Further Considerations Regarding Implementing the SSFC Process
The SSFC process has proved flexible enough to incorporate the variety of presenting psychosocial needs of families and the range of emotional development seen in adults affected by EDs at QuEDS. A recent evaluation of 35 consecutive adult patients who started outpatient therapy at QuEDS revealed that approximately 70% of clients (24/35) took the opportunity to include their family in their treatment via an SSFC. Clients and carers reported that the SSFC process was a safe and accessible way to approach interpersonal problems caused by the ED that may have previously been experienced as overwhelming, conflictual, or were avoided altogether. Utilizing an already existing therapeutic relationship with the client’s key worker to introduce the SSFC helped clients accept the idea of family involvement. The one-at-a-time nature of the approach also seemed to assist with this ambivalence. The collaborative agenda setting and co-facilitation of the sessions by a family worker trained in the SSFC method who did not have a prior relationship with either the client or the family members also appeared helpful in encouraging a neutral environment for participants. QuEDS has a large multidisciplinary treatment team and the co-facilitation method also helped to extend clinician exposure to an intervention that was novel to the agency.
The low-intensity nature of the SSFC approach did initially concern some clinicians at the service who suggested that offering only a single session to families would chance “opening Pandora’s box,” with relational problems being exposed but not able to be fully addressed. Given the difficulty of engaging and retaining clients with EDs in treatment programs in general, and the importance of preserving the therapeutic alliance, this was an understandable concern. Clinicians were able to recognize, however, that family members who were more involved, even briefly, were more likely to encourage their loved one to persist in the treatment program if difficulties arose. Consequently, information and orientation to the model also needed to be provided to clinicians as well as to clients and carers. The evidence base for SSFC with other serious mental illnesses was emphasized and the safe and effective nature of the “as-needed” approach with similar complex issues like drug and alcohol problems was highlighted.
Families can have many roles in the care of an individual affected by an ED: to provide information, investigate help, instigate care, interpret treatment, support identity development, reduce isolation, resource recovery, and instill hope (McDonald, 2018). Clinicians striving to do the same for families of adults with EDs are encouraged to consider expanding their therapeutic practice to include use of single session family consultation.
