Maudsley Family Based Therapy Explained – Part 3

Maudsley Family Based Therapy: What families say about it!

By BodyMatters’ Clinical Psychologist Christie Lomas

In Part 1 of this series, Clinical Psychologist Christie Lomas explained what Maudsley Family Based Therapy involves and why it’s considered the ‘gold-standard’ of treatment methods for adolescents and children with Anorexia Nervosa.

Here in Part 2 of the series, she answers the questions commonly asked of therapists by families considering this approach.

To give an understanding of how families actually feel about participating in Maudsley Family Based Therapy (FBT) in part 3 of the series, Christie has taken excerpts from the book “I’ve got my kid back: Empowering parents to beat Anorexia Nervosa” by June Alexander. This book is a wonderful resource for families struggling with an eating disorder. Alexander expertly interviewed eleven families and transcribed these interviews into case studies where family members describe their struggles with anorexia, their experiences in seeking treatment and their engagement in FBT. Christie offers Maudsley Family Based Therapy at the BodyMatters clinic, please contact us on (02) 9908 3833 if you would like to book a session with Christie or discuss your situation.

Do families think Maudsley Family Based Therapy actually works?

Chloe (10)

Chloe was so scared of gaining weight that she became convinced that she must not swallow her saliva in case it contained calories, storing it in plastic bags instead. She would not allow herself to cry for fear of consuming the salt in her tears. She poured milk into her shoes and stuffed jelly in her underwear. Chloe’s battle with Anorexia began at age 10 and continued for four long years with multiple hospitalisations. After engaging in one year of FBT, Chloe’s family describe that for the first time in more than 4 years, their daughter reached and maintained a consistent healthy weight, was able to get back to school and required no further hospitalisations. The family described a huge amount of relief at the understanding approach offered by the family-based therapist. They say that without FBT, anorexia would be winning!

 

Matthew (11)

“Anorexia had devoured Matthew’s personality and replaced it with a sad, anxious, dispirited child who looked in the mirror, sucking in his face and drawing in his stomach to see how many ribs would stick out.”  During one of his hospitalisations, Matthew was so weary and told his mother he was ready to surrender the last thread of his tormented life. Within a few days of commencing FBT, Matthew’s family report that amazing changes began to happen. “The unrelenting persistence from his parents at every meal and snack time was connecting more strongly with Matthew and increasingly bypassing his illness”. After a few weeks, the urge to complete his daily exercise routine began to fade, as did his associated feelings of guilt. Matthew says, “Suddenly, my urge to do any [exercise] at all stopped”. Four months after starting FBT, Matthew’s mother heard words that were music to her ears, Matthew came home from school and called “Hey Mum, I’m hungry!”.

 

Kelly (14)

Kelly’s parents describe that early on in her illness Kelly’s behaviour would get “wilder and wilder” , apart from refusing food, Kelly cut and burnt herself and they could see in her eyes they were not dealing with a rational person any more. “The human was stripped away; eyes glazed, manic grin.” Two years after Kelly’s first weight loss and multiple hospitalisations requiring nasogastric feeding, the family engaged in FBT. Within six months of starting FBT, Kelly reached her healthy body weight and achieved good physical health. Six weeks after reaching this weight, her psychiatric symptoms began to disappear spontaneously and during the next five months her mental health returned to normal.

 

Kristen (13)

“Anorexia slowly crept up on me. It has taken two years of my life, and continues to torment me”.  “I spent weeks in and out of hospitals with my self-hatred continuing to build and my family struggling to cope. Nothing changed, no matter how long I spent in hospital or with doctors, counsellors or dieticians.” But a new direction was then taken with the introduction of FBT. Kristen achieved a healthy weight and for the first time since developing anorexia began eating dinner and going out with friends. Given that she was able to take such rewarding steps in recovery, Kristen reported looking forward to FBT sessions. “We have a good chat”. “Last time I spoke for fifty minutes with our therapist and my parents only got ten minutes!” Kristen is in Phase three of her treatment, where treatment focus moves more to individual issues with the adolescent, rather than on the family as a whole.

 

Hayley (11)

Hayley described what suffering from Anorexia was like for her. “You lose everything. I lost all my sport, I lost my freedom, I had to be watched 24/7 and could not do anything. When I was not in hospital, I was stuck at home, too sick to go to school, and I lost some precious years of my life. I would struggle with my moods and get angry. It would just happen and I would take it out on people. I do not do that anymore.”  After suffering with Anorexia for six years, Hayley completed the three-phases of FBT within fifteen months, she gained more than 10 kilograms and grew 15 centimetres.  Hayley’s mother says “After all those early years of discouragement and dismissals from doctors, the turnaround in Hayley’s health after starting FBT was truly amazing.” Nine months after completing FBT, Hayley is achieving well at school, has required no further hospital admissions, has gained another 4 kilograms and grown several more centimetres. Having reached and maintained a safe weight, she has resumed playing sport.  Hayley’s mother says “We have our daughter back”.

 

Claire (15)

Initially told to ‘not worry’ as she hadn’t lost enough weight to be a concern, Claire’s parents watched as their daughter starved herself, her weight loss very quickly spiralling down. They went from thinking that Claire had a borderline illness to understanding they were caught up in a life and death battle.  Most of her personality has disappeared into the clutches of anorexia. After eight months of searching for treatment, the family engaged in FBT and Claire reclaimed much of her sense of self and this process is continuing. “I now have more contact with people outside my home”, Claire said. Summing up her journey, Claire said, “Getting your life back and being able to live free from anorexia is worth the fight”.

 

Kylie (12)

Beginning with running laps in the backyard, insisting in low fat foods and vegetarianism, Kylie went from thin to skeletal very quickly. After more than one year of unsuccessful interventions, Kylie’s family found FBT. Today Kylie is almost fifteen, and while her illness continues to impact her family, with FBT it is gradually losing control. The family report that mealtimes have become almost normal. Although sometimes displaying anxiety and requiring prompting,  to take fifteen minutes instead of two hours for breakfast is a huge step forward. Kylie has almost reached her target weight, and her parents are hopeful of more progress when her weight restoration is complete. Kylie’s anxiety levels have dropped and she is also more socially active.

 

Billie (10)

At age fifteen, a third of Billie’s life had been dominated by anorexia nervosa. She has had multiple hospital admissions and survived on a nasogastric feeding tube for two years. Since starting FBT and now age 19, Billie has required no further hospital admissions and has taken big steps toward independent living. There have been slips and slides, but progress too. Billie is still finding and rebuilding her sense of self but Billie acknowledges that FBT was the key to her recovery and that her own will began to fight back through this process. Billie and her family agree that FBT reunited their family.

 

Annabelle (12)

Annabelle began to develop anorexia at the age of twelve. She was feeling overweight and over the next two years began cutting food out of her diet and counting calories. By the age of 15 Annabelle began taking diet pills and conflict in the home hit an all time high. Eight months into FBT, the family report that Annabelle’s sense of self began returning ‘like a switch going on’ shortly after she reached a healthy weight. They report a great sense of relief at seeing glimpses of Annabelle’s personality returning at this time. The family moved through the three phases of FBT in about twelve months.

 

Alice (13)

Alice says “I kept telling myself that if I lost more weight, everything would be alright and I would be able to eat. But I would lose more weight, and everything would not be alright, so I would have to lose even more”. At one point, Alice’s parents feared their daughter had disappeared. “There was nothing in her eyes”, “Twice, in those three months, I saw them flicker. They were the only indication that somewhere in her mind, Alice was alive. She was conveying one message to us and it was, ‘I don’t want to be here’. Her illness was taking her from us.” With the support of FBT, Alice’s parents persisted and gradually, Alice began to reclaim her sense of self, furthermore, they noted how FBT helped to strengthen their family relationships.  The family say that FBT helps you realise how important everyone is, interacting and supporting each other.  Nine months of weekly FBT followed by nine months of follow-up sessions became rewarding for each member of the family. Besides fighting Alice’s illness, they learnt more about themselves; any strength in the family’s dynamics were identified, tested and ultimately further strengthened.  They report that FBT has saved Alice and their family and that there were many things they learnt during their therapy which continue to guide and support them. “The therapy is not just about anorexia; it is about helping each other and recognising signs”.

 

What do parents say about their experience of Maudsley Family Based Therapy?

Several themes were identified as important for parents when engaging in FBT. In the following section we explore parents’ reactions to realising: (1) Parents are responsible for getting their child to eat; (2) A commitment and high level of persistence is required to fight anorexia; and (3) All blame is removed from the parents as a cause of the eating disorder.

 

(1)    Parents are responsible for getting their child to eat

Helping parents to work together is an important aspect in getting started in fighting anorexia. All parents have amazing strengths to contribute to fighting the illness and it is very sad that they have been blamed by some therapists for the development of their child’s eating disorder. Getting parents working together and involved in the clear role of re-feeding is step one in the battle against anorexia.

* Matthew’s parents said their therapist assured them that FBT would empower them, but warned, ‘You won’t be able to give an inch’. ‘Over and over, she could not believe the remedy really was simple. She looked for a catch but could find none. Gradually she began to see the strategy made sense – good common sense. She and her husband were to sit with Matthew until he ate each meal and snack, however long that might take; they were to encourage him and persist, but not give up.  The therapist was empowering them to confront the anorexia and seize back the control that it had snatched from them and their son. They had fed their child when he was a baby; of course they could do it again.’

* One set of parents thought they would be able to relax after finding FBT, but instead were told they would be doing the work.  “What the [FBT] team said was such a turnaround on all that we had been told before. It was a revelation for Ted and I to be told that we would be confronting the illness”.

* FBT empowered Claire’s parents to stand their ground and insist Claire eat. They report they needed permission for this as they felt their family doctor had specifically removed it months earlier. They felt their confidence as parents was being restored through re-feeding their child.

*Kelly’ mother said, “Fighting anorexia was full on…. but as with children with cancer, parents could do amazing things when push came to shove’. When a child is diagnosed with anorexia, food is the first priority, and other problems should be sorted after that. Both Kelly’s parents liked the directive of ‘Step in now, get the weight up and help your child get better’.

* Kristen’s parents reported, “In contrast to earlier advice, now we were told to insist that she eat her meals. We had to be the food police after all.”

* Hayley’s parents took turns at taking Hayley’s lunch to school. The re-feeding made sense to her father who would park the car in the school car park and sit with Hayley while she ate. “It felt strange….but if this is what it would take for Hayley to get well then I was happy to do it. “In some ways life was easier for me before we began family-based treatment because once we accepted the challenge of confronting Hayley’s illness, there could be no backing down.”

* “Anabelle’s father liked the FBT approach. He understood why the founders of the treatment decided the key was to empower parents.  He said, “Who else would take all the crap?”.  FBT does take the view that the family are the key to the successful treatment of anorexia nervosa. The family are the ones with most love and devotion to their child and thus the best resource to fight this illness. It is the role of the FBT therapist to support the family in this battle with the eating disorder.

(2)     Commitment and a high level of persistence is required to fight anorexia

Beating anorexia involves finding ways the eating disorder is being maintained and putting in place strategies to ensure this maintenance cannot continue such as eating lunch at school with the child. It involves lots of practical steps, frequent problem solving and most importantly unrelenting persistence and a full commitment from the family.

* Annabelle’s mother reports, “We were told not to start the program unless we could commit to it 100 per cent, because anything less than that and it would not work”.  “She said, “I decided I would rather do this 100 per cent and have our lives turned upside down for one year rather than have the illness drag on year after year”.

* On learning a concentrated effort would be required to challenge the illness, Kristen’s father committed himself to the battle that lay ahead. He arranged to take one day off work each week to attend the therapy sessions, and rearranged his work hours so he could help at lunchtimes. “Fighting anorexia is character building; you can let your challenges overwhelm you or get on with overcoming them and become stronger for it.”

* Claire’s parents report their FBT therapist forewarned them that Claire’s illness would worsen before improving but that they were on the right track. The therapist helped them to commit to supporting each other, and to learning to recognise when the other is struggling.  They were told to be more determined than the eating disorder. Claire’s father said he “had to take many deep breaths and remind himself not to take it personally.  No matter how much he wanted to retaliate with words, he knew that would be a mistake. Shouting would not help-worse, it would strengthen the anorexia.”

* Knowing they must increase Kylie’s weight before their next appointment spurred her parents to keep challenging the illness. “Without the therapist, it would be easy to let the momentum slip and not push Kylie to eat to her next meal”. “For now, every gram of extra weight means a little less illness and a little more Kylie”.

* Billie’s mother took her lunch to school and insisted her daughter eat everything on the plate before returning to the classroom. Her vigilance was unrelenting. “Often I had been called an ‘over-controlling parent’, but if I had not cared and persisted, we would not have gotten our kid back.”

* Alice’s parents report “Initially, Alice was a shell. We had broken the disease, but we wondered if we had broken her spirit and lost our daughter as well. It was very distressing, but our therapist was supportive. She kept reassuring us, ‘Alice will come back’, and month by month, Alice’s cheekiness did gradually come back.” With the support of FBT Alice’s parents persisted and gradually, Alice began to reclaim her sense of self. “Having a child who develops anorexia nervosa opens up a whole new world. Perhaps for the first time, you learn the meaning of 100 per cent effort, because 1 per cent less and this illness will beat you.”

* Alice’s father was initially sceptical about seeing a FBT therapist. Accepting the severity of the consequences of the illness was difficult for him and he continued to drag himself away from work until the therapist challenged him and overcame his scepticism for her profession. The family therapist laid it on the line for him saying, “This is your decision – you choose; your daughter or your work. “ The fight against Alice’s anorexia made the decision to change his work ethic easy.  “There was no contest really”. “I would choose my daughter every time”.

 

 

(3)    All blame is removed from the parents as a cause of the eating disorder

The absence of blame with the FBT approach was a huge relief for many parents.  FBT does not in any way see that parents are to blame for their child’s eating disorder, but that is it the Anorexia itself that is to blame.

* Alice’s parents report that one of the many good things about FBT is its teaching that you are not to blame. “It is imperative that parents feel no guilt – you don’t if your child has juvenile diabetes, and it should be the same for parents of children with anorexia.”

* One couple described how they had often wondered if they were doing something wrong with their child rearing. But the FBT team was reassuring them that ‘no family is perfect’ and they would not be pulled apart and analysed as before. Their family was being acknowledged and accepted for what it is was, and the therapist was ready to support it.

* Kelly’s parents said their [FBT] therapist emphasised Kelly’s illness was not their fault and, although they had never felt it was, his words were reassuring. The “no-blame” for parents is a strong part of family-based treatment.

* Matthew’s parents said their FBT therapist explained to them how the love and support would strengthen Matthew’s will in fighting his illness. That it was Matthew’s illness, not Matthew that was resisting recovery efforts. The concept of externalisation is central to FBT. This is where the child is viewed as separate from the eating disorder and that it is the eating disorder that is causing the child to refuse to eat, to scream, shout, throw food and engage in all those behaviours that families find so difficult when trying to help their child to eat. The young person is not to blame for the illness and neither are their parents, it is anorexia that is to blame.

What do adolescents say about Maudsley Family Based Therapy?

Several themes were revealed as important for adolescents engaging in FBT including: (1) Initial  anxiety and or anger regarding weight gain and eating forbidden foods; (2)  Feelings of relief; (3) Gradual acceptance of FBT; and (4) Gratitude toward parents and FBT approach.

(1)    Anxiety / Anger regarding gaining weight  & having to eat forbidden foods

Anxiety was a common concern amongst adolescents during the initial session.  For example, despite thinking to himself ‘this therapist guy kinda makes sense’, Matthew reported continuing to feel anxious upon hearing he would have to eat a ‘forbidden food’ within the coming week.

It is a very common experience that when starting FBT, the eating disorder will get worse before it gets better. It will push back in an attempt to get parents to back down on the stance against the illness. On beginning FBT, Billie’s illness fought back and her dislike of her mother intensified. The more weight Billie put on, the angrier she became.  However, she reports “Having my mother supervise my meals was much better than sitting in hospital and being told I had half an hour to eat”.

A frequently used strategy of the anorexia is the rejection of parents with the hope that parents will soften their approach for fear of losing their relationship with their child. This is a really difficult time for parents as they fear the loss of their parent-child bond. It takes great determination for parents to remain in their role as parents and not of friend and to understand it is not the bond with their child that is being lost, but the bond with the eating disorder. Annabelle’s mother described fighting feelings of rejection from her daughter “my heart was breaking. The trip home from therapy was usually the worse because Annabelle would be upset at her weight gain and issues brought up in therapy. Her illness fought against this confrontation”. Annabelle reflects back on her experience of FBT. “Weight restoration was as stressful as it was important and there was no easy way to achieve it”.  She admits that she was not capable of thinking for herself until she was re-fed, and that she needed her family to facilitate this. Reaching a healthy weight put her in a position where she could think more clearly.

 

(2)    Feelings of relief

* Matthew described that despite his fears, having his mother and father challenge his illness was making him feel a little happier that he had to sit there, because deep down a little, hidden and much starved part of him did want to eat. Eventually, Matthew decided he might as well do what his parents wanted him to do – eat the mouthful of ice-cream and sip the lemonade – and get the agony over quickly.

* Kelly described what it was like to change her relationship with food. ‘It was like the lifting of a veil from my mind’. It ….was not a gradual lift, but a jerk’.

* Hayley described her struggle with over-exercising.  “I was playing too much sport – netball, touch football and school sport; I was on the run all the time. I forced myself to do it. I struggled and everyone could see it, but until I started family-based treatment, nobody stopped me.”

* Annabelle reports “when I started to eat and get well, the light around me got brighter and I began to cherish simple things, like seeing the sun in the morning.”

(3)    Gradual acceptance of Maudsley Family Based Therapy

* When he first heard about FBT, Matthew shared his thoughts, “You can’t do this to me”, but that he got to a certain stage where he started to think “this is okay”. “As I gained weight I felt better.  Deep down I hoped the treatment would work, but for a while my illness thought it could cope and beat it.”

* Alice reported “I wanted my parent’s help to get better, but if I ate I felt a strong need to be punished”.

(4)    Gratitude towards parents and Maudsley Family Based Therapy approach

* Matthew said “I am so glad to have my parents and caring teachers. You need at least the equivalent of a caring mother and father because they need to be on board 100% of the time to help you recover. I say this because during my recovery I looked for any chance to feed my illness rather than me – like at school when someone wasn’t keeping watch, I would tip the chicken out of my sandwich”. “I was only eleven and am very grateful to my parents for persevering. Without them, I would have struggled to recover, because this illness was stronger than my will”

* Kelly does not believe she would be alive today without FBT. “At the state I was in, I don’t think I would have hung on to life. Without my parents, I would not have made the five to seven years that is the average recovery period with old treatment methods. I would have passively killed myself through starvation or actively committed suicide. The acuteness was terrifying.”

* A month after starting FBT, Kristen made and presented a framed certificate to her parents, describing them as her ‘heroes’ and thanking them for their unrelenting effort in helping her to fight her anorexia.

* Annabelle reflects on her recovery: “Anorexia is phenomenal. It takes over your mind. FBT is the only way to beat it. No one could convince me to eat. Someone had to make me, and it had to be as quick as possible. I needed help to reach the stage where I could feed myself and be able to function at a basic level. My parents and sister have been, and continue to be, the best people to help me. As much as you hate your parents at the time, you know they love you. Your family is the biggest part of your life, your biggest resource.

 

What do families say about why siblings need to be included in Maudsley Family Based Therapy?

Involving siblings ensures that very clear roles can be established. Siblings become the support for the adolescent in the session and at home. They are not trying to get the adolescent to eat.  This is essential so the parents can focus on the life-saving job of re-feeding knowing their adolescent has some support and the adolescent themselves know there is someone to talk to when things are tough for them. Kelly reported that given her sister “wasn’t making me eat…. I did not feel unkindly towards her” and thus felt she could turn to her for support.  Another reason for the inclusion of siblings in treatment is to help siblings to separate the eating disorder from their sibling. This helps them to understand that is it the eating disorder that gets their sister to do all these things they find so frustrating and annoying. Helping siblings to externalise the illness, reduces criticism and anger toward the adolescent suffering with the eating disorder. Furthermore, including siblings in treatment, gives them a role and voice which helps to alleviate their own levels of anxiety regarding what is happening with their sister/brother.

* Kristen’s sister describes how difficult it is living with someone suffering with an eating disorder. “Kristen was really sick, and in and out of hospital. I felt a bit angry at her, for always taking up our mother’s time, and felt scared.”

* Kristen’s sister said she found the FBT sessions helpful in understanding anorexia. “The biggest thing I have learnt is how big this illness is, how much of your life it takes over – your concentration, your memory, your physical self, bones and muscles; you push everyone away and it isolates you. It is not something you can go and have surgery for, and it is not about behaviour – it is a disease. People with anorexia can’t help what they are doing. When Kristen would get really angry and upset, I’d try to remember that.”

* Claire’s parents report that “the manipulative and hurtful illness was pushing the buttons of each family member”.

* Billie’s mother said “The important role of sibling support cannot be underestimated……Billie gave [her sister] many insights into her illness that became the catalyst for change and progression in her recovery.

* Prior to FBT Annabelle’s sister described feeling excluded from what was happening with her sister. She said she was frequently “left in the dark” that her parents did not share the information they found, would not answer her questions and held discussions in her absence.

Keeping siblings involved in the therapy process also means they are less vulnerable to falling for the eating disorder’s persuasive ways. During FBT, the family needs to uncover all the ways in which the anorexia is staying strong for their child. While all young people experience some similar behaviour, the key is the parents using their knowledge of their child to assess and work out how the anorexia is affecting their child so it can be stopped. All the little things add up and need to be sorted out if the child is to eventually divorce anorexia.

* Chloe’s parents report, “Our son began to be tricked by the eating disorder. He began taking his unwell sister on long and inappropriate walks”.

* Annabelle’s sister spoke about being devoted to being her sister’s friend and maintaining her trust, however felt she was betraying her parents as they did not know many of eating disorder’s secrets that she did. She reports taking chocolates from her sister when distressed about them because she thought it would make her happier and feel a little better.

* Even Kylie’s grandparents were outsmarted by the manipulative anorexia when they looked after her for a few hours one day and Kylie was to drink a milkshake as a snack.  Kylie’s grandparents proudly reported she had drunk all her shake, however her parents found traces of the shake in the bathroom sink.

 

What do families say about how Maudsley Family Based Therapy compares to other treatment approaches for anorexia nervosa?

* Matthew’s parents described how they lost valuable time allowing the illness to extend its hold, while searching for the right treatment. “Prior to starting family-based treatment, doctors had been basing decisions on what they knew, on what they had been taught years before, but Matthew was getting worse. They seemed to be trying to make him feel they had some control over his illness, when we knew absolutely that they didn’t.” However, on learning that they would be responsible for getting Matthew to eat, his mother wondered how the method could work when all their attempts had previously been unsuccessful.  She thought, “There had to be more to it; there had to be a catch.  This cannot possibly work, because surely the therapy team first needs to deal with the thoughts in Matthew’s head’.  One of the strengths of FBT is that the health emergency is placed as a first priority. Exploring ‘why’ the eating disorder has occurred is not the issue of focus.

* Kelly’s mother stated, “I wished the doctors who treated Kelly with traditional methods during the first eighteen months could have seen the changes in her as a result of re-feeding to a genuinely healthy weight. The big difference with FBT is that you treat food as medicine – you cure the starvation first and then deal with anything else. With traditional therapy, a psychological line is taken, food isn’t pushed, and the child is expected to choose to get well. The critical link between good nutrition, weight gain and mental health is undervalued.” She goes on to say, “I wonder if traditional therapies, where causes are sought and blame is attributed, may, in some cases, do more harm than good. If a psychiatrist had sat down with Kelly when she was ill she would have reported that we were obsessively controlling parents and that she hated us and we hated her; she doesn’t think that now but certainly did so then”.

One of the interesting things that happens during FBT is the emotional recovery which occurs with increased parental control and firmness. The FBT stance is that to wait for the adolescent to be motivated to get well is too risky. The parents need to take control immediately! During this process, the adolescent becomes less involved with the illness due to their parents not allowing this and begin to feel more separate from the illness and to want to get better.

* Hayley’s mother reflected that “if the illness had to happen, she is glad it happened while Hayley was under parental supervision. If she had been over eighteen, she probably would be dead by now because she wouldn’t have helped herself.

* Similarly, Claire’s mother said of her daughter, “Claire simply was not able to act on the information she was given.  The disordered thinking caused by anorexia nervosa cannot be overcome by logic and reason alone”.

* Claire’s parents were confused by the advise they received from the family doctor who suggested that Claire was not medically compromised and thus not a concern unless her weight dropped. “The doctors’ opinion challenged their parental intuition, and they didn’t know his view was common – that symptoms of anorexia were often not acknowledged until the situation is drastic. The long-established practice was that a child would have to be very thin before symptoms of the illness would be taken seriously. “ Claire’s parents said they went from thinking she had a borderline illness to understanding they were caught up in a life and death battle.

* Similarly, Kylie’s parents were told by their doctor not to confront Kylie about her food restriction, but to let her make her own decisions. They were told, “She won’t starve. She will eat when she is hungry’. This wasn’t fitting with what their instincts were telling them.

* Kirsten’s mother reported, “we seemed to be getting nowhere and I was angry.  Despite their best efforts, Kristen’s individual counsellor had been unable to ‘break through’ and assist her with her mental state. When we met the family-based treatment team we noticed an immediate contrast with our previous experiences. For the first time, the focus was on the illness and this was encouraging. It made sense that for Kristen to fight her illness, she first had to be at a healthy and stable weight so the team could work with her mind.”

* Hayley’s father says “Unfortunately, until we found family-based treatment, out efforts to get help kept ‘hitting walls’.

* Kylie’s parents said, “Our experience to this point had been negative…but now we were given hope”.  They want FBT to be available everywhere….and supported by national health benefit schemes. Their dream is for families to avoid the struggle they have had in seeking and acquiring help for Kylie. They believe their marriage has grown stronger and is more united as a result of fighting Kylie’s illness. “When pressures mount, FBT provides a supportive setting in which they can release and discuss any pent-up feelings. “With the therapist, you feel free to say things you haven’t told your partner”.  “You try not to cry at home because you have to be strong, but in the presence of our therapist, we can cry and it helps” said Kylie’s father.

* Billie’s parents report having three years “of protracted horror and misinformation” as they sought help to save their daughter. They recall professionals shaking their heads and saying “What have you done to your daughter?”. Billie’s mother said, “I had no idea how to help her”. The family received mixed messages that the parents were not to blame, but then being told that Billie’s mother was over-controlling. The family report that until they began FBT, doctors had saved Billie’s life but had not treated her illness. This family travelled more than 800 kilometres from their home to receive FBT. Billie’s mother says “the upheaval was worthwhile…because this treatment turned out to be the best thing ever. For the first time we felt accepted as a family, and for the first time the medical staff externalised the illness, separating it from Billie’s sense of self”.

 

References

 Alexander, J.  with Le Grange, D. (2009). My kid is back: Empowering parents to beat Anorexia Nervosa Melbourne: Melbourne University Press.