Healing functioning through family therapy

March 14, 2023

At first, when Ramira and Silvestre Morales’ youngest daughter began losing weight, it didn’t seem like a big deal. But then she began to lose weight faster. Too fast, in fact.

So they sought help from Venice Family Clinic, their family’s trusted health care provider for the past three decades. At the check-up, Ramira and Silvestre discovered that their middle school-age daughter had lost 25 pounds in one month because of disordered eating. They were shocked, upset, worried and confused.

So their clinician connected the family to the Clinic’s Behavioral Health department via on-call services so they could speak to a therapist that same day.

Director of Behavioral Health Iliniza (Nisa) Baty was on-call that day and ended up working with Ramira, Silvestre and their daughter over the next few months, sometimes together and sometimes separately.

“We didn’t know what our daughter was going through, why she started losing a lot of weight. Nisa was a lot of help to us in understanding it,” Silvestre said. “We felt guilty as parents and blamed each other, but Nisa said not to blame ourselves, that these things can happen.”

Addressing issues together

Getting their daughter to a healthy weight and headspace was going to take a team effort, from both the clinical and family points of view. A case like this one was just one of the reasons why over the past several years Baty has focused on building her department’s capacity to work effectively with families.

Historically the Clinic’s Behavioral Health program focused on adults and individuals. Once we began providing mental health services in 2018 at Culver City Middle and High Schools through our Sandy Segal Youth Health Center, the Clinic started to incorporate more family therapy into its services generally. Baty says that now more than half of our therapists are comfortable working with families, helping to bring positive change to family systems and its members.

“Family therapy is a crucial model to creating healthier functioning, and the earlier the intervention the better,” Baty said. “Oftentimes there is multigenerational trauma, and the best way to interrupt that transmission is to support parents with their children. If you can address the functioning of the family – the way the system responds to internal and external stressors – you can increase the structural supports that contribute to a child’s resiliency, ability to cope and capacity to have healthy relationships into adulthood.”

Looking at the whole picture

Baty worked with Ramira and Silvestre’s daughter individually, helping to challenge distorted belief systems she had about herself and learn how not to mute feelings of hunger. Baty also taught Ramira and Silvestre about disordered eating and body dysmorphia, as well as how to manage stress with coping strategies.

At one point Ramira and Silvestre’s daughter needed to be admitted to a hospital, and Baty helped them process the shame and blame they felt for themselves about the situation. She also advised them how to approach their daughter’s return home – among other things that they should create routines around meal times and reduce the amount of hovering over her they were doing.

“When kids are depressed or anxious, it usually shows up behaviorally. Something is going on underneath, and the behavior is a cry for help,” Baty said. “Parents want the best for their children, but when they don’t know what to do, they may hover or get exasperated, and that can be smothering for the child. Creating space for dialogue within the family can be constructive, so that parents can learn what does work for their children. The family therapy process often leads to a parent saying they could use some support as an individual, too.”

Once Baty got a better understanding of the Morales family’s dynamic, she realized that the daughter wasn’t the only one experiencing mental health issues that affected other family members.

“I’m a very anxious person. I don’t always know how to cope with my anxiety, and my children can see that,” said Silvestre, who eventually had seven sessions with Nisa on his own. “Nisa helped me learn ways to be more calm. She taught me that we can help our children more if we stay calm, be understanding and take time to learn. When my wife and I blame each other, our daughter gets worse. When we’re calm and controlled, she gets better. Nisa taught us how to take care of ourselves and each other.”

Feeling good about the future

Today, Ramira and Silvestre’s daughter is much better: The high school sophomore’s eating is no longer disordered, and she enjoys playing sports in school. She has shared her personal journey with friends, who are supportive. One friend has even turned to her for advice, as their sibling has an eating disorder.

Ramira and Silvestre continue to work on themselves, too. To help alleviate anxiety, Silvestre takes walks and does breathing exercises that Baty taught him. The couple enjoys hiking together in the Santa Monica Mountains to de-stress as well.

“A lot of mental issues happen in our community, and many people don’t know how to ask for help or who to talk to. We know our case isn’t the only one,” Ramira said.

“Venice Family Clinic was the first place we found help when we moved here from a small village in Oaxaca, Mexico, 30 years ago. It’s a big part of our family. They’ve helped us with medical problems, immigration paperwork, school physicals for our children, and our mental health. Now we know it’s very important to get therapy and where to get help if we need it. We feel more hope for the future now.”