For years now, eating disorders patients and their families been watching and waiting for clinical trials to verify what treatment experts have been observing in practice: that the family-based Maudsley method really is the most effective treatment for many young anorexia patients. Last week The New York Times reported a new study by Maudsley pioneer Daniel Le Grange at the University of Chicago:
Researchers randomly assigned 121 patients ages 12 to 18, mostly girls, to a year of either family or individual therapy at the University of Chicago and at Stanford—24 hours in all. … Twelve months after the treatment had ended, 49 percent of those who had been in family therapy were in full remission, more than double the 23 percent of those who had been in individual therapy. And among patients who were in remission at the end of the treatment itself, only 10 percent of the family-therapy group had relapsed a year later, compared with 40 percent of those who had individual therapy.
That’s pretty impressive, especially given the short duration of treatment–24 hours isn’t a whole lot of treatment for a life-threatening illness. But it is important to consider the caveats. These patients were mostly teenage girls, and all had been ill for no more than a year and were at least 75 percent of their healthy body weight. And as a general rule, pre-screening for the Maudsley method excludes families with overly domineering or controlling parents who are unwilling to change themselves.
How does the Maudsley approach work? The family treats food as medicine, and it’s the job of the parents to administer this medicine–and to see that the patient absorbs it. But there’s more to it:
…the therapist sits in on a family meal to observe the dynamics, Dr. Le Grange said. Everyone in the family has a role: Siblings are instructed to clear out once they are finished eating, ‘not jump up and yell at their sister for not eating or yell at the parent.’ Unlike traditional approaches, the Maudsley method ‘says we don’t think the parents are to blame for the problem,’ Dr. Le Grange said. ‘We think they’re part of the solution, and should be center stage.’ Their job is to be calm, supportive and consistent.
Teaching families to be “calm, supportive, and consistent,” I suspect, is key to the Maudsley method’s success. Unfortunately, more serious eating disorders often occur in families that are already struggling with substance abuse, depression, anxiety disorders and physical and emotional abuse. Sometimes, the eating disorder represents a dysfunctional but quite understandable attempt by a sensitive child to escape the uncontrolled conflict or rigidity of the family. Few of these families would qualify for the Maudsley method, unless other family members are themselves willing to change.
There’s one other critical aspect of the Maudsley method that often gets overlooked in general descriptions of the approach. Once the patient’s weight and brain function is restored and the family has learned a new way to feed, calm, and support her–and, perhaps, each other–she does move on to individual therapy. In other words, once her family has given her the nourishment she needs to think straight, she still needs to develop the tools to mature into a strong and self-reliant adult apart from them.The Maudsley approach does not replace individual therapy, but precedes it.
The ultimate goal of all effective treatment of eating disorders is to equip the patient to thrive on her (or his) own. Strong families not only need to learn how to provide the “calm, supportive, and consistent” base for a healthy childhood, but they also need to know how and when to release their children to the wider world.