I was present, as a researcher, in a family group. Using Playmobil figures, each family member was to show the others how they experienced the situation in their family. The young woman with ED placed the ED (a skeleton) in the centre of the table. She put her siblings at the far end of the table, together with a little dog. Mum and Dad were put far apart from each other (they were divorced). “It’s my fault that the family is destroyed” she said, crying. “Everything would be better if only I were dead.” Her father turned to me and said: “You have to keep hold of that. Now, you have really got to see how things are for us.” (Fieldnote)
The results can be summarised in two main categories: ‘Connectedness and recognition’ and ‘Open yourself and share’
Connectedness and recognition
The participants described the MFT as an arena where families could meet, a space for recognition where it was possible to speak of things happening in the family with others with similar difficulties who understand. They spoke of different kinds of understanding and fellowship; in the mothers’ group, the fathers’ group, the young women’s and siblings’ groups and in the large group with everyone present. Many of the group members said that it felt good and freeing, but also painful, to meet other families with similar experiences. What these families had had in common was a considerable loneliness because it is so difficult for outsiders to grasp what it is like in a home dominated by an ED. Here, at last, they had the experience of meeting others who had the same, and who understood how it was for them. A mother expressed this as follows:
“The first time, the first meeting of the mothers` group, we sat in our group and as soon as we sat down, I began to cry. I was totally unprepared for that because I do not cry easily. It was a shock, but at the same time, it was a signal that I had now come to some people who… A strange experience, as I felt I wanted to scream. And I think that it was because I realised that at last there were people who understood what I was talking about…. I understood that there was truth in that you said that you understood what I was talking about – and it was quite liberating – good and bad at the same time.” (Group interview 1).
The mothers described powerful shared feelings, with a lot of tears and crying, with them all on the same wavelength. They also found relief together, with the other mothers who had had many of the same feelings as them.
“I could start a sentence and another of the mothers could finish it for me.” (Group interview 1)
“That’s how it is for me. The crushing sorrow. It’s just the same for you.” (Mother 1).
“We think that it’s only us who are going through this, but it’s really not so– I don’t have to go round and take it all on my shoulders.” (Mother 5).
“It was fantastic. It was moving. There were family histories. We became just like one big family and everyone opened up.” (Mother 3).
A father said that it was especially valuable for him to talk to the other fathers in the fathers’ group. There, the fathers could speak about their issues without the mothers present. MFT led to ‘aha-experiences’, as well as giving structure to chaos. Another father spoke of his loneliness and frustration when outsiders asked how it was going with his daughter. The answer was often that it was not good with her, but those who had inquired had neither the time nor the possibility of fully grasping the situation. It struck a chord with the other fathers when he said, somewhat humorously:
“I have a standard answer – it depends on how long you have. Do you have five or six hours?” (Group interview 1).
A father put it like this:
“You understood that you are not alone. You know the whole picture. I had felt myself completely set apart. Exactly as if I were alone with it. Other fathers said just the same.” (Father 6)
Several of the young women with ED reported that participation in MFT could be both good and bad. You met others, but could also feel exposed, as it was apparent to everyone why you were there.
“It was great to meet other girls at different stages of their illness. It gives you hope. If they can do it, then I can do it.” (Young woman 2).
The siblings said that they found it good to meet and talk with other siblings, because there were things that they did not want to discuss with their parents. It was also helpful to see their parents together with their sister in the MFT. Nonetheless, difficult feelings could be brought up, and participation in MFT good and bad at the same time.
“It’s hard being here, my heart gets heavy and I get to know things that are unpleasant. But it has made me much more secure, and I take part for the sake of my sister. (Group interview 2)
The participants reported themselves as having been treated with respect and having been believed and said that they were taken seriously by both the other group members and the therapists. Some said that they had never had such an opportunity as a family, of something so well-tailored to them. The families challenged each other more than the therapists did. Even though the therapists had both expertise and empathy, they nonetheless did not have the same lived understanding of how it is to live with an ED as did the other families in MFT.
“The therapists know a lot, but still can’t have the same understanding of your problems as do the others who have exactly the same problems. You have the feeling that they don’t quite get what you’re talking about, even though they know a lot about it. It’s, plain and simple, just not possible to understand the pain and anxiety without having been there yourself.” (Group interview 2).
“I pretty much forgot that the therapists were there, trying to keep us on track. I was in MFT to talk to the group, not the therapists. The therapists were just extras. Those who can really help each other are the girls and the families.” (Young woman 1)
Open yourself and share
In the passage above, we saw how the participants experience their encounter with others with comparable experiences, who understood how it was in their family. The meeting with these other families created an underlying safety in the group. They experienced the MFT group as a place tolerant of their need to cry or to be angry. They spoke of valuing receiving help to distinguish between realistic and unrealistic concerns, and in reflecting over what was sensible and what not. The parents spoke of membership of the MFT group as having been helpful with feelings of guilt, and said that they had affirmation of being good enough, of not blaming oneself but, rather, being proud that one had stayed the course and done one’s best. The parents shared with each other the importance of thinking of oneself, and of daring to set one’s own needs before those of the daughter. It is vitally important to take care of oneself and of the family, and to live as normally as possible, in order to be able to support your daughter. They reflected, as well, on the importance of openness in relation to the daughter with ED, and the young women got to see how things were for their parents.
“I have learned something from everyone – things added and things subtracted.” (Group interview 1).
“We got some extra tools – we learned to work together.” (Group interview 4).
“It was help with tidying and sorting - what’s mine, what’s my sister’s, what’s Mumand Dad’s.” (Young woman 2).
MFT works less with ED and its symptoms than with communication and cooperation. Several of the participants talked about being stuck, and about being anxious about triggering the ED and difficult emotions. A father described it as being like a wall between his daughter and the rest of the family, and said that they needed help to tear down this wall in order to make possible communication within the family and in relation to the daughter. At the same time, they were scared of crossing boundaries and anxious and uncertain about what might happen if they were too abrupt.
“Before we started in MFT it was just as if there was a wall between her and us in relation to the disease, but then something happened in the MFT which meant that the wall was broken down a bit. You knew what we could talk about, have some shared experiences around the illness that we could speak about – because we have been so scared – am I am crossing a boundary here, if I say…. or is it something I mustn’t say. You become very watchful. This wall really set a limit in that she didn’t really know what to say to us, because we didn’t really understand what this was all about. And so you sit on the other side of the wall, afraid that if you say this or that it might be wrong, or there again maybe smart. You sit and wonder what to do: should you try to tempt her with something? Should she get something if she does it? You sit there like a question mark. And you don’t start to climb over the wall because you don’t know what awaits you on the other side…” (Father 5)
Several of the group members said that it could be easier to talk about difficult things in the large group with everyone together, than as a family. It was often easier to put difficult questions to the other families.
“I forgot myself a bit – in the MFT I dared to say things out loud to everybody in the big group that I had never dared to say at home. Here were others who understood, and who gave confirmation – looked at you and nodded whilst you spoke, recognised what you were saying. People had things complementary to yours, it was like that too. We discussed, other families came with suggestions for solutions, how they do things, what others do that is good or not so good.” (Young woman 1)
They also found it helpful to mix up the families, to find oneself another mother or daughter. It felt good to the young women to meet other parents, and they often dared to ask them questions they had struggled to ask their own.
Some of the participants in MFT said that the young women showed more of their healthier side and behaved more openly than they usually did at home or in the hospital where the ED often claimed even more space. At the same time, the young women were quiet and shy, and little forthcoming in the group discussions.
“Many (girls) think – that’s not relevant, one mustn’t say that. I have nothing to contribute. We are not used to presenting our needs – saying it aloud, and we find all possible reasons not to speak.” (Group interview 4)
In the fieldnote below, the silence and under-pressure atmosphere in the group are described, as well as how the therapist got the young women to participate more and give more of themselves.
There was a tense atmosphere in the large group. The participants complained that the young women were very quiet and shared very little. They talked in lowered voices and it seemed that words had to be dragged out of them. They often answered ‘Yes’, ‘No’ or ‘I don’t know’. We divided up into our peer groups, the young women with a therapist. They were asked to write, by themselves, some key words about what their life would be like without an ED. Then they shared between themselves about the words they had written down, and the conversation flowed much more easily. Back in the plenary group, the therapist improvised: “I have agreed with the young women that we will exploit the good atmosphere of our peer group and share with everyone else in the large group. The other participants can ask the young women concrete questions and they will tell you what we have talked about.” It turned out to be a good concrete conversation, neither philosophical nor theoretical. (Fieldnote).
This simple exercise of writing down keywords, first for themselves then shared with each other in the young women’s group, led to increased safety and openness. What followed was a friendly but firm challenge from the therapist to share the same in the big group.
The concreteness of the task showed itself to be helpful in both the small and large groups. One of the young women spoke of how using Playmobil figures led to openness and insight in the family group:
“We set them up in such a way that we could see ourselves and the family. Who stood close by and who stood far away, and which way the faces pointed. A light came on for everyone – how we saw things very differently, but also very much the same. I liked that. Lovely to do something other than just sit and talk.” (Group interview 4).
There were many difficult topics, and difficult thoughts and feelings that came up in the MFT. The fathers, mothers and the young women all mentioned, however, humour as rescuing when difficult topics and questions were taken up.
“Otherwise, it could have quickly got really serious. It could have made it [the MFT] really dismal.” (Group interview 1)
Humour loosened things up and was experienced as liberating, it created unity and let the participants relax.
“It’s important to have humour. If I couldn’t have laughed, I wouldn’t have coped.” (Group interview 3).
“It’s almost more important to be able to talk to each other, than moving heaven and earth in trying to get well… Try to live a normal life in so far as one can, talk and have a bit of fun together.” (Mother 6).
Several of the participants told us that their family had become much better at talking to each other after having been in MFT. They learned to listen to each other, hear what the others were saying, understanding more of their thinking. And they were able to practice speaking about difficult things and sharing feelings. As a result, they were able to speak much more openly about everything. This gave rise to increased understanding.
“She [her daughter] was like an oyster before. They speak to each other in a completely different way now and dare to take up difficult things. MFT helped to make it possible for them to have a proper sister-to-sister talk, in an entirely different way than before. I am so grateful that we did it!” (Mother 2).
“MFT has been most important for my parents but has indirectly been good for me as well as things are better at home.” (Group interview 3).
“I believe that MFT has been the most important thing in getting well. I learned that it is important to say what you are feeling; learned to speak. When the family understands more, it’s better equipped to be supportive, so that you don’t have to do the work of getting well completely by yourself. It is so good! We wouldn’t have the relationships we have [in the family] if it hadn’t been for MFT, guaranteed.” (Young woman 1)
“It’s the MFT that has helped us the most. I would have liked to have two rounds of it.” (Father 3)
“Really, all families could make use of MFT, including those without [illness and] diagnosis.” (Young woman 2)