Eating Disorders Information (EDI)

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What is the family approach?

The family approach widens the net of therapy to include not just the patient, but also the patient's family. It takes the view that, on the one hand, the family might be a crucial tool in the recovery from the mental illness and also, on the other hand, that the mental illness might be a response to a particular pattern of family interactions that needs correcting.

What causes an eating disorder?

There are two different ways of going about family therapy and both have different answers.

The Maudsley method says, essentially, that we don't know, but that doesn't matter. A course of family therapy following the Maudsley approach would simply begin by empowering the parents to enforce eating at meal time without addressing any of the underlying issues that might have caused the eating disorder. Once the anorexic teenager has worked her way up to a healthier weight, the therapy then begins to look at helping her to work through adolescent issues that she might not be coping with.

The Family Systems approach takes the opposite route: it practically ignores the patient's disordered eating, instead beginning by looking at how the patient's family interacts with one another in an attempt to work out why the eating disorder might have started. Once the therapist feels s/he has worked out what behaviours or patterns of interaction are responsible for causing and continuing the disorder, s/he intervenes to change them. The theory is that, once the cause of the eating disorder has been dealt with, the anorexic teenager will no longer have any need to starve herself and the illness will disappear.

While both of these methods approach eating disorders from completely different angles, it is unclear which is most effective. However, what is generally believed is that family therapy, in whatever form, is the most effective form of therapy for anorexia when the sufferer is still an adolescent living with his/her family- although the evidence for the belief has been contested.

Where can I go to find out more?

For more information on the Maudsley approach to family therapy, you can go to the website of Maudsley Hospital's Eating Disorder Unit, or to the website of Maudsley Parents, which is run by parents who have seen their teenage children treated by the Maudsley method.
For more information about the family systems approach, or to search for a local therapist who could help you, click here.

References

Books:
Lock, J., le Grange, D., Agras, W. S. & Dare, C., 2001. Treatment Manual for Anorexia Nervosa. The Guilford Press: New York
Palazzoli, M. S., 1974. Self-Starvation: from the Intrapsychic to the Transpersonal Approach to Anorexia Nervosa, Human Context Books: London
Journal Articles:
Wilson, G., et al., 2007. "Psychological Treatment of Eating Disorders", American Psychologist, 62(3), 199-216