Posted by Sarah Emerman on Fri, Aug 06, 2010 @ 02:55 PM
By Sarah Emerman, Joanna Hardis, and Dr. Mark Warren
Making the decision to bring your child in for an assessment can be a difficult and trying process. Your child may be resistant to coming and/or may try to convince you that they can decrease behaviors without help. The truth of the matter is that it is very rare for a child to make the decision to get treatment on their own. Because adolescence is the period of time where brain and bone development take place, avoiding or putting off getting treatment can be detrimental to your child’s health. When you come for an assessment at CCED, our goal is to make your family feel supported, and insure that you have a plan on how to best get treatment for your child.
Adolescent assessments last approximately two hours. Similar to adult assessments, we ask that you bring the paperwork mailed to you and come twenty minutes early to fill out additional measures. We recommend you make a list of questions and read as much as possible about Maudsley Family Therapy prior to your assessment so that the clinician can address your questions and concerns.
Within the first forty-five minutes of your child’s assessment, our clinician will speak with your child privately to gain insight into their perception of the illness. Since the assessment is a diagnostic procedure and not individual therapy, we will tell you what your child says. Our assessment clinician makes your child aware that what they say is not confidential. The clinician will then meet with you privately to get a sense of the parents’ concerns, perceptions, and observations. In addition, the clinician will provide psychoeducation about eating disorders and Maudsley Family Based Therapy. At the end of the assessment the clinician will make treatment recommendations regarding level of care and the next steps to be taken.
The treatment recommendation will be based on the support needed by the family, family history, the sense of urgency, current behaviors, issues from nutritional insufficiency, and medical risks and recommendations. The ultimate goal of an adolescent assessment is that the family leaves feeling comfortable that there are options for a plan that will serve the needs of the family and, most importantly, guides your child on a path to recovery and health.
For more information on Maudsley Family Therapy, we recommend FEAST, Maudsley Parents , and Dr. Sarah Ravin’s blog.
If you are interested in setting up an assessment for your child, please contact (216) 765-0500.
Posted by Mark Warren on Fri, Jan 08, 2010 @ 10:47 AM
By Dr. Jorey Friedman Beegun and Dr. Mark Warren
In Family Based Treatment (also known as the Maudsley method), parents play an active role in refeeding their child with the goal of restoring their child's weight to a range that is appropriate for their age, height and optimal medical and psychiatric functioning (as determined by a team of professionals and tailored specifically to the child). Once that has occurred, the parents gradually return control of eating back to the adolescent in a manner that stabilizes weight and behavior and allows for a focus on adolescent developmental issues that are often thrown off track by the illness.
Phase I of the Maudsley method in treating anorexia involves a shift of total control of eating from child to parents during which time the parents are responsible for making all choices surrounding food and re-feeding the adolescent. This first phase of treatment is critical because of need for the child to be gaining weight during a time in which their brain is malnourished and the fear of weight gain is acute. Given that many of the thoughts associated with anorexia nervosa are side effects of malnourishment itself, having an individual therapist or family member try to "convince" the adolescent to eat and gain weight is not successful and has no empirical support. What their brain needs is food and Phase I coaches the parent on providing their child the medicine (food) they need.
Phase II commences when a child has been successfully re-fed and parents believe that the child is ready to attempt to re-gain some control over their eating and food choices. Phase II extends from the very first collaborative moment around eating between the parents and child until the point where the child is able to successfully feed him or herself on a regular basis. This does not mean that the child will have no eating disordered thoughts, feelings, or body image issues as the time in which is takes for these to diminish or dissolve entirely is different for each child. However, the child's ability to tolerate and process these feelings is such that they can be working on eating independently in a gradual fashion. Thoughts, feelings, and body image can be successfully addressed in phase III when normal teenage issues move into the forefront.
Phase III begins when the adolescent is able to maintain appropriate body weight and restriction has stopped. The focus shifts to an exploration of how the eating disorder has impacted the formation of a healthy adolescent identity and works to help both the parents and adolescent get back on track in terms of supporting age-appropriate developmental tasks.
It is important to note that the there are differences between the phases in FBT for those struggling with Bulimia Nervosa and Eating Disorder, Not Otherwise Specified given that those adolescents are often weight-restored. The Maudsley Method is more collaborative with these diagnoses, the degree of which is clinically determined during the initial Maudsley sessions.
Contributions by Sarah Emerman
Posted by Mark Warren on Fri, Dec 25, 2009 @ 10:25 AM
By Dr. Jorey Friedman Beegun and Dr. Mark Warren
One of the most exciting developments in eating disorder treatment has been the Maudsley method of family based therapy (FBT). For adolescents with eating disorders, both the research and our clinical experience point to the effectiveness of the Maudsley method in the stabilization of difficult to treat illnesses for which there may be a poor prognosis based on the complexities of the illnesses and historically ineffective treatment. While there is push for funding to continue studying these disorders in children and adolescents, the research published in the last few years clearly points to overwhelming benefit of involving parents in eating disorder treatment. For adolescents who have had their illness less than three years, are under 19 years old, and living at home, it remains the only evidence-based treatment for anorexia. In a study comparing a family-oriented approach to individual supportive therapy for those with bulimia or frequent binge/purge symptoms that might not meet the diagnostic criteria for bulimia, parent involvement more than doubled the number of adolescents who were able to abstain from their symptoms at the 6 month follow-up. At CCED, we have had considerable success with the application of this model for patients who don't fall specifically within these guidelines and are working on ways to study this in a more formalized manner.
The core of FBT is the understanding that parents don't cause eating disorders, but instead play the primary role in the successful treatment of their child's eating disorder. For too long, parents of children with eating disorders were viewed as one of the causes of their child's illness. We are now aware that this belief is false, has no scientific support, and has likely resulted in significant damage for those who suffer from eating disorders by removing the people from their treatment plan who know and love them the most - their family. In the FBT treatment model, parents are seen as the primary treatment providers who receive coaching and support from a knowledgeable therapy treatment team. Both research and our years of clinical practice of FBT has demonstrated that parents can have extraordinary success in restoring their child's health.
There are multiple excellent resources online for FBT. Two in particular we recommend are F.E.A.S.T. and Maudsley Parents. If you have a child or loved one with an eating disorder we strongly encourage you to become familiar with this treatment model. In addition, we recommend an excellent book, Help Your Teenager Beat an Eating Disorder, written by Dr. James Lock and Dr. Daniel LeGrange, two experts in the eating disorder field. They are responsible for the most recent published research using the Maudsley method for parents considering and/or currently doing this form of therapy.
Next week: What are the phases of the Maudsley method?
Contributions by Sarah Emerman
Posted by Mark Warren on Fri, Sep 11, 2009 @ 11:53 AM
The term “evidence-based treatment” refers to therapy that has demonstrated statistically significant improvements or changes in behavior. In most kinds of healthcare, the only kind of treatment a person would accept is something that is evidence based. If someone was getting treatment for cancer, diabetes, or another life threatening illness, they would seek out care that had significant evidence that it worked. Unfortunately, the history of psychiatric treatment is filled with ineffective care used because it was marketed well or because there was nothing else available. Luckily this is no longer true.
Evidence-based therapy for the treatment of eating disorders has only existed for the past 15 years. Although various types of therapy have been proven to show progress in some clients, evidence to support any given treatment is not as good as we would like it to be. It is, however, better than it used to be. The major limitations to research are the short length of many trials in what we now know are long term illnesses, and the difficulty of doing randomized controlled clinical trials. Nonetheless, given that there was no effective treatment prior to 15 years ago, what we know now is a significant improvement.
For adults, evidence-based treatments include Cognitive-behavioral therapy, Dialectical-behavioral therapy,and Interpersonal therapy. If you are 18 years or older and are currently suffering from an eating disorder, these are the therapies to try first. If you are under the age of 18 and have anorexia, the Maudsley method is the only treatment that is evidence-based and should therefore be tried prior to any other treatment. We will cover each of these treatments separately over the next few weeks.
Next week: How can I tell if my therapy is working?
Contributions by Sarah Emerman