The Maudsley Therapy is a relatively new treatment for adolescents with Anorexia Nervosa. In a nutshell, the parents are responsible for feeding the child and finding any acceptable way to be sure she eats. The treatment team aids the parents and empowers them to leave no wiggle room for the child to continue to restrict. The parents are full members of the treatment process and an integral part of recovery.
There is nothing novel about the concept behind the Maudsley treatment. Behavioral problems in children more often than not stem from ongoing issues in family dynamics. Accordingly, treating adolescents almost always includes family therapy, and that therapy also must support the parents' authority. Although teenagers are continually working on--and pushing acceptable limits of--their independence, parents ultimately have the responsibility and ability to set rules and enforce them.
What does make the Maudsley method unique is that, unlike so much of the treatment for Anorexia Nervosa, it seems to work. This approach focuses on children early in the course of the illness, and, as I have written many times, the chance for a relatively fast and full recovery is greatest before the eating disorder has fully taken hold. Using Maudsley either after inpatient treatment or right after initial diagnosis can enable a child and family to overcome the eating disorder and its psychological and emotional causes in the initial stages of the illness. The treatment tackles the triggers in daily life and helps heal the family dynamics that may be at the core of the disorder. With the eating disorder so exposed, the child can no longer hide her feelings or her symptoms and is instantly brought back into her life and into the relationships around her. The process does not allow the eating disorder to transform from starvation into a way of life.
Any ray of hope within the professional community quickly makes its way into clinical practice. Effectively, this means that therapists will try to incorporate new, promising treatment alternatives into the process of recovery. The Maudsley method is no exception.
But there are several obstacles to adapting the treatment to adults with a chronic eating disorder. First, the patient is an adult. As I wrote in the last post, it is critical that this adult have the autonomy to make decisions about her treatment. Imposing any steadfast rules--and the fear and uncertainty that is sure to follow--only strengthens the hold of the eating disorder: the patient has no other tools to cope with high levels of stress. Second, what does relinquishing some control over food look like for an adult? Third, who is the person (or are the people) in charge of supervising the eating? And exactly what role does this person have in treatment?
The first step is one simple fundamental adaptation to the Maudsley concept. A child often has little awareness of the scope of the eating disorder, how much the illness consumes her and the long term risk to her life. Most adults with a chronic eating disorder--those without the delusional component I discussed in an early post--are much more aware of these realities. Because of this difference, a patient will often be willing to accept that, despite her resolve and motivation to get better, she cannot do so on her own. The eating disorder thoughts remain too powerful. And that means she will need help throughout the day to eat. If more structured programs have had limited long term benefit, using the relationships in her life to help her eat can not only be effective but can be appealing to the patient herself. It can offer a new alternative rather than returning to the limited and largely ineffective options she has tried in the past.
The other difference is that the patient cannot be forced to eat the way a child can. Instead, she needs first to establish the proposed changes to the meal plan on a regular basis--preferably daily to weekly--with her nutritionist. She then needs to share these changes with the designated person or people in her life who are going to help her face the eating disorder thoughts. And third, she needs to empower her helpers and herself to make these changes happen. The patient needs to acknowledge that the changes in her eating will only take place when people in her personal life are allowed to support her against the eating disorder. This person is usually a parent or friend, significant other or spouse. Under certain circumstances, the therapist can also offer this kind of support and be effective. The difference between this situation and a parent helping an adolescent is that this helper does not have the same kind of authority a parent does. Accordingly, the power to make changes comes only from the collaboration between this person and the patient herself. So the crucial component to success is the patient's ability to let people into her life. That is how the Maudsley approach is most similar for adults: it insists the patient no longer is so alone.
After the last two posts indirectly referred to the possible role families play both in the inception of an eating disorder and in the healing process, I think the next post should focus more specifically on the family as a whole and how disordered eating and an eating disorder disrupts its function.