While researching a story for the newsletter Eating Disorders Recovery Today (Family Based Treatment: New Directions), I uncovered a number of novel uses of what is known as the Maudsley approach, or Family Based Treatment (FBT). This approach was developed in England roughly 20 years ago and has since gained popularity in the U.S. The core of the FBT philosophy is that the parents of the anorexic child or adolescent are put firmly in charge of refeeding their child rather than medical professionals and therapists. Where often parents feel blamed or somehow responsible for their child’s eating disorder, FBT shifts the blame from parents and teaches that parents and child are allies against a common enemy: the eating disorder. FBT also instills confidence in parents that they can work with their child to conquer the disorder.
FBT was at first used mainly as a treatment for adolescent anorexics, but after seeing how effective it can be among those patients, researchers have continued to widen their use of the approach to include bulimics and other forms of eating problems. They have also begun to combine FBT with other modes of therapy, such as cognitive behavior techniques, nutrition education, psychoeducation (educating families about the biology of eating disorders), and memory and cognitive exercises.
At the Mt. Sinai eating disorders program in New York City, researchers have been looking at the effectiveness of FBT with sub-threshold anorexics, patients who have disordered eating but fall short of a full-blown anorexia diagnosis. Dr. Alicia Hirsch at Mt. Sinai told me that she can foresee the day when FBT will be used with adults as well as adolescents, perhaps with spouses taking on the support role of parents.
In one sense, Sarah K. Ravin, Ph.D., is already doing this kind of work. Dr. Ravin, a private post-doctoral psychology resident in Coral Gables, FL, became interested in FBT while training at Children’s National Medical Center’s Eating Disorders Clinic in Washington, D.C. and working with a multidisciplinary treatment team that followed Maudsley protocol for treatment of adolescent anorexics. Work at college counseling centers at American University in Washington, D.C. and the University of Miami followed. When I talked to her, she was employing a modified FBT treatment plan with a college student.
The parental, or support role in that case was played by the patient’s boyfriend, whom, Dr. Ravin said, had been “very involved and pushed her to get treatment.” She noted, “The couple shares many meals together, including dinner most nights. More than anything, the patient needs meal support, and [the boyfriend] can be very helpful with that.” Dr. Ravin acknowledged the potential complications of this treatment plan since traditional Maudsley calls for the parent to temporarily assume a more authoritarian role while the patient regresses developmentally. But she noted that the boyfriend assumed more of a support role without being too permissive: He needed to be able to say “No, we’re not having rice cakes for dinner.”
Dr. Ravin has also had the experience of being the only member on a treatment team advocating FBT. In order to help family members, psychiatrists and nutritionists understand the value of this approach, Dr. Ravin told me, “I’ve made reading lists for people, emailed and photocopied articles. It’s a tough line to toe, because when you’re young and less experienced as I am, oftentimes people who are 50 or 60 don’t want to be told what to do by a young person.”
If you’ve read our book, you know that Marcia and I are strong advocates of FBT, and urge readers to consider some form of the Maudsley approach. The reality is that many communities in the U.S. don’t have trained Madsley practioners such as Marcia. It is still possible, however, to seek experts who believe that parents or loved ones are not to blame, and encourage them to be key players in the recovery of their child, partner or loved one.
Two sites that offer Maudsley information, tips on how to search for a qualified Maudsley practitioner and a list of family based practitioners around the world are F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders) and Maudsley Parents.