Videoconferencing: Bringing Family Therapy to Remote Areas

Treating patients with anorexia nervosa usually requires a multifaceted approach that includes psychopharmacology, nutritional, and psychological and medical management programs, among others.

Family therapy is a critical components of treatment, particularly for young patients, but it requires that all family members participate when possible. This can be especially challenging when the family lives in a remote rural area because most comprehensive hospital-based treatment programs for eating disorders are located in large urban centers.

Two physicians at Children’s Hospital of Eastern Ontario, Canada, have used modern technology to allow a rural family to have access to their hospital’s family therapy program (Telemedicine Journal and e-Health 2003; 9:111). Gary S. Goldfield, PhD and Ahmed Boachie, MD, used the hospital’s Telehealth program to conduct family therapy with a 16-year-old patient with restricting-type anorexia nervosa and her family. The family lives in a small city in Northern Ontario, far from Ottawa.

An emergency admission

The girl was first admitted to the hospital on an emergency basis, with a body mass index (BMI) of 15.4, blood pressure of 98/60, and hypothermia. Nutritional therapy was begun.

After the patient’s condition stabilized, Drs. Goldfield and Boachie arranged a face-to-face family assessment conducted with all family members, to learn more about the family dynamics and to encourage the parents to take charge of their daughter’s problems. The family agreed to try the hospital’s Telehealth videoconferencing program. The communications system has a feature that allows camera control by family members and by the hospital. The ability to control each other’s cameras and to pan around the room allowed the therapist as well as the family to see facial expressions and to read body language from both locations.

All 8 sessions were held with the patient’s father and sister in their own community and the patient and her mother and the therapist in the hospital. Sessions were conducted once a week and lasted about an hour.

By the end of the eighth session, the patient felt closer to her family, particularly to her father. At discharge, she had gained significant weight and had a BMI of 19.5. She accepted the fact that she had an eating disorder and was taking responsibility for her recovery. She also was now aware of the many emotional issues that were involved in her illness. As for the family, all members reported being highly satisfied with the arrangement, and had no concerns about confidentiality.