There is a lot of discussion about how best to treat eating disorders. Individual therapy has been the traditional treatment in the past. The new kid on the block in the United States is called The Maudsley Approach or Family Based Training and was developed in London in the 1970's. Some treatment providers are now trained in this approach but many are not. There is also some controversy in the eating disorder field regarding this method. It is not uncommon for parents to contact a professional who is not aware of its existence or he may have only minimal understanding that it focuses on the family. Many professionals don't agree with the method and are not afraid to tell parents their opinion on the matter. Below I have identified the primary components of both the traditional treatment of eating disorders and the newer Maudsley Approach. I have also put forth some advantages and disadvantages of the newer FBT (family based treatment). Traditional Therapy *Individual therapy with your daughter *Peripheral contact with parents depending on the therapist (some do more family work) *Individual issues that contribute and maintain the ED are assessed and addressed *Family therapy if deemed necessary (often conducted by a second therapist) *Parents work with child at home to eat more as advised by nutritionist *Nutritionist's role to focus on food, increase calories and confront food fears *Treatment team: physician, nutritionist and therapist *Attempts are made to keep daughter in control of as much as possible as related to ED *Parents role is to support and encourage The Maudsley Approach/Family Based Treatment (FBT) *All family are involved in treatment from beginning to end *First or second session involves a family meal at the therapist's office *Immediate re-feeding at home begins *Parents are coached to re-feed at home with therapist support *Siblings are to align with ill brother or sister; they are to encourage, not coach *Usually a treatment team: physician, nutritionist and therapist but not always *Only after weight restoration will individual issues like depression be addressed *Recovery not complete until daughter's menses returns *Parents take control of anything that relates to the ED; she maintains autonomy in other areas *Daughter is to comply with parent re-feeding until later stages of treatment Advantages of The Maudsley Approach *If it is effective, treatment is usually shorter *Parents are empowered to re-feed their child instead of someone outside the home *Parents are coached as to how to re-feed their child at home *Whole family is involved and siblings feel good about helping their ill sister or brother *Often other issues resolve as your daughter's nutrition improves Disadvantages of The Maudsley Approach *It is not effective for every family *Not all parents are able to deal with the intensity of angry and hostile behavior during re-feeding *High level of commitment regarding food preparation, organization and follow through *Necessity of one parent having to be present at every meal; may have to make changes in schedule to be more available *Can be high stress on marriage due to importance of presenting a united front Lock, J., Le Grange, D., Agras, W. S., C. Dare. 2001. Treatment manual for anorexia nervosa: A family-based approach. New York: Guildford Publications, Inc. Lock, J., and D. Le Grange. 2005. Help your teenager beat an eating disorder. New York: Guilford Press
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