Shaping Space to Support Siblings

This post was originally written for F.E.A.S.T. and first published on 1 June 2020. Thank you for the invitation to contribute Judy Krasna!

Engaging in family therapy is often a momentous undertaking, both pragmatically and emotionally. From finding a therapist, to scheduling, and rallying the troops to the first meeting, there is a tremendous amount of time, persistence, and persuasion involved on the parents’ behalf. As a family-based treatment therapist, parents often ask me if siblings need to participate in the family meetings. Most often, parents are reluctant to bring them for a variety of reasons, from not wanting to disrupt their soccer practice to wanting to keep the peace with their loved one with an eating disorder who does not want them to come. Despite these hurdles, the sibling perspective and experience is critical, not only because siblings are valuable sources of both observations and support. They also have their own concerns that need to be heard and cared for.

Siblings of individuals that are experiencing an eating disorder are in a unique role. Many times, they are the ones to first notice signs that something is amiss with their sister or brother. Additionally, many find themselves in a bind between being both their sibling’s confidant and their parents’ confidant. When they do participate in family therapy, siblings often walk a tenuous line between sharing what is going on for them and navigating potential rage from their sibling when they express concerns for their eating disorder behaviors. In family-based treatment, we coach parents and siblings to have siblings take a step back from managing concerning behaviors and just be in their usual brother or sister role – to hang out, play games, talk, or watch movies together. In practice, however, this is much more challenging, as they often witness concerning behaviors that parents miss or are not present for.

Due to these stressors, along with the parents’ pressing need to pull their other son or daughter out of an eating disorder, the siblings’ needs frequently take a side or back seat, not only by parents, but by siblings themselves. They often pick-up the slack around the home, take care of managing their own day-to-day trials and tribulations, and buoy the family’s despair with their successes and independence in their own lives. Time and time again, I hear siblings tell me, and their parents, that they are “fine” and just want to know how to help. The flipside of this is that I also hear how upset siblings are with how much of their lives are taken up by their sibling’s eating disorder behaviors, and they don’t want to spend any more time on it by coming to family therapy.

When we allow siblings to stay in these spaces, we miss a valuable opportunity to usher siblings through their own developmental and emotional encounters. Siblings that state that they are fine may very well be fine, but naming the challenges and creating a consistent check-in with them solidifies that despite the rest of the emergencies going on, they are still seen, heard, and cared for. Siblings that want to help their sister or brother and participate in family therapy only in ways focused on their sibling can end up feeling invisible and drained from being in a support-only role. When they remove themselves from the situation, distance themselves from family, and refuse to engage in family therapy, siblings can develop their own ideas of what is going on, anxieties can grow, and they miss out on conversations that build understanding, connection, and healing.

There are many experiences, feelings, themes, and phases that siblings go through when they have a brother or sister that is experiencing an eating disorder and these can vary across time, based on their own age, their developmental level, proximity to behaviors, the severity of their siblings’ illness, and their level of involvement in their sibling’s recovery. As parents and providers, we can all help to create space for them, consistently, to name the challenges and feelings, and to have a space free from the illness. This could be an open invitation on the therapist’s behalf to have sibling-only check-ins. It could also be a weekly date with a parent, where ED talk is off the table. It could be a special ritual, like reading together at bedtime. Big, small, or both, the goal is to make this space consistent and 100% about the sibling. While this is especially hard when one is on the front lines fighting the fire of the eating disorder, it is essential for a sibling to know that there is a place to go that is “smoke-free” and available just for them to provide the space they need if, and when, they need it.