By, Dr. Mark Warren
As readers of this blog are aware, in the world of evidence-based treatment for eating disorders, Maudsley Family Based Treatment (FBT) is the most effective therapy for adolescents with anorexia. The evidence for Maudsley is extraordinarily solid and the effectiveness seems clearly greater than any other available treatment. Given this information, when an adolescent presents at CCED with an eating disorder, Maudsley treatment is always recommended as a first line of intervention. To do otherwise would be to ignore the current research on evidence based treatment for eating disorders. Having said this, it is often not easy to begin Maudsley, to continue it, or sometimes to even wrap one’s head around why it is the necessary treatment.
There are many reasons for this; one of these is that the recommendation of FBT is often at odds with everything the family may have heard about eating disorders. The notions that parents don’t cause eating disorders, that parents may cure eating disorders, that eating disorders are not about children being over controlling or controlled, and that you cant talk someone out of an eating disorder are conceptualizations that are often being heard for the first time. For some it can be difficult to abandon previously held frameworks about the eating disorder and accept these notions as truths.
Sometimes other professionals have reinforced these misunderstandings, thus complicating the route to effective treatment. These are often professionals that are trusted and have demonstrated interest and caring for your child and your family. Unfortunately, many of these same professionals carry the same misconceptions discussed above. So in spite of their tremendous skills, intelligence, and abilities, they may not be aware of the latest expertise and research in eating disorders.
Other barriers include the lack of resources in the community. Many areas do not have FBT trained therapists available, and in our area we are the only agency that does FBT. Therefore, FBT may present issues around travel, time, and money. In addition, for therapists, training in Maudsley may be difficult to obtain. Even if they are aware that Maudsley is the most effective therapy, if they are not at a center where it is practiced it may be difficult for them to get the education they need to provide the best care.
Finally, for patients and families, stigma exists even though in a better world it would not. The suggestion of the severity of the illness, that it is primary, that nobody caused it but the entire family is needed to cure it may result in a greater sense of stigma when treatment is first discussed. Ultimately, however, we believe that the FBT model will help both parents and child feel less stigmatized and more hopeful about the recovery process.
For more information on Maudsley Family Based Therapy and resources in your area check out Maudsley Parents.
We also recommend:
Eating with Your Anorexic by, Laura Collins
Brave Girl Eating by, Harriet Brown
For questions or comments regarding this post, please email blog@eatingdisorderscleveland.org.
Contributions by Dr. Jorey Friedman Beegun and Sarah Emerman