le Grange D
The University of Chicago, Department of Psychiatry, IL 60637, USA.
J Clin Psychol. 1999 Jun;55(6):727-39. doi: 10.1002/(sici)1097-4679(199906)55:6<727::aid-jclp6>3.0.co;2-3.
Successful treatment of anorexia nervosa remains elusive for many cases. Involving the family in the treatment of adolescents with anorexia nervosa has proved to be of benefit for young clients with a short duration of illness. In fact, the benefits of family therapy have been shown to be enduring at five-year follow-up. Engaging in treatment and commitment to therapy are important factors affecting treatment outcome. For instance, parental criticism of the anorexic offspring can lead to early dropout of treatment or poor outcome in treatment. The case presented in this article demonstrates how the family's help can be solicited in restoring the adolescent's health in much the same way had the client been admitted to a specialist inpatient facility. Although the treatment in this case was relatively uncomplicated and brief, the family had to overcome their initial exasperation with the client's self-starvation in order to be helpful in the process of the adolescent's weight restoration. When this initial stumbling block was resolved, in part by the therapist's modeling of an uncritical stance toward the client's dilemma, the family was successful in nurturing their daughter back to health. Once the client's weight was restored, and the adolescent reintegrated with her peer group, she could negotiate her continued individuation from her parents, but without the eating disorder to cloud their relationship.
对于许多神经性厌食症病例而言,成功的治疗方法仍然难以捉摸。事实证明,让家庭参与青少年神经性厌食症的治疗,对病程较短的年轻患者有益。实际上,家庭治疗的益处已在五年随访中得到证实。参与治疗以及对治疗的投入是影响治疗效果的重要因素。例如,父母对患有厌食症的子女进行批评,可能导致治疗提前中断或治疗效果不佳。本文所呈现的案例展示了如何像患者入住专科住院机构那样,争取家庭的帮助来恢复青少年的健康。尽管该案例中的治疗相对简单且疗程较短,但家庭必须克服最初对患者自我节食行为的恼怒,以便在青少年体重恢复过程中发挥作用。当这个最初的障碍,部分通过治疗师对患者困境采取不加评判的态度得以解决后,家庭成功地帮助女儿恢复了健康。一旦患者体重恢复,并且青少年重新融入同龄人群体,她就能够在不影响与父母关系的情况下,与父母协商如何持续实现个体化发展,而不再受饮食失调问题的困扰。