Supporting Adolescents in ED treatment
Adolescents in Treatment: What to Consider
When working with adolescents at the residential level for treatment of eating disorders, there are unique aspects for everyone to consider, including families and treatment team members. Below are key areas to be aware of in best understanding how to support teenagers in treatment.
Adolescent Brain and Development
First and foremost, it is imperative to understand adolescents in terms of their cognitive development. Adolescent’s brains are not fully formed; what we expect sometimes as adults is beyond what is developmentally appropriate. Per the American Academy of Child and Adolescent Psychiatry (AACAP), studies indicate that brains continue to develop throughout adolescence and into early adulthood. The AACAP reports that the frontal cortex area of the brain, the area responsible for helping us think before acting and using logical reasoning, develops in the late teenage/early adult years. As a result, we will commonly see adolescents who act on impulse or make illogical demands.
According to psychologist Jean Piaget, individuals aged 11 through early adulthood are in the Formal Operational Stage of cognitive brain development. It is during this time that individuals are able to begin to think abstractly (a shift from concrete thinking) and begin to think logically. This relates directly to how teenagers process information. In other words, adolescents are thinking more about what others are telling them, rather than simply accepting what is told. Additionally, during this stage of development, adolescents are starting to ponder moral and social issues. What they were raised to believe may not fit with their current understanding of the world.
A common thread regarding these core characteristics is the emergence of new ways of understanding the world and processing information, without taking things at face value. This can present as a teenager strongly believing that their eating disorder will not come with serious medical complications, that bad outcomes ‘won’t happen’ to them, despite their treatment team or parents giving them this information. This is not necessarily our teenagers being willful, there are biological explanations for their thoughts and actions.
Independence and/or Dependence
Adolescents are seeking to test their levels independence and dependence. Many of our clients in treatment tend to lean towards one extreme as it relates to their loved ones. Some teenagers may completely isolate from their families, while others regress and become increasingly reliant on others for activities that they used to manage on their own. It is important for family members to be aware of these shifts, and that a balance between dependence and independence is a beneficial place to aim, with the support of the treatment team.
Another feature of adolescence is valuing peer opinion and beliefs over those of family members. It is at this stage of life that ‘fitting in’ and being part of a peer group becomes more important than having healthy relationships with family members. This is why a minor fight with a friend may result in days of being in a bad mood. As adults, it may feel hard to relate to this emotional discomfort.
Simply listening is typically a better intervention than giving advice, remembering adolescents value peer opinion over parental opinion at this time.
Family and Relationships
While teenagers are in treatment for their eating disorder, the relationships that they experience with the other clients and staff highlight their interpersonal strengths and challenges. I always tell clients that every interaction at treatment is a learning opportunity, which can help to increase opportunities for prosocial interactions in the real world. The teens are constantly being challenged to communicate through means other than their eating disorder, which can create stressful social interactions. Families are an extremely important part of treatment. As staff, we give feedback to members of a client’s family (when needed) in order for life after treatment to be recovery-oriented for the entire system. Most of our clients return to their existing home environment, so we work hard to create changes supporting recovery.
If I could give family members one piece of advice, it would be to be open to the feedback from staff, and to take care of themselves (therapy is always a wonderful option!) in order to best support their loved one in treatment.
There is a reason the family therapist is telling a parent to use certain language, or to practice active listening skills, for example. No family or individual is perfect. We all say or do things that we wished we hadn’t. With that said, parents have to do a lot of their own work while their teen is in treatment. Marital difficulties, family conflict and other challenges can increase due to the stress of having a child in a higher level of care. It is important for families to learn and recognize what are client versus parenting issues. Many times we hear from our clients that their parents have made them feel stuck in the middle or that they themselves feel they are the reason for family issues. Our adolescents read both verbal and nonverbal cues very well.
An increased awareness of the messages being sent to clients is an important aspect for parents to manage for their child’s recovery. Whether parents are in a together or not, it is important for them to present as a united front against the eating disorder.
Working with adolescents in treatment requires an understanding of the unique needs of this age group. Not only are these clients struggling with everything that comes along with eating disorder and mental illness, their brains are at a developmental stage in which true abstract and logical thinking is starting to form. For loved ones, it is important to be sensitive to the unique needs of the individual with an eating disorder.
Additionally, family members should remember their involvement (or lack thereof) can strongly impact the recovery process.
American Academy of Child and Adolescent Psychiatry Aacap.org
Piaget, J. (1970). Piaget's theory.
ABOUT THE AUTHOR: ELISSA CHAKOFF
Elissa Chakoff, LMFT is skilled in Family Therapy, Individual Therapy, Group Therapy, Crisis Intervention, and Supervision. She currently serves as the Clinical Director of Clementine Twin Lakes, a unique residential treatment program exclusively for adolescent girls, between the ages of 11 to 17, seeking treatment for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder or Exercise Addiction located in Clifton, VA.