A topic we discuss regularly with carers is the importance of alignment. But what do we mean by the word ‘alignment’ in eating disorder treatment?   

Alignment means presenting a united front against your young person’s eating disorder, be it parents, carers and/or the treatment team. Presenting a united front is important because it protects against triangulation by your young person and their eating disorder (in this context, triangulation refers to the splitting that can occur if your young person preferences one parent’s approach to the eating disorder over the other). Parents may feel pulled to align or side with their young person in distress, which can inadvertently mean siding with the eating disorder. We understand that this is a normal reaction for parents to want to ease their child’s distress and we are all doing the best we can with the knowledge we have. However, when triangulation occurs with one parent, it can leave the other parent with a sense of betrayal, moving the focus away from the main goal of addressing the eating disorder.

A sense of camaraderie and common purpose is vital for all members of the care team.   

Carer alignment is especially important when carer/s are co-parenting between two different homes. Sometimes, in a co-parenting arrangement, the young person may openly preference one parent over the other, as they are seen by the eating disorder to be the carer that won’t push for full adherence to the treatment plan. If this type of splitting behaviour is outside of your young person’s usual values, then we should always remember to attribute that behaviour to the eating disorder and not your young person. 

Alignment isn’t necessarily about each carer doing the exact same tasks in the exact same way…it means having the same larger, shared vision and establishing each person’s strengths within that framework. Does one of you feel more confident about setting boundaries? Is one of you more confident with meal support? Think of this like project management and divide out the various tasks to each carer, based on your individual strengths (ie grocery shopping, meal preparation, meal support, post-meal distractions, medical appointments etc). Acknowledge each other’s strengths and lean into those.

Here’s how to practice the ALIGN method at home with your partner or fellow members of your care team:

ADAPT:

Understand that treating an eating disorder will require you to constantly adapt your approach. Listen and be open to suggestions from one another, from the treatment team, and from your young person (not their eating disorder!). Don’t get too attached to one particular approach as the eating disorder is a shape-shifter and what works this week may not be effective next week.  

LISTEN: 

Make it a habit to practice active listening and non-violent communication when discussing care of your young person (eg try not to talk over each other; practice active listening; try to understand the other carer’s experience/point of view, use I statements to express your perspective). Reflect on what has been said. Ask for clarification. Give your response. Repeat.   

INVESTIGATE: 

Investigate not Interrogate. ‘Help me to understand what’s going on there’ vs WHAT IS WRONG WITH YOU? WHY DID YOU DO THAT? Take intentional time to check in with each other and ask open-ended questions to one another: How is your energy level? What feels different right now? What adjustments are needed? Am I seeing everything you’re seeing? 

GRATITUDE: 

Find times daily to express gratitude to one another for reasons including caregiving of the young person and other reasons that have nothing to do with treatment. This is hard work. Being seen goes a long way. 

NOURISH: 

Feed yourself too. Take individual time away from your young person for your hobbies/interests if you can, even a walk with a friend or a coffee in the sunshine. Farm out some tasks to your village…can a friend/family member take your other children to sports or to school or for a sleepover or a meal? Say no to things more than you think you need to…it’s okay that you can’t do everything right now. Put on your own mask first so you are able to help your young person.  

Finally, please remember that this is not about getting it perfectly right all the time. These skills take time and practice and we are constantly learning what works and adapting our approach…feedback not failure.  And please do reach out to us at EDV for further resources to support you in your caring role. 

With thanks to Equip Health for permission to reproduce this content