In my last post I introduced the concept of the Maudsley approach to family therapy and eating disorders. Today, let's explore the approach in more detail...
The Maudsley approach to eating disorders treatment is based on a method developed by two British researchers, Christopher Dare and Ivan Eisler, during the 1980’s at the Maudsley Hospital in London. The approach has since grown in popularity with the help of researchers and eating disorders specialists Drs. James Lock and Daniel le Grange.
As mentioned in my previous post, results of studies investigating the Maudsley method are indeed promising. The approach was developed, in part, out of the need for better-researched methods of intervention for eating disorders, and in response to the rising costs of inpatient care and the restrictions by insurance companies on coverage of inpatient care. Controlled research trials were conducted in order to evaluate the effectiveness of the Maudsley method and to determine the best duration and frequency for interventions.
The Maudsley approach, in essence, is a family centered method of treating anorexia and bulimia. It emphasizes that, in contrast to some more traditional theories, the parents are not the cause of their child's eating disorder. Instead, it sees the parents as key players in eating disorders recovery. According to the website MaudsleyParents.org, this method of ED treatment can be construed as an intensive outpatient treatment where parents play an active and positive role in order to:
- Help restore their child’s weight to normal levels expected given their adolescent’s age and height
- Hand the control over eating back to the adolescent, and
- Encourage normal adolescent development through an in-depth discussion of these crucial developmental issues as they pertain to their child.
The stated goals above form the outline for the Three Phases of Treatment in Maudsley Therapy. In the First Phase of Treatment (1-10 sessions), weight restoration of the patient is the key target of interventions. In this phase, the healthcare professional will assess the family’s typical interaction pattern and eating habits as well as assist parents in re-feeding their child. Weight restoration becomes a joint effort between therapist, parents, and child. Sibling support is also garnered during this phase. A key intervention of this phase is the "therapeutic family meal" (or "coached family meal") is typically conducted during this phase. For information on how to conduct a therapeutic family meal, see the resources below.
In the second Phase of treatment (sessions #11-16, approximately), the parents are assisted in helping their child to regain more control of their eating. Again, the main goal is the return of the patient to physical health. Individual parenting style is taken into account more in this phase.
The final phase of treatment, Phase Three, occurs when the patient is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has abated. The focus of this phase then shifts to assisting the patient in developing a healthy adolescent identity. According to Drs. Lock and le Grange, this task "entails a review of central issues of adolescence and includes supporting increased personal autonomy for the adolescent, the development of appropriate parental boundaries, as well as the need for the parents to reorganize their life together after their children’s prospective departure." Thus it should be emphasized that when utilizing the Maudsley method, more traditional psychotherapy is not introduced into treatment until weight restoration is achieved.
Further information about the Maudsley method, resources and practical guides:
1. Lock, J., Grange, D.L., Agras, W.S., & Dare, C. (2001). Treatment manual for anorexia nervosa: A family based approach. New York: Guilford, 270 pp.
2. case example
3. Herrin, m., & Matsumoto, N. (2007). The parent’s guide to eating disorders (Second edition). Carlsbad, CA: Gurze Books.
5. Treasure, J., Smith, G., & Crane, A. (2007). Skills-based learning for caring for a loved one with an eating disorder. New York: Routledge.
7. le Grange, D., & Lock, J. (2007). Treating Bulimia in Adolescents: A family based approach. New York: The Guilford Press.
8. Lock, J., & le Grange, D. (2004). Help your teenager beat an eating disorder. New York: The Guilford Press.