Dear Readers,
While researching the article, “Family Based Treatment: New Directions,” which appeared in the Summer 2009 edition of Eating Disorders Recovery Today newsletter, I gathered more good material than I had space for. So I’m devoting some blog posts to interviews that didn’t make it into the article. This one, on Dr. Pierre Leichner’s work with meal support for kids with eating disorders, will be a two-parter, so stay tuned for the next installment!
For those of you who are not familiar with Family Based Treatment (FBT), also known as the Maudsley approach, it emerged about twenty years ago from researchers at the Maudsley Hospital in London. A central feature of FBT is that parents, who were once blamed for the child’s disorder, become an integral part of the recovery process through refeeding their child at home. This method, though demanding on the parents, has been shown in studies to be highly effective, and is growing in popularity in the United States.
My goal in the article was to see how Maudsley is being refined and adapted in the U.S. I found a number of examples of such innovative work, but I also encountered several practitioners who, completely separately from FBT, developed techniques that emphasize the important role of parental support and help in adolescent recovery from eating disorders.
One of these experts is Pierre Leichner, M.D., psychiatrist and former psychiatric director of the eating disorders program at the British Columbia Children’s Hospital in Vancouver, who developed a family meal support program.
Fifteen years ago, Dr. Leichner began to see two trends emerge : an increasing emphasis on client satisfaction and client feedback in clinics, and the realization that friends and family could be important aids in recovery. The old hierarchical model was giving way to a more egalitarian, collaborative approach, whether the treatment was for eating disorders, drug addiction, diabetes or depression.
In the late ’90s, Dr. Leichner developed, through trial and error, a more collaborative way to coax eating-disordered children and adolescents to eat again. Dr. Leichner calls meal support therapy--where a group of eating-disordered patients eats meals with the help of a coach--“one of the most underrated and understudied parts of managing people with eating disorders.” If therapists and doctors “can find common ground with the patient” instead of forcing the patient to eat in order to recover, Dr. Leichner discovered, the results could be exceptionally good.
Dr. Leichner relied on interviews with former patients to help refine his meal support technique. “We peeled away the onion constructed of medical myths: You can’t trust a patient to tell you what works, you can’t trust a patient to do exercise, you can’t trust them to serve themselves meals—those were all myths,” he says.
At British Columbia Children’s Hospital’s Intensive Treatment Service (ITS), up to 12 inpatients sit down to regular meals with two support staff members. A patient new to the group might have meals served to her or him for the first week or so, but within a month, most are serving themselves. The setting is homey, with metal cutlery and glassware. Food is served family style, in large bowls set out beside the table. Patients serve themselves, and then sit down. All have been coached before by a dietitian on serving sizes and quantities before the meal, so supervision at the meal is minimal.
“We strive for more and more autonomy, until patients feel comfortable sitting at the table for a full half hour,” says Dr. Leichner. Soon, patients who were refusing to eat or drink, some of whom were being tube fed when they arrived, are feeding themselves on their own. “It’s difficult to do,” Dr. Leichner says of his method, but the positive environment of the meal setting and the way the staff “rewards recovery” rather than continuation of bad behaviors makes change possible.
Take care,
Nancy
Coming in the next and last installment of this post: Continuing meal support therapy at home after leaving the hospital.
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