On the first day parents begin Walden’s Adolescent Intensive Outpatient Program (IOP) the question always asked is, “What about my other kids?” This question is usually brought up due to the time commitment required by parents to support their child in treatment and their being worried about their other children feeling neglected. This is a legitimate concern given the amount of time IOP can consume, including family dinners in program three times per week.

In response to this question, we tell parents that they are more then welcome to bring in the siblings for family dinner, but more importantly for family meetings. However, often parents are worried about involving the other children in treatment in fear of overwhelming them and may try to keep the eating disorder from consuming all of the family’s time. Unfortunately, when there is an eating disorder present it takes over the house and the siblings are more impacted and concerned than most parents are aware.

Adolescents in treatment often tell us that they feel like their siblings don’t care about the struggle they are going through or that they are angry at them for causing stress at home. On the other hand, siblings tend to be the ones that don’t talk about their feelings and tend to not ask questions since they don’t want to make the situation worse. The common emotions seen from the siblings are usually fear and confusion. For example, siblings as young as five have come into family meetings and asked questions like, “Will my brother/sister die?” “How come they have such a hard time at meals?” “Will they ever be the way they were before?”

Once siblings are given a chance to ask questions we discuss how they can be involved. The role of the siblings is to be a support for their brother or sister. They should not be concerned with making sure their brother or sister is eating 100% or using other behaviors. Treatment is a difficult process for adolescents to go through and often our clients need someone to vent to about treatment and their providers. The siblings can be the person who listens and offers support. At meal times they do not have to remind the client why they need to eat, but can act as a friend, someone who they can talk to about school, friends, or anything not related to treatment.

Since treatment is time consuming, we encourage parents to take time each week to spend alone time with the other kids in the family. During this time, we encourage parents to try not to talk about treatment, but instead catch up with their other children about what happened in their week and do activities they enjoy so they do not start to feel resentment toward their brother or sister that’s in treatment. If siblings are having a hard time getting along with their brother or sister in treatment, this is something they can bring up in family therapy and we can make a plan to have the kids all spend time together doing things unrelated to treatment.

About the author: 

Michelle Felton is the lead clinician of the Adolescent Intensive Outpatient Program for Walden Behavioral Care in Waltham, MA. She earned her bachelor’s degree in Psychology from Keene State College and her master’s degree in Community Mental Health from Argosy University in Phoenix, AZ. Michelle’s professional interest include the treatment of eating disorders in adolescents, athletes, and families.

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