Maudsley Family Therapy

Maudsley Family Therapy, also known as Family-Based Treatment or the Maudsley Approach, is a family therapy devised by Christopher Dare and colleagues at the Maudsley Hospital in London in 1985. It was originally intended for the treatment of anorexia nervosa in adolescents under the age of 18 in the home environment with therapeutic oversight by a trained professional. It was then adapted for use in the treatment of bulimia nervosa.^[1][2][3] A comparison study of family to individual therapy was conducted with eighty anorexia patients. The outcome of the study showed family therapy to be the most efficient approach in patients under 18 and within 3 years of the onset of their illness. Conversely individual therapy was found to be more efficient in patients over 18.^[4]

A key component of the therapy is parental oversight of the childs diet and eating behavior in the early phase of treatment. Maudsley Family Therapy is an evidenced-based approach to the treatment of AN and BN whose efficacy has been supported by empirical research.

In addition to AN and BN the Maudsley approach has been adapted for use in other eating disorders including those behaviors which lead to childhood obesity, such as binge eating, as well as for use in older patients.^[5][6][7]

Family based treatment for both anorexia and bulimia nervosa has been manualized:

• Treating Bulimia in Adolescents A Family-Based Approach by Daniel le Grange and James Lock Publisher: The Guilford Press; 1 edition (June 19, 2009) Language: English ISBN 1-60623-351-3 ISBN 978-1-60623-351-1
• Treatment Manual for Anorexia Nervosa: A Family-Based Approach by James Lock MD PhD, Daniel le Grange PhD, Christopher Dare Publisher: The Guilford Press; 1 edition (October 20, 2000) Language: English ISBN 1-57230-607-6 ISBN 978-1-57230-607-3

Phases of treatment

There are three phases involved in the Maudsley method, the treatment usually lasts one year and involves between 15-20 sessions.

Phase I: Weight restoration:

In Phase I, the therapist focuses on the physiological, cognitive and emotional effects of malnutrition associated with AN. One major component of this phase is restoring the adolescent's weight. A key psychological aspect of phase one is externalizing the illness.

Phase II: Returning control over eating to the adolescent;

This phase involves the adolescent gradually taking control over their own eating again.

Phase III: Establishing healthy adolescent identity

Phase III begins when the adolescent is able to maintain their weight above 95% of ideal weight on their own and no longer engages in self-starvation. Treatment focuses on the psychological impact AN has had on the adolescent's identity and the formation of a healthy adolescent identity.

FBT certification

Family-Based Treatment is a distinct form of Family therapy. FBT was initially developed for anorexia nervosa and later adapted for bulimia nervosa. Certification of family-based treatment therapists is available through Training Institute for Child and Adolescent Eating Disorders at either Stanford University in Palo Alto, California or the University of Chicago in Chicago, Illinois. Certification training requires basic and advanced workshops and 25 hours of supervised training on 3 cases during three treatment phases.

See also

• Eating disorders
• anorexia nervosa
• bulimia nervosa

References

1. ^ Wallis A, Rhodes P, Kohn M, Madden S. Five-years of family based treatment for anorexia nervosa: the Maudsley Model at the Children's Hospital at Westmead. Int J Adolesc Med Health. 2007 Jul-Sep;19(3):277-83. PMID 17937144
2. ^ LE Grange D.The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry. 2005 Oct;4(3):142-6.PMID 16633532
3. ^ le Grange D, Crosby RD, Rathouz PJ, Leventhal BL. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Arch Gen Psychiatry. 2007 Sep;64(9):1049-56.PMID 17768270
4. ^ Russell GF, Szmukler GI, Dare C, Eisler I. Arch Gen Psychiatry. 1987 Dec;44(12):1047-56. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. PMID 3318754
5. ^ Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol. 1994 Sep;13(5):373-83.PMID 7805631
6. ^ Wildes JE, Marcus MD, Kalarchian MA, Levine MD, Houck PR, Cheng Y.Int J Obes (Lond). 16 February 2010. Self-reported binge eating in severe pediatric obesity: impact on weight change in a randomized controlled trial of family-based treatment. PMID 20157322
7. ^ Kalarchian MA et al. Family-based treatment of severe pediatric obesity: randomized, controlled trial. Pediatrics. 2009 Oct;124(4):1060-8. Epub 28 September 2009. PMID 19786444

Bibliography

• Le Grange, D., & Lock, J. (2005). Help your teenager beat an eating disorder. The Guilford Press, 1,
• One Spoonful at a Time by Harriet Brown N.Y. Times Article on the Maudsley approach.
• The Maudsley family based-treatment for adolescent anorexia nervosa. Daniel LeGrange World Psychiatry 2005 Oct;4(3):142-146 PMCID:PMC1414759 Article
• The Maudsley Model for Children and Adolescents with Anorexia Nervosa: Theory Clinical Practice and Empirical Support. Paul Rhodes ANZJFT; Dec.2003:(4) Article;[1]
• Family-based Treatment for Adolescent Eating Disorders: Current Status, New Applications, Future Directions Loeb, KL and Le Grange, D. Int J Child Adolesc health 1 January 2009;2(2):243-254
• Family-Based Treatment May Be Effective in Severe Pediatric Obesity

External links

• Maudsley Parents
• Brave Girl Eating, a memoir
• Training Institute for Child and Adolescent Eating Disorders
• My Kid is Back: Empowering Parents to Beat Anorexia Nervosa
• Using the Family to Combat Childhood and Adult Obesity
• Family-Based Obesity Treatment, Then and Now: Twenty-Five Years of Pediatric Obesity Treatment
• F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders)
• Eating With Your Anorexic, a memoir