Behavioral Family Therapy
The overall perspective of this therapeutic approach is to see the parents as a resource in the treatment of adolescent patients with AN. Mobilizing parents and family members as a resource is the most important theoretical position that sets this approach apart from other family and individual therapies for AN. Parents play an important role throughout the three phases of this treatment. Thus, the first phase of treatment attempts to reinvigorate parental roles in the family system, particularly as it is related to the patient's eating behaviors. This is considered the key therapeutic maneuver in this phase of family treatment. Therapy is almost entirely focused on the eating disorder and its symptoms and begins with a family meal. The therapist's goal in this phase is to develop a strong parental alliance on the one hand and to align the patient with a peer or sibling sub-system. The families are encouraged to work out for themselves the best way to re-feed their anorexic child.
The theoretical understanding or overall philosophy of the Maudsley approach is that the adolescent is imbedded in the family, and that the parents’ involvement in therapy is vitally important for ultimate success in treatment. In anorexia nervosa the adolescent is seen as regressed. Therefore, parents should be involved in their offspring’s treatment, while showing respect and regard for the adolescent’s point of view and experience. This treatment pays close attention to adolescent development and aims to guide the parents eventually to assist their adolescent with developmental tasks. In doing so, fundamentally working on other family conflicts or disagreements have to be deferred until the eating disorder behaviors are out of the way. Normal adolescent development is seen as having been arrested by the presence of the eating disorder. The parents are temporarily put in charge to help reduce the hold this disorder has over the adolescent’s life.
The Maudsley approach differs from other treatments of adolescents in several key ways. First, as pointed out above, the adolescent is not viewed as being in control of her behavior, instead the eating disorder controls the adolescent. Thus in this way only, the adolescent is seen as not functioning on an adolescent level, but instead as a much younger child who is in need of a great deal of help from her parents. Second, the treatment aims to correct this position by improving parental control over the adolescent’s eating (also read ‘eating disorder’). This control has often been lost because parents might feel that they are to blame for the eating disorder or the symptoms have frightened them to the extent that they are too afraid to act decisively. Third, the Maudsley approach strongly advocates that the therapist should primarily focus her/his attention on the task of weight restoration, particularly in the early parts of treatment. The Maudsley approach, as opposed to Minuchin’s approach, tends to ‘stay with the eating disorder for longer, i.e., the therapist remains alert not to become distracted from the central therapeutic task which is to keep the parents focused on re-feeding their adolescent so as to free her from the control of the eating disorder.