With special thanks to Jill Lubienski and the South, Mid and West Wales Specialist Eating Disorder Teams
Every year without fail my uncle sends packages of mangoes from our farm in a rural village in India and with anticipation, we look forward to enjoying their juicy delights as part of a family ritual. There is a tradition to how they are eaten and passed down through the generations. The maternal head of the household- usually the mother slices them all, arranged on a plate, and is the one that eats the middle pulp section- is often seen as the least favourable but is often secretly the most delicious and messy !! My daughter recently said to me as she was waiting for her slices, “ Mum why do you always have the middle bit”- to which I exclaimed “It remains one of the few places where I have some authority” and we laughed.
Later on, I began to think about this again within the concept of parental authority- much espoused within NVR literature and a concept that we speak to a lot in our work with parents. Within the “mango ceremony”- my role as the mother cutting the mango- is legitimized by history and culture. It is a performance carried out with assertiveness and a right to which I feel very entitled and present. There is no choice, no arguments, no escalations. Even my tone and body language show confidence and that the family are observant of this role and ritual. It feels good. It also has within it all the concepts of an old authority that jokingly I reminded everyone no longer resides within many parental roles in family life. No wonder it is such an alluring moment!
And yet for parents living with their children or young person with an eating disorder, this legitimacy to feed, to choose and apportion meals, to enjoy, to remember family traditions erodes over relentlessly long periods of time. This sense of authority that can sometimes tantalise us to command meal times of the ‘old’ can flare up during meal times and then lead to hopelessness, loss and grief of what can no longer be. We often speak of the escalation pattern of symmetry and complementarity that unfolds again and again which leads to battle-weary lives both at the dinner table and outside.
So how can we savour more of these ‘mango moments’ – however small that legitimise parents’ rights to hold these spaces with assertion, nurturing presence and dare I say a little humour? In a recent training that my colleague Jill Lubienski and I undertook specializing in working with NVR and Eating Disorders, we were able to explore these experiences for practitioners in helping parents in occupying these most troubled of spaces, the family meal time and with their participation harness and adapt the Cycle of Supported meal framework as part of an NVR intervention.
The Cycle of Supported Meal is described by John Burnham, Beki Brain and Juanella,(2021 June 175 Context Magazine) as a five-part cycle of supported meals (highlighted in bold black) which is associated with the family-based treatment of Anorexia Nervosa. This article usefully punctuates each part of the cycle with principles from NVR to assist in raising parental presence.
The specific contributions from our NVR training are in blue on the cycle which I will explore in more detail:
NVR Contributions to the Cycle of Supported Meals
- Between
The between phase is when the parent is supported and coached in developing a plan about both the meal, the portion, how it is prepared and who is present as well as exploring setbacks. In our training, we asked how might parents who are spinning multiple plates prioritise what is important right now. Practitioners reminding themselves and the parents of the life and death struggle being the small plate priority was an important conversation that was often lost in the overwhelm and complexity of family dynamics. Creating a visual aid through ‘plates’ was an important practice tool that highlighted uniting parents into their legitimate right to keep their child healthy and alive as a priority. Also creating a language of resistance around any associated violence was explored- this still remains taboo for practitioners for fear of humiliating, shaming and increasing the risk of deterioration and yet for a young person to experience parental strength that denies violence can only appeal to the part of the young person that also wants the violence to stop. Use of supporters and asking friends, aunts, and grandparents to assist in shopping to buy the necessary food that has the dietary and nutritional requirements for this phase of treatment seemed essential as parents became exhausted by demands around low calories, low fats, vegan and vegetarian arguments dominated by disordered eating and not life choices. Values to promote parents’ self-care such as courage to keep going, grounding, mantras and imaginary techniques to position and anchor themselves in their child’s life that parents can embody are practiced through role plays. This then can become habit forming if never second nature. Knowing this is their right as parents to anchor physically in their child’s life – all speaks to the resistance movements by our founders that harnessed these energies to occupy spaces where they were not welcome. The between space gives parents opportunities to voice and be coached by the NVR practitioner to both the struggle, to dare to imagine and to plan actions before the cycle begins.
- Just Before
The just before the meal phase involves practices of de-escalation in the moment, strike when the iron is cold, pressing pause, breathing, remembering mantras related to the small plate, “I am keeping you alive” “ I will not be provoked”, preparing seating arrangements for low stimulation, parental unity or support from others, planning where are they seating, what code do they use to support each other, what are the supportive messages coached between parents/ supporter and remembering the logic of control- “I can only control what I do” “The success is in my response and not whether my child eats or not”. The just before is underpinned by the work done in the between phase.
- During:
During the meal practitioners shared the importance of keeping things simple with the principle of connection and persistence. Parents embodying the new authority position with a brief supportive statement of acceptance and confidence. “ I know this is really hard but you can do this”. Noticing their own embodied presence that depicts not only their own courage but connecting non-verbally to their child that they too have courage.
- Afterwards:
The period after the meal often involves having to sit quietly for a period of rest, often with a parent. One practitioner spoke in the training of the importance of the parent to forgive both themselves and their child during this phase- if things did not go to plan. The idea of forgiving the relationship brings to mind the reconciliation gestures, acts of unconditional connection, reparation and that this relationship matters no matter what. Often these gestures are connected to food so in this context gestures were often loving words given afterwards without any probing about the mealtime that could stimulate shame. Shared activities such as watching a movie or a favourite Series such as “Friends” or “ Greys Anatomy” (These seemed popular in our training group !!), light chit chat about nothing in particular that highlights vigilant care that says without words “I am not blaming you and I know that you are suffering but life keeps going”.
- After Afterwards:
The after afterwards is a short period of time between meals in which some element of resistance is important to instill legitimacy and energy into the depleted system. So in our training we explored how might “sit-withs look like” and came to a shared understanding that if a meal had not been consumed as a priority a very very short sit-withs ( 30 seconds to 1 minute) for that day is carried out. This would be practiced carefully and risk assessed in advance in the between phase which the parent would be coached to think of a time, perhaps 7 pm (after meal and the afterwards time and before snack) to go to their young person’s room or where they are ( not at the dining table) and say a brief statement such as “at 5pm today, you threw your dinner on the floor, this is not ok, love. We know you can do this even though its hard” . The parent is coached to use assertive, yet loving and clear voice tones, to notice their bodies posture and position- to breathe for those 30 seconds after their message. To end their message with a loving statement. “We are downstairs, be lovely to see you in a bit. Love you”. This takes energy and time, for some having a supporter to send a message like this at 7 pm that says “ Your mum and dad mentioned you hadn’t eaten your evening meal. We know you can do this even though it’s hard. I’m here to listen. Love you” on alternative days may offer much-needed respite and an appreciation of all that the parents are doing and reminding the child they are not alone.
And then we move again to 1. Between spaces with NVR practitioners where ‘setbacks’ what’s achieved, coaching again, building upon the foundations and so on and so forth.
Concluding thoughts.
During the training practitioners who were working in the field described how the cycle of supported meals occupied most of each day. Parents and their children prioritise six meals or snacks each day so we recognized earlier on that the NVR contributions needed to fully coach the parents and be practiced by parents in advance so that the ability to be able to regulate, choosing a position of strength, peace and connected silence could be possible. Certain methods such as sit-withs, supporter messages had to be timely, short and very very sweet. The gestures of reconciliation needed to connect to quality of time together and activities that liberate parents and their children from the roles that are driven by the eating disorder, so that other voices and parts can be revealed. We hope that these NVR additions complement the existing high-quality of interventions and theoretical evidence within Eating Disorder Services and the incredible work done.
Thinking about the idea of parental authority around food reminds me of the multi-sensory processes involved in this ever-evolving cycle of food as nourishment, connection, memories and rituals that become disrupted. That within the NVR contribution to the Cycle of Supporting Meals, helping parents both to imagine moments where parents can recreate a sense of their own agency and step into their own sensory relationship with food restores memories from their own cultural heritage. A reminder and a hope that each parent has a right to a ‘mango moment’ and that with time so will their child.
Written by Shila Desai, Family and Systemic Psychotherapist / Supervisor
Senior Clinician & Trainer
NVR Association (NVRA) Accredited Practitioner and Supervisor
Illustrated by Rose McGowan and with special thanks to Jill Lubienski and the South, Mid and West Wales Specialist Eating Disorder Teams.