During the course of my son’s illness we utilized a variety of approaches to help him recover. As I have written in other posts we didn’t really employ any one specific method, but instead utilized many different modalities of treatment and sometimes we “played it by ear” and did what just seemed to make the most common sense. We worked in conjunction with a wonderful therapist who also was very flexible and if it was working didn’t change it and if it wasn’t working explored the reasons why and helped us make changes to the treatment plan.
At the present time The Maudsley Method or Family Based Treatment (FBT) is quite popular and enjoys a great deal of success. There were many aspects of FBT that we incorporated into our own treatment plan.
I have asked myself many times whether this method has really been in practice, without an official name, for many generations. When I was growing up meals were prepared by my parents. When I woke in the morning breakfast was served by either my mother or father. Lunch was packed the evening before or lunch money was given before we left for school. Even if lunch money was provided, the choices were “hot lunch” or “a la carte” and you had to sign up for them. If you signed up for “hot lunch” you were served something like meat loaf, mashed potatoes, and green beans and if you chose “a la carte” you got a hot dog or hamburger with french fries and a vegetable. Dessert was provided and white milk, chocolate milk or water was offered to drink. There were not a whole lot of choices. As I entered junior high and high school, soda started and ice cream were added to the menu. After school, I went outside and played and was called home at dinnertime. Dinner was prepared by my mother or father. We had input as to what was purchased at the grocery store, but our meals were planned by my parents and we basically just showed up at the table. My parents certainly tried to plan meals around our individual likes and dislikes, but they had the final say. There were meals that weren’t that appealing to me, but it was expected that I was going to eat them, not negotiate them. It was expected that my sister and I would finish our meal. There was no such thing as which items on the plate weren’t going to be eaten at all or what percentage of the meal we would eat. The expectation was that we would eat what was on the plate and there were consequences if we didn’t. Food was viewed as a vital part of our health, just like medicine. I didn’t have the option to refuse my antibiotic if I had strep throat or negotiate taking only part of it and meals were not considered any different. It didn’t really occur to me to argue about what was on my plate because I understood that it wasn’t up for a vote.
The generation in which I grew up was probably the last generation where the entire family ate dinner together most days of the week. This often included breakfast as well. Parents planned and cooked the meals and children ate them. Obviously, there were some exceptions to this, but for the most part that was the way it was. Eating meals together was considered important and it was easier to do then. When I was growing up one parent was often at home. During the 70’s when so many things were beginning to change my mother did work part-time, but she was home most of the week and our meals were organized. We also didn’t have nearly as many activities that began at dinnertime. I played softball as a kid and our games did begin at 6PM, but we only had 2 games per week and it was only for 6 weeks in the spring. After- school activities ended by 4 or 5 and we were home by dinnertime. On the evenings that we had a softball game dinner was prepared early because my mother was home or we ate together after the game.
Raising my own kids has been much different. It is more often than not necessary for both parents to be working nowadays. As a result activities that often took place after school are now scheduled in the evening to allow for working parents to provide transportation. Many kids now play more organized sports and the neighborhood “pick-up” game that was played in the backyard after school has all but gone by the wayside. Organized sports often demand a lot of time with both practices and games. Many times kids are playing multiple sports or are involved in many different activities simultaneously, sometimes requiring that they are out nearly every evening of the week.
While moving the start time for these activities to the early evening is very helpful to working parents, it wreaks havoc on the concept of family dinners. Busy parents often do not have the time or the energy to come home from work, drop their child at an activity, cook dinner and then go back and pick up their child. Who wants to eat a family meal at 8PM or later when there is still homework and preparation for the next day that has yet to be done? Who wants to clean up dishes at 9 or 10PM? The result is that kids are often getting their own dinner with no one to supervise what has been prepared or that what is designated for dinner is really being consumed. Dinner is many times being given in “shifts” and hurriedly eaten without the time for proper attention to whether the child is consuming the entire meal. It is easy, under these circumstances, for dinner to be whatever the child can grab on the go. A “meal” at that point can have a very wide and loose interpretation.
I found it very easy to fall into the routine of not having family meals. My kids were grabbing what they could and, because my husband and I were tired after working, the definition of a meal enjoyed wide parameters. We were barely making it to the various activities on time and dinner was becoming secondary to the activity. Personally, I was never totally on board with this concept. I would see tired, grouchy parents taking tired, grouchy kids to various activities. The even more tired and grouchier younger siblings were also dragged along (in my case it was to sporting events) and dinner consisted of sitting on a blanket eating, yes I’ll say it, JUNK! These exhausted, irritable kids were usually placated by exhausted, overstressed parents with anything that would keep them happy and contented. I was no different. If it took 2 lbs. of gummy worms and a couple of Chicken Tenders for dinner to keep an exhausted 4 year old from making a scene worthy of an academy award, then bring it on.
Our family did make changes though. The changes were in large part due to our son’s eating disorder, but honestly the changes began even before the eating disorder was recognized for what it was. I grew up with family meals and felt that they were important. The chaos that our family had fallen into with all of the activities and very little time to spend together as a family was disturbing to me and I didn’t feel that it served any of us well. The activities became limited to one evening activity per child and we tried to arrange it so that they could fall on the same evening whenever possible. We designated Saturdays and Sundays as days that we always ate together. This restored a balance, but still not enough of a balance when our son got sick. When we first recognized that there was a problem, we started making sure that one of us was always home serving dinner. This would mean that one of us had to miss watching a baseball game or a soccer game. We took turns and one of us always prepared dinner and sat with the children. This also meant that younger children didn’t have to be out every time an older sibling had a game and that was a huge improvement.
Were my parents and generations before them practicing a simple form of FBT without even realizing it? I think they were. I am not romanticizing previous generations or criticizing this one; there are positive and negative lessons to be learned from every generation. I do think that the idea of family meals, meal supervision, and children eating what their parents prepare without negotiation or bargaining is something previous generations seemed to do well. FBT? Maybe, or maybe just common sense and a slower pace. The only suggestions that I could give regarding family meals is perhaps to cut back on evening activities if they are taking up most of the week and to prepare meals on the weekend to allow more time for a family meal on activity nights. The Maudsley Method or FBT spell out the details quite well and have had great success working with patients and families struggling with eating disorders.