Resolving barriers to involving male loved ones in eating disorder treatment

Presented by Rebecca Brumm, Chief Clinical Offer at Within Health, and Joe Kelly, Family Coach at Within Health

When someone is struggling with an eating disorder, it’s important to involve their loved ones in their recovery process, both for the benefit of the client and for the benefit of the supportive loved one. Unfortunately, there are many barriers to involving male loved ones, such as fathers and husbands, in a client’s eating disorder treatment. 

These barriers exist for many reasons, including male acculturation and provider oversights, such as viewing men as “in the background.” Whatever the reason, providers can use many strategies to resolve these barriers and involve male loved ones in treating their family members, partners, and friends. 

Circle of caring: who are we talking about when we talk about male loved ones? 

When considering the male loved ones of an eating disorder client, people are most likely to think of men like boyfriends, husbands, partners, and fathers; however, these aren’t the only men who can influence a person’s life.

When we expand the circle of caring to consider other men, we come to realize that there are step-fathers, deployed partners, ex-husbands, uncles, brothers, cousins, nephews, grandfathers, friends, and neighbors.

It may be challenging to involve male loved ones in treatment if they aren’t nearby. This is especially true for a husband deployed overseas or a father living elsewhere. These men are, of course, very important to the eating disorder patient, but there are still other men in the circle of caring to consider when approaching the patient’s recovery plan and process.

Abusive males in the client’s family

If a client has had a history of a male loved one mistreating or abusing them, they will rightfully not want to include that man in their recovery process, as it could be triggering and harmful. Eating disorder patients who were abused or abandoned as children by a male loved one need to be heard during treatment. They need their experience to be respected and validated.

Providers cannot allow their experience to blind them to the potential of including other, more positive male loved ones who can reduce risk, foster growth, and contribute to healing. Fostering these healthy male relationships help set clients up for future success and long-term recovery. Plus, it also has the male loved one’s best interests in mind, as he is likely feeling helpless, afraid, and frustrated that he can’t make his loved one’s pain disappear.

Where are male loved ones emotionally when providers meet them?

Like anyone else, different men may be in different emotional places when they begin engaging in their loved one’s treatment. Some men may lack understanding of their loved one’s eating disorder, why it happened, and what caused it. Some men even express concern that they caused the eating disorder. They may feel angry, confused, helpless, and desperate for guidance.

When a male loved one doesn’t feel capable of helping and is struggling emotionally, they have fewer resources and emotional capacity to care for the eating disorder client. Research indicates that child behavior improves when their parents’ psychological symptoms are improved via treatment.1 So, including them in treatment can help address some of the male loved one’s mental health symptoms, challenges, fears, and beyond.

However, many men struggle with how to approach their loved one’s recovery process. They often ask how they can fix the eating disorder or how long it will take to resolve, which are not helpful questions. They can’t heal an eating disorder, but there are things they can do to support recovery and reduce walking on eggshells. They must learn to shift their mindset from fixing to asking what tools they can use to support recovery.

Barriers to involving men in their loved one’s eating disorder treatment 

There are many cultural, psychological, and gender-related barriers to involving men in their loved one’s treatment.

Male acculturation

Due to societal and cultural influences, men are taught to behave and believe certain things. Men tend to value working toward solving a problem and think that talking about it is passive and ineffective. Men often distrust institutions run by women and enforce generational cycles of silence.

Fathers usually don’t speak to their sons about important things, and adult men don’t disclose emotions to each other. They may find that engaging in family or couple’s therapy during their partner’s eating disorder treatment is not solution-oriented and, thus, fruitless.

Other beliefs and behaviors

Men are also more likely to:

  • Believe his loved one’s problems are due to a lack of motivation
  • Resist the idea that his loved one has a mental illness
  • Believe his child’s problems are developmentally appropriate and they’ll eventually pass
  • Believe that fathers don’t matter as much or influence daughters as much as mothers

Barriers for providers

Providers are people with biases, just like everyone else. But what’s important is that they interrogate and challenge their own biases, judgments, and assumptions to ensure that they can provide their clients with the best care possible, which includes involving their male loved ones in their treatment plan.

Some behaviors or attitudes among providers that might inhibit male loved one engagement with therapy, treatment, and resources include:

  • Doubting that male loved one engagement is worth the effort
  • Fearing the unknown, such as violence or volatility
  • Believing that male loved ones are not receptive or teachable
  • Having little training in male acculturation and communication
  • Readily accepting male non-participation as the norm
  • Focusing on male loved one skill deficits as opposed to assets

Effective provider strategies for engaging men in a client’s eating disorder treatment

Many providers may have trouble engaging male loved ones in their clients’ eating disorder treatment programming, but there are strategies to use to increase engagement, such as:

  • Explicitly invite the male loved one to attend therapy and explain how important they are to the client’s recovery
  • Pay attention to the male loved one’s needs too
  • Focus on the male loved one’s assets and strengths
  • Focus on their love for the client and motivation to help
  • Challenge the “too busy” excuse that many men provide, emphasizing their value
  • Gather his data and puzzle pieces, such as how he views and perceives the eating disorder
  • Focus on his role in the family, how he responds to behaviors, and how he feels about the rest of the family dynamics
  • Revise intake forms and records to identify and note multiple male loved ones in the client’s life instead of just partners and fathers

Many men have the desire to fix the situation when in fact, eating disorders can’t be fixed. But instead of shaming the male loved one for this attitude, interpret his “how can I fix this?” questions as expressions of his fear and love, his distress over his loved one’s distress, and his motivation to take action.

Typically, providers find that giving men abstract answers can lead to frustration and disappointment and possibly demotivate them to continue involvement. Another strategy for involving and encouraging male loved ones is to provide them with tangible things to do that can help support their loved ones in recovery. 

Concrete actions might involve making meals, making a meal schedule, going grocery shopping, engaging their loved one with gardening, learning how to practice intuitive and mindful eating himself, etc. 

These concrete actions and goals can help male loved ones feel like they’re making a difference in the client’s recovery. It can also empower them as caretakers or supporters within a support system.

Resources

  1. Kahn RS, Brandt D, Whitaker RC. Combined Effect of Mothers' and Fathers' Mental Health Symptoms on Children's Behavioral and Emotional Well-being. The Archives of Pediatrics & Adolescent Medicine, 158(8), 721–729.