Scenario 1 (parents and extended family)

Antonia and Doug’s 16-year old daughter, Isabella, is suffering from anorexia nervosa. Emotions can run high, particularly with extended family members over meal support. Antonia and Doug feel this stress particularly during extended family get-togethers. Today, they are together at the grandparents for dinner to celebrate Easter Sunday with various other family members. 

WITHOUT MOTIVATIONAL INTERVIEWING 

Isabella: I don’t want any lamb – I’ll just have some of the veg. 

Gran: That’s not enough Isabella… this is going too far (looks in exasperation at Antonia) … look at your cousins. You need to eat to feed your growing bodies and ”some veg” is just not enough. 

Mum: (sigh) Try and eat a bit of lamb, sweetie. 

Isabella: I can’t mum… You know I can’t …besides it’s later than I normally eat and I reckon I’ve eaten what I should have eaten for today…according to my meal plan. 

Grandad: Meal plan? When your mum was your age, she ate because she was hungry, she needed food. She didn’t need to have any meal plan! You should be thankful you’ve got food on your plate. 

Isabella: I feel anything but thankful… I’m not eating it 

Dad: (to Grandad) Look John, you know what the score is here. We’ve discussed it over and over again. (to Isabella) Honey, try and eat some more, show your Grandad how well you’ve been working with your team at the Clinic. 

Grandad: We just can’t understand her having to go to a hospital to learn how to eat. It is simple – you eat when your belly is empty, you eat when you’re hungry! (shakes his head). Must be a modern thing, all of this anorexia stuff. Is it the latest fad? 

Aunt: There certainly appears to be a lot of it around. You just have to open any magazine these days. They’re either telling us not to feed our kids too much, or how to deal with these eating disorders. We live in one crazy old mixed up world. 

Mum: I know it’s really tough to grasp but this type of talk isn’t really great at the table. Do you mind if we change the subject? 

Gran: We’re only worried about her Antonia…. we just don’t understand. We saw her at breakfast and she eats virtually nothing, then again at lunchtime, same thing and now when you think ‘my goodness, she must be starving’, it’s way past her normal dinner time, she’s eating like a tiny bird yet again. Grandad and I are worried sick about you, Bella. You’re 

fading away to nothing. I can see your bones stick out on your shoulders. Your gonna land up yourself up in hospital for good if you’re not careful. 

Isabella: Mum, please tell them to stop. They’re doing my head in. 

Uncle: That’s a bit rude of you Isabella – remember who you’re talking to please. 

Cousin: Oooh, yeah a friend of mine, Emma….well someone in her sister’s class at school just died of anorexia. How awful is that? I can’t begin to tell you how I’d feel if that was you Bella! 

Dad: Please can we just change the subject??? 

Isabella: I don’t have anorexia. Please can you all just leave me alone. I’m not ill. You don’t need to worry about me. I just don’t want to eat this friggin’ lamb! Can’t you just respect the fact that I want to eat veg and potatoes and that’s it. Geez… (digging knife hard into potato) 

Gran: OK…just leave it… let Antonia and Doug deal with it. We’re feeling way out of our depths in all of this. 

Grandad: Julian, pass me the sauce, you know how to appreciate your gran’s cooking don’t you? Let’s show Bella how it’s done. 

Mum: Please … please be sensitive. Isabella isn’t well. She can’t help it and those comments just do not help us. 

Dad: We should never have come. We should have stayed at home. This was a mistake. Family get togethers are ALWAYS a mistake these days. We all end up hurt, angry, frustrated….it just does not work. Let’s try and reschedule our next meeting for a year or two when we’ve rid ourselves of this Goddamn illness. Bella, get your coat. We’re leaving. 

Gran: (tearfully…to Grandad) Now look what you and your mouth have done. Antonia, honey, try and understand it from our perspective…. we just didn’t have anything like this when we were young. It is so tough to watch our granddaughter starve herself. We struggle to understand how it has come this far. 

Mum: Are you making out we are to blame?? 

Gran: I don’t know who’s to blame. She was fine last year when we were all on holiday at Centre Parks. We just cannot understand it. Nobody else has suffered from this, what do you call it? 

Mum: Yeah well shit happens. As Doug says, we’ll leave you to enjoy the rest of your celebrations and remove our problem child. Bella, get your jacket, let’s go. I’ve got some salad in the fridge which you WILL bloody well eat…. 

Aunt: Can’t you just bring the salad over here? That way at least you and Doug get to eat Easter dinner. 

Isabella: While Family Problem Child nibbles her lettuce leaves? We’re going…. (grabs coat and rushes out of door) 

Gran: Bella, sweetie, don’t forget your Easter eggs…. 

WITH MOTIVATIONAL INTERVIEWING 

Isabella: I don’t want any lamb – I’ll just have some of the veg. 

Gran: That’s not enough Isabella… this picking at your food can’t go on. You need to eat to feed your growing bodies – can’t you understand that ‘some veg’ is just not enough? 

Mum: Bear with us, Sheila, we’re going through a bit of a tough time at the moment. We’re getting there but it’s taking a lot of patience and understanding. Tough call, I know, it’s not a rational illness and I’ve brought some information that you may find useful. I’ve left it on the dresser – you may want to take a look at it over the coming weeks. We’ve certainly found it useful. Giving information 

Gran: Hmmm…that would help us because at the moment, we just don’t understand it. I just want to see her eat normally again. She’s getting so thin. 

Isabella: I can’t eat this mum… You know I can’t …besides it’s later than I normally eat and I reckon I’ve eaten what I should have eaten for today, according to my meal plan. 

Grandad: Meal plan? When your mum was your age, she ate when she was hungry, when she needed food. She did not get away with wasting any of it. 

Isabella: I’m not eating it (voice raised) 

Dad: OK, everybody’s getting a bit uptight. Do you mind if we all take a bit of a breather for a moment. (to Grandad) Mum, Dad….. I know it’s difficult for you to get a handle on what’s happening with Isabella. You’ve never been faced with this illness before and I can totally understand your bewilderment. The three of us really appreciate your support and your trust that we are handling it. Complex reflection + MI empathy/praise 

Mum has brought some information for family members to read at a future point. However, in the immediate situation, Dad senses an increase in the emotional climate and tries to diffuse it. He asks permission before empathizing with his parents over their difficulty in understanding the illness. He also praises and affirms the support that they've given. 

Grandad: Just cannot understand her not wanting to eat. Must be a modern thing, all of this anorexia stuff. Is it the latest fad? 

Aunt: There certainly appears to be a lot of it around. You just have to open any magazine these days. They’re either telling us not to feed our kids too much, or how to deal with these eating disorders. We live in one crazy old mixed up world. 

Mum: Yep there is a lot in the media. However, we have one huge thing going for us and that’s the support of a large, caring family who all want the best for Bella. You do not know just how important that is to us right now. 

Gran: We do worry Antonia…. we just want to see her better again. 

Mum: That’s what we all want Mum….including Isabella – you have all these wonderful plans, Bella, don’t you? Want to talk about your trip to Europe this summer? Simple reflection + closed question 

Grandpa: She’ll have to eat then. She simply cannot go away for ten days and eat nothing. 

Mum: We have our plan from now until then and you know what you’ve got to do, don’t you, sweetie? She is so looking forward to visiting Italy and France. Family gatherings are tough for Bella where eating together is concerned. However, she and I had a discussion on Thursday on how she would deal with any anxiety today. What was the plan you had decided upon, Bella? Simple reflection + closed question + giving information + open question 

Mum raises the emotional climate by drawing awareness to the green shoots (i.e. the benefits of a strong, supportive, collaborative family network). She joins Dad in continuing to express appreciation for their support whilst rolling with any resistance. They try to derail the current worries and concerns (food talk) as they are aware of the pitfalls of food talk over the dinner table. Instead, Mum turns the conversation around focusing on the bigger picture and future plans involving healthier behaviour. 

Isabella: OK I’d decided if it got a bit much, I would take a break …then come back and try again. 

Uncle: That’s fair enough – really impressed that you’ve developed some strategies there – that approach will definitely stand you in good stead in life, kiddo! 

Cousin: Oooh yeah… a friend of mine, Emma….well someone in her sister’s class at school just died of anorexia. How awful is that? I can’t begin to tell you how bad I’d feel if that was you! 

Dad: That is not going to happen here, Jane. You are your cousin have a whole lifetime of family celebrations ahead of you. What is really important is that Isabella has been working hard with her team and they’re real pleased with her progress and the efforts she’s been making. Reflection + giving information 

Whilst acknowledging cousin’s comment, Dad turns conversation around to one with a more upbeat and positive tone. 

Isabella: OK listen you guys, I’m going to go and sit next door just to do a bit of breathing…try and get my head together again. 

Dad: Well done, Bella. Really impressed by you doing whatever it takes to fight back. affirmation 

Mum: Do you want one of us to sit with you? Closed question 

Isabella: No, I’m fine, I want to be on my own for a bit – I’ll just go through and sit in the living room and watch some TV. 

Mum: Once you’re feeling a bit calmer, let us know what will make it easier for you in terms of supporting you through dinner. 

Mum subtly sends a message that eating dinner is non-negotiable, as well as promoting Isabella’s autonomy in that she can make the choices as to what support will be more acceptable to her. 

Isabella: (sigh) Yep, I guess I could try and eat a tiny bit lamb though it’s not my favourite. 

Dad: We trust you that you know what you have got to do to reach your target this week. And….you’ve got some pretty impressive goals lined up for later this year! We all want to help you get there. 

Uncle: We sure do. 

Gran: There’s also some ham in the fridge and tuna salad. 

Mum: That could work – sounds like there’s plenty of choice for you there. Simple reflection 

Isabella walks out the door 

Mum: Doug and I really appreciate all your support on this. I know it’s difficult to rationalize and it really can put a spoke in the wheel of any family get-togethers but you know, you’re all being so supportive in what could have been a really difficult situation…so we’d just like to say thanks. 

Aunt: That’s what we’re here for Antonia…that’s what families are for! 

Dad emphasizes his trust in Bella that she knows what to do for her wellbeing, again highlighting the ‘bigger picture’ and future plans. They end again by affirming the importance of a collaborative approach to fighting the ED.