Some of my most heart-breaking work is with higher weight adults and their parents, usually mothers. The pain of both child and parent is evident, as is their frustration, confusion and helplessness about how to discuss matters of weight. I write this blog to give guidance to both parties partaking in this family therapy experience.

Generally parents (usually Mom) and adult children (usually Daughter) haven’t been in therapy together, but sometimes times they have a long, unhappy history of family therapy. In either case, here’s what each typically feels as therapy begins. My higher weight client feels highly vulnerable speaking directly with her mother about such a tender subject, for the first or umpteenth time, expecting to be blamed and shamed.

Equally, Mom (or Dad, or Dad and Mom) come in feeling frustrated, helpless and guilty. Most often Mom is also worried about her child’s health which adds to the difficulty of having a rational conversation. Moreover, parents too anticipate that discussions will be as painfully unsuccessful as previous ones were. Both parties are on edge and would probably rather be almost anywhere else but in my office together about to share emotions that are some of the most difficult they may ever experience in their lives.

In order to make the experience productive, my job is to ensure that client and parent feel emotionally safe and heard. Sometimes each, or both, is articulate and other times I may need to do much of the talking to explain how the parties feel. Usually the daughter is ashamed of her weight, fears hurting her parents by putting any blame on them, and strives to take all the responsibility for her size. Clients are generally highly protective of their parents, which covers considerable repressed rage at them for being too under- or over-involved or invested (or a mixture of both) in the client’s life (and size).

The truth is that I’ve never met parents in my office who were not on some level relieved to get authentic feelings out in the open in a constructive way. They’ve been feeling guilty and frustrated for so long that they either caused or couldn’t fix their child, that they’re eager to learn what they can do differently. Some cry when I tell them that whatever they did, they tried their best, and that it’s now time for their adult child to be responsible for taking care of her (or his) own body. The hardest thing for parents is to tolerate their helplessness during this transition to the client feeling 100% ownership of her body. This shift makes clients feel empowered but also frightened that they won’t succeed in self-care based on their past experience.

Of course, this is just one kind of beginning with parent and an adult child of higher weight, but it has been typical in my clinical experience. My job is to get and keep the ball rolling. The rest is up to them.

Best,

Karen

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