There is exciting news in eating disorder treatment!
Recent research into a particular kind of family therapy approach shows remarkable promise: Family-Based Treatment, or "The Maudsley Approach." As one of the leaders in the field was quoted saying in October 2010, this approach: "should be the gold standard or first-line outpatient treatment for medically stable teens." In a field where there is very little data on what works, this research offers both optimism and strong results.
The evidence has been mounting for decades, but the most recent studies confirm what has been a growing interest in this approach. Despite lingering skepticism in the field for this departure from usual treatment, a 2008 paper published in the Journal of Clinical Child & Adolescent Psychology said "At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa."
The authors of another 2008 article (available by special permission on the FEAST site) describe published research on family-based interventions showing "at 4-5 year follow-up, the majority (60-90%) will have fully recovered while only 10-15% will still be seriously ill"... "Outpatient family therapy compares quite favorably to other treatment modalities such as inpatient care where full recovery rates vary between 33% - 55%."
Put simply, the Maudsley Approach sees the parents of the ill person as the best ally for recovery. The effects of dieting (or insufficient food for a person's activity level) are for many people a self-perpetuating cycle that requires intervention. In this evidence-based approach, parents are seen as the most committed and competent people in the patient's life and therefore best qualified to find ways to fight the illness, to regain healthy weight, and end unhealthy behaviors.
Without question, the Family-Based Maudsley Treatment approach represents a very different way of looking at eating disorders and treatment from traditional approaches. Some in the eating disorders community are shocked and even offended by the emphasis on nutrition and behaviors instead of insight and motivation. Still others remain skeptical of the role of parents in the treatment. Yet the results are clear: there is no other scientifically-validated treatment approach for adolescents with anorexia living at home who have been ill fewer than three years. The approach is also appropriate for bulimia and for older patients whose families are able to take on this role, according to leading researchers in the field.
In most cases, the treatment has three phases over a period of 6-12 months, led by a family-based therapist (some family therapists do family-based therapy, most do not), and involve the entire family in hour-long weekly sessions. The parents are coached in how to help the patient eat (and/or stop purging and over-exercising) and siblings are encouraged to ally with the ill sibling. Patients are neither expected to nor asked to cooperate - in fact in the first session of Family-Based Maudsley Treatment a family meal is eaten in the therapist's office and the ill person is asked to resist eating to demonstrate the difficulties and dynamics of the family around the meal.
(The treatment for bulimia is slightly different: the patients - usually older and more ready to engage in therapy - are more involved with the problem-solving phase of recovery.)
No one is blamed in Maudsley treatment - the illness is not seen as anyone's fault. In fact, finding cause for the eating disorder is not part of the treatment at all.
The Family-Based Treatment / Maudsley Approach to eating disorder treatment was first developed by progressive clinicians in the 1980s at the Maudsley Hospital in London. Initially used for anorexia nervosa, a modified version appropriate for bulimia nervosa is also in use. Clinical treatment manuals are available, published by Guilford Press (Anorexia manual / Bulimia manual ). Since successful use in the UK, the treatment has spread to the United States, Australia, Canada, France, Germany, Israel and Poland. Research has validated the use of the Family-Based Maudsley Treatment approach for use with children and adolescents living at home. Modified versions of the original protocol have been used successfully with older patients, multi-family group trainings, Binge Eating Disorder patients, and for couples.
The three phases of treatment are:
- Parents take responsibility for decisions of what, when, and how much the ill patient eats as well as behaviors around food.
- After weight restoration is nearly achieved, control is carefully given back to the patient.
- Finally, the therapist and family work to restore normal and age-appropriate lifestyle and relations between family members.
At this time it is still difficult to find clinicians trained in the Family-Based Maudsley Treatment approach. Unfortunately, many parents will find that their local clinicians are either unfamiliar with or openly dismissive of the approach. It will take time for information and training to find its way into widespread practice, but parents can travel to evidence-based clinics for treatment or arrange for consultations between modern clinics and local resources. Clinicians interested in learning about or training in the approach can contact TRAIN2TREAT4ED.com.
For more information on Eating Disorder treatment approaches, please see our Treating EDs page.