Family Based Therapy

Historically, parents have been blamed for causing their child’s eating disorder; however, this is certainly not the case.  Rather, they are essential to the treatment plan in. most cases.  In one form of treatment, they are the essential piece in beginning the nutritional stabilization of the child- at home.  Many times, parents are blamed for the development of their child’s eating disorder, but they are not the cause. Family-Based Therapy, or the Maudsley Approach, to eating disorder treatment sees parents as an ally in the treatment of their child. This three-phase model of treatment has proven to be very effective, and is the most evidence-based treatment for teenagers with anorexia nervosa. Typically conducted in 15-20 treatment sessions over 6-12 months, the Maudsley Approach is considered by some to be the first-line treatment. Parents play an active role in helping their child to restore weight, gain back control over their eating, and encouraging normal adolescent development and relationships.

 

PHASE I

The first phase of the Maudsley approach is largely dedicated to rapid weight restoration of the adolescent and the coaching of his or her parents. The child has no say in their meals, and parents have complete control over the planning and preparation. There is typically a family meal eaten with a therapist or dietitian to provide an opportunity to coach the parents. Pushing and encouraging their child to eat the amount of food necessary for weight restoration can be difficult, so the professional can demonstrate proper, supportive techniques. It also provides an opportunity for the therapist or dietitian to observe the family’s typical interaction around eating so that any issues can be addressed during treatment. It’s also important in this first phase to encourage the adolescent to begin establishing or re-establishing relationships with siblings and peers to avoid being “taken up” into a parental relationship.

 

PHASE II

The second phase of the Maudsley approach focuses on encouraging parents to help their child take back control over their eating. For this phase to begin, the adolescent needs to have accepted the parental demand for increased food intake, shown steady weight gain, and any family tension around food should be showing signs of relief. Other family or parenting issues that have not been addressed can be brought up in therapy during this phase as well.

 

PHASE III

The third phase of treatment focuses on healing the impact the eating disorder has had on the adolescent and their establishment of a healthy identity. The adolescent should now be able to maintain a weight above 95% of their goal all on their own, and parents support increased autonomy with appropriate parental boundaries. The therapist and/or dietitian work with the family to restore a normal, age-appropriate lifestyle together.

 

Although the Maudsley Approach was originally developed for treatment of anorexia nervosa in adolescents, it has proven to be an effective treatment model for adults and those with bulimia nervosa as well. Allowing for exploration of other family issues, behaviors, or attitudes, this approach encompasses factors beyond just the eating disorder and recognizes that neither the ill individual or their family are to blame for their behaviors.