Maudsley Family Based Therapy Explained – Part 2

Maudsley Family Based Therapy FAQ’s

by BodyMatter’s 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. 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.

Is Maudsley  a one size fits all approach?

As outlined in Part 1 of the Maudsley Family Based Therapy (FBT) explanation, there are specific objectives that are covered in each of the phases of treatment. However each family and each young person is different. The speed at which treatment proceeds in addition to the specifics of each approach is dictated by what is required in each family. These needs are continually assessed and addressed throughout treatment. Hence, this is an evolving treatment tailored to each family, not a blanket approach.

Can Maudsley FBT be delivered concurrently with individual sessions?

The therapist spends ten to fifteen minutes at the start of each session of FBT engaging individually with the young person when they are weighed, updating on their week and issues they would like raised in the session before being joined by the rest of their family. It is important not to make the whole session an individual focus in the initial stages in the treatment of an eating disorder. We certainly acknowledge the importance of individual sessions, however the timing of these must be correct. The initial focus has to be on helping the family restore the young person back to a healthy weight. It would be dangerous to shift focus from re-feeding early in treatment. However, more of an individual focus can proceed in Phase III of treatment when the young person’s weight is restored.  It is only then that they can actually make proper use of an individual focus given the improved psychological functioning that occurs following weight restoration. Furthermore, as described earlier, there is limited evidence to support an individual approach for anorexia nervosa in adolescents. Grange et al (2012) compared FBT to Adolescent Focussed Individual Therapy and found that those young people suffering from high obsessional thinking and greater eating disorder psychopathology, did better with FBT by the end of treatment. Also FBT led to faster physical recovery, which is essential given the serious, life-long medical complications associated with eating disorders.

 Can you speed up the phases?

We cannot accelerate progression through the three phases of treatment. The speed with which we progress through these phases varies depending on the young person’s progress with their weight and several other indicators which we are continually assessing in each session. Given the seriousness of this illness, if we shift the focus from weight restoration in the beginning to focus on other issues, the consequences could be drastic and the result, hospitalisation or worse.

Why does the whole family need to come to each session?

Parents are often very concerned about taking brothers or sisters out of school and leaving work to attend therapy with their child who is suffering with an eating disorder. We understand this is very difficult for families and acknowledge that it means members of the family miss out on important jobs or activities. However, anorexia is such a serious disorder that it requires a serious level of commitment. It is essential that all members of the family and anyone else living in the household who is involved in meals, attend therapy.

Some parents worry about ‘exposing’ their young children to what is really going on with their adolescent with the eating disorder. However, it is also our experience that everyone in the family will have been effected by the anorexia or is aware that ‘something worrying is going on’ with their brother or sister and NOT knowing can be extremely anxiety provoking for them. Hence, all members of the family have something to contribute in helping their sibling or son/daughter get back from this illness. It is so important to have all family members present for FBT that we would rather reschedule an appointment to ensure all of the family can attend.

How much are all siblings really needed in Maudsley FBT?

Siblings are essential to the Maudsley approach in treating anorexia. Anorexia is such a severe illness that all members of the family must attend as each has a very special role in this therapy. While parents are focussed on the role of re-feeding, the young person will need support within the family. Siblings form that support. Quite often siblings in an attempt to be helpful, take on the role of a parent, however this only tends to isolate the sufferer and to increased feelings of being  ‘ganged up on’ by the family.  The therapist helps siblings offer support and step out of a parenting role which allows the parents (knowing their child with anorexia is being supported), to focus on their very important task of getting their son/daughter back to a healthy weight. This also gives siblings a voice and a role in recovery.

We are a blended or separated family, how can Maudsley FBT work for us?

FBT can be modified to be delivered to just about any family structure. For example, single parents can take on the task of re-feeding their young person on their own or could enlist the help of a support person such as a close friend or extended family member.  In a separated family where the young person is in the shared custody of their two separated parents, we would initially work with the household within which the young person spends the most time and conduct separate sessions with the other parent and their household with the young person. This is similar for blended families. The rule is, whoever lives in the household and is involved with meals needs to be involved in this treatment.

Why can’t we just send our adolescent to hospital to be treated?

Hospitalisation is seen as a temporary step which is essential if your young person is at immediate risk of dying, but not a permanent solution to the illness. Eventually your son/daughter is discharged back into your care. Following discharge, many young people lose weight rapidly and relapse. This can set up a vicious cycle of losing weight, being admitted, gaining weight, then discharged and losing weight once again. Relapse can happen over and over again and result in a considerable amount of time away from family and friends. Furthermore, the longer your young person remains underweight, the higher risk he/she is for the very serious lifelong medical complications associated with severe malnutrition. We view your family as having the resources to take on the eating disorder and we will commit to helping you do this.

 Why do you have to weigh in each session?

We understand that weighing can be incredibly anxiety provoking for those suffering with an eating disorder. However, weighing is essential to monitoring progress and determining the direction therapy will take for the day. A different day, can bring a different purpose depending on whether weight is up, down or maintained.

My child is not currently underweight, however has been diagnosed with Bulimia, Eating Disorder (NOS) or has signs of an eating disorder…can FBT help?

Absolutely! We work with many young people who have been identified early by their very alert parents to the signs of an eating disorder. They may be in the healthy weight range for their height and age however display the intense fear of weight gain and marked body image disturbance associated with eating disorders such as anorexia nervosa. FBT works in the same way for these families. The effect of the parents taking control of food and eating in phase 1 of treatment is incredibly containing for the young person and the aim becomes the maintenance of weight during this period of containment. The result of this first phase of treatment is a reduction of many of the cognitive symptoms of the eating disorder.