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Session 3

Parents and Carers – Disordered Eating

Session 3

Emotion-Focused Therapy

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How can I help my loved
one to cope in a different way?

Irregular or disordered eating patterns are often used to manage difficult emotions, however, this is often a problematic coping strategy.

Therefore, it is helpful to support someone to find alternative, more helpful ways to communicate and manage these emotions. This can be done using emotion coaching strategies.

What is emotion coaching?

Emotion coaching is a strategy for supporting the behavioural and emotional wellbeing of children, adolescents and adults.

It can also be used to support the development of emotional health in general through strengthening connections in the brain involved in the regulation of emotions, increasing co-operation and flexibility.

It can be used as a way to connect with your loved one in the moment, re-direct behaviour and avoid or de-escalate outbursts.

This helps your loved one to develop their skills to manage their own emotions in a more helpful way, rather than using behaviours such as irregular or disordered eating.

A note on validation

Validation is key as the first step in emotion coaching!

Validation helps to calm the brain and can help to make your loved one more flexible and open to comfort, reassurance and practical support.

It can help to strengthen relationships and reduce resistance to help.

Don’t be put off by their response, keep going as this is letting them know you are listening, and you care

Validation is NOT…
Offering reassurance, problem solving, focusing on the bright side, using logic and is not the same as agreeing with your loved one’s thoughts feelings or behaviours

Tips and tricks on validation

You can validate feelings, attitudes, thoughts, behaviours and even silence!

Use tentative language such as...

“I imagine you might…”,
“Perhaps you want to…”
“It would make sense that…”,
“I get why you would...”

Your best guess is better than asking questions

Focus on their positive intentions or motivations to manage their distress/reduce discomfort/pain e.g., “I imagine that you self harm as it offers some relief to the hurt you are feeling”

Try to be aware of your tone, volume and body language e.g., if your loved one is angry you will need to validate with some energy in your voice.

You can use emotion coaching in person, over the phone, in text or email/letter or through a closed door!

It’s a new skill so practice will help build your confidence and competence in using it.

Steps of Emotion Coaching (efft.org)

Step one:

Validate. Swapping “BUT to BECAUSE”. This helps to convey that you are trying to understand why your loved one might be feeling, thinking or behaving the way that they do.
Validating their emotional experience will have a calming effect for your loved one. Validation is most effective when you use three ‘because’ sentences as this demonstrates your effort to understand their experience.

It helps reduce the intensity of their thoughts/feelings when the external environment (you) matches their internal experience (their thoughts/feelings).
We are often pulled to offer reassurance or solutions, these are more effective AFTER first validating!

Step two:

A - Emotional support. This includes, comfort (e.g. a hug), reassurance (e.g. “it’s going to be ok”), hope (e.g. “I know we can get through this”), belief in your loved one (e.g. “I can see how hard you’re trying”), togetherness (e.g. “I’m here for you”).

B - Practical support. It’s helpful to be specific and to give two suggestions in keeping with what you were validating. These can include distraction, redirection, exposure, setting limits and taking control where appropriate.

Here’s an example…

Step 1 – Validate

“I could understand why you might not want to eat breakfast because you don’t feel hungry, and because perhaps you are worried about eating too much, and because you might be worried about gaining weight”

Step 2
Emotional support

“I can see that you are trying your best at the moment, I’m here and we’ll get through it together”

Step 3
Practical support

“Let’s sit together and have breakfast, and then we can play a game or watch a film afterwards”

Validating difficult
emotional states

It can be particularly difficult to validate emotions/emotional states that we might find challenging such as anger, hopelessness, self-blame or silence.

Remember, validation is a way of connecting with your loved ones struggles and letting them know you are there to try and support.

We might be worried about making these worse or not knowing how to handle them.

Validating anger

For an emotion to run its course, it needs to be expressed and worked through - validating helps with this.

For an emotion to run its course, it needs to be expressed and worked through - validating helps with this.

Suppressed or incomplete anger can be particularly toxic. It fuels mental health symptoms like anxiety, depression, OCD and eating disorders, even self-harm behaviours and suicidality.

Supporting the expression of your loved ones anger can be an incredibly powerful tool for healing. In fact, by helping your loved one to work through anger, you will be supporting them to reduce the need for symptoms. It will also make it less likely that they will act out their anger physically or with aggression.

It can be particularly difficult to validate anger if it is directed towards you; it is still helpful to do. However, remember that does not mean you become their punching bag, rather that you are holding the bag for them to voice these feelings.

Here is an example of how to validate anger

“I don’t blame you for feeling angry when you can’t go out with your friends because you were really looking forward to it and because you don’t want to miss out and because you might be worried that they will stop inviting you to things.”

Try to match your loved one’s tone and energy, while not becoming angry yourself!

For more information on how to validate anger, look here -

Caregiver Anger Video - ( www.mentalhealthfoundations.ca/caregiver-webinar-anger) Mental Health Foundations - EFFT - ( www.mentalhealthfoundations.ca/)

Different responses to emotion coaching

Don’t be put off if your loved one does not respond (outwardly) in a positive way when you first try this. This does not mean that it is not helpful.

We know that the use of emotion coaching can result in the release of calming neuro-chemicals in the brain which can have a soothing effect in the body even if we can’t see it!

What if they do not respond?

There is no pressure for your loved one to engage with you verbally at this time. Meeting silence with further validation and support conveys understanding and respect - and this goes a long way in maintaining connection, encouraging (hopefully) for your loved one to eventually open up

You may get some ‘push-back’ such as

"Why are you talking to me like that? That's weird." - is can be helpful to validate, acknoeledging that you might sound a little strange and that they might be wondering if you are being genuine

Be honest with then, explain that you want to be able to help and support them, and therefore you are trying new and different things and that you will keep trying. Let them know that you will check-in with them as to how it is going.

What if they do not respond?

“You can’t possibly understand.”

Validate how this might feel for them. You are right, I can’t fully get what this is like for you and I imagine that might be frustrating because you have tried telling me so many times and because it might mean you feel like you have to deal with it alone leave’.
Emotional support ‘I do want to get it, and I am here no matter what’ Practical support ‘can we set some time aside to talk and I will focus on really listening to what you have to say

“I’m not sad – I’m mad!”

– you have helped your loved one to identify their emotion, now this is an opportunity to validate their anger.

How to respond to
silence

Responding to silence,
using emotion coaching

“I wonder if you are silent because it might feel uncomfortable to talk to others about your eating.”

“I could imagine that you might not want to talk to me because I haven’t always been understanding oraccepting of your struggles with food in the past.”

“I can understand why it might be hard for us to talk about your eating because we haven’t always been in the habit of talking about the tough stuff together.”

Emotional support: There is no pressure to talk right now, I am here when you are ready.

Practical support: I will check back in with you in a little while and we could spend some time together doing X.

How to respond
to resistance

How do I respond to my loved ones resistance to change or resistance to my support?

“I can see why you might not want my help because in the past I have made unhelpful suggestions and because at the minute you might not feel ready for things to change and because you might be worried that it will lead to more arguments between us.”

Emotional support: We can take it at your pace, I really want to support you through this.

Practical support: Why don’t we sit down together and think of a good place to start, and I will make sure that I try to stay calm so we don’t end up in arguments.

Am I doing it right?

When your loved one does not respond, when there is push back or when they are silent, you might ask yourself

“am I doing this right?”

These are normal responses, especially when you are trying a different way of communicating.

Do not be discouraged if there is not an immediate positive response or shift.

Keep practicing – it’s ok to note down some ideas or practise with someone else before delivering this.

Do not give up! Consistency is key and shows that you were willing to try something different in order to help.

Acknowledgments: What is disordered eating?

Content created by:

  • Dr Salma Suri (module lead) – Consultant Child and Adolescent Psychiatrist NELFT (London) Eating Disorder Service
  • Dr Katie Quayle (module lead) – Clinical Psychologist NELFT (London) Eating Disorder Service
  • With contributions from Dr Nadia Daer – Clinical Psychologist NELFT (London) Eating Disorder Service

Emotion-Focussed Family Therapy (EFFT) material used with permission from the International Institute for Emotion-Focussed Family Therapy www.mentalhealthfoundations.ca - Adele Lafrance, Natasha Files, Sheila Paluzzi and Jennifer Danby.

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