 423-437. DOI: 10.1097/YCO.0000000000000360
  12. Khalsa S.S., Portnoff L.C., McCurdy-McKinnon D. & Feusner J.D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5: 20.
  13. Linardon J., Hindle A. & Brennan L. (2018). Dropout from cognitive-behavioral therapy for eating disorders: A meta-analysis of randomized, controlled trials. International Journal of Eating Disorders; 51: 381-391.
  14. Lock J. (2015). An update on evidence-based psychosocial treatments for eating disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 44: 707-721. DOI: 10.1080/15374416.2014.971458
  15. Lo Tempio E., Forsberg S., Bryson S.W., Fitzpatrick K.K., Le Grange D. & Lock J. (2013). Patients’ characteristics and the quality of the therapeutic alliance in family-based treatment and individual therapy for adolescents with anorexia nervosa. Journal of Family Therapy, 35: 29-52. DOI: 10.1111/1467-6427.12011
  16. MacDonald D.E., Trottier K., McFarlane T. & Olmsted M.P. (2015). Empirically defining rapid response to intensive treatment to maximize prognostic utility for bulimia nervosa and purging disorder. Behaviour Research and Therapy, 68: 48-53.
  17. McFarlane T., MacDonald D.E., Trottier K. & Olmsted M.P. (2015). The effectiveness of an individualized form of day hospital treatment. Eating Disorders: Journal of Treatment and Prevention, 23: 191-205. DOI: 10.1080/10640266.2014.981430
  18. Minuchin S., Rosman B.L. & Baker L. (1978). Psychosomatic families: Anorexia nervosa in context. Cambridge: Harvard University Press (trad. it. Famiglie psicosomatiche.
  19. Roma: Astrolabio, 1980). Mysliwiec R. (2020). Neuroscience of Adolescent Anorexia Nervosa: Implications for Family-Based Treatment (FBT). Frontiers in Psychiatry, 11, 418. DOI: 10.3389/fpsyt.2020.00418.
  20. National Institute for Clinical Excellence (NICE) (2016). Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders.
  21. Selvini Palazzoli M. (1963). L’anoressia mentale. Milano: Feltrinelli (2a ed. rivista 1981).
  22. Södersten P., Brodin U., Sjöberg J. et al. (2019). Treatment outcomes for eating disorders in Sweden: data from the national quality registry. BMJ Open, 9:e024179.
  23. Ugazio V. (1998). Storie permesse, storie proibite. Polarità semantiche familiari e psicopatologia. Torino: Bollati Boringhieri (2a ed. ampliata, aggiornata e rivista 2012; 3a ed. con glossario e bibliografia ragionata 2018).
  24. Ugazio V. (2010). Los trastornos de la conducta alimentaria: cuando el rechazo a la jerarquia se vuelve derrubamiento de las diferencias. Mosaico, 44: 25-35.
  25. Ugazio V. (2013). La famiglia nel trattamento dei disturbi alimentari. In: Gentile M.G., a cura di, Nutrizione clinica e psicopatologie correlate (pp. 45-57). Fidenza: Mattioli.
  26. Ugazio V. (2019). Anorexic girls and their families: how can we deal with their semantic and its dilemmas? Psychotherapy Section Review, 63: 10-23.
  27. Werz J., Voderholzer U. & Tuschen-Caffier B. (2021). Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa. Eating Weight Disorders.

Valeria Ugazio, Lisa Chiara Fellin, Le dinamiche di potere nella terapia con anoressiche e bulimiche: da vincolo a risorsa? in "TERAPIA FAMILIARE" 128/2022, pp 31-54, DOI: 10.3280/TF2022-128003