When an adolescent is diagnosed with an eating disorder, the belief often is that the family - whether directly or indirectly - has played a part in the development of the disorder, either psychologically, or physiologically. But a new type of treatment, called the Maudsley Approach, is challenging that belief. The treatment method is intended specifically for adolescents who are in the early stages of developing an eating disorder.

Though there has been some limited success with family-based therapy, very little has been documented. Most successful eating disorder treatments are based around an individual approach. A psychologist, dietician, physician, and possibly a nurse, work with the patient to restore him or her to health. The Maudsley Approach is different in that it requires participation from the entire family, and in particular from the parents.

With this type of treatment, the parents take on the responsibility of getting their child to eat healthily again. It requires a lot of commitment. At least one parent must be present for every meal or snack that their child eats. If the teen suffers from bulimia, the parent must also stay with him or her for at least one hour after food has been consumed. During this time, the patient will be participating in counseling sessions that may or may not include the rest of the family.

Initial clinical studies of the Maudsley Approach have returned surprisingly positive results. About two-thirds of all patients who participated in the studies were recovered at the end of treatment (which typically lasts no longer than 12 months), and at a five-year follow-up 75-90% had reached and maintained a healthy weight. Considering the fact that most other treatments only show a 30-40% success rate and little long-term success, the Maudsley Approach is very promising, especially in light of its short time frame.

Three Phases
The Maudsley Approach is broken down into three phases. The length of each phase is not pre-determined, but instead depends on how quickly the patient and his or her family respond and when the therapist deems them ready to move on to the next phase.

Phase I
In Phase I of the approach, the therapist talks with the patient and his or her family, making some determinations about the family’s interpersonal relationships and eating habits. The therapist may even “sit in” on a family dinner to make more accurate observations. Based on this information, the therapist will counsel the parents on how to begin re-feeding their child. The therapist will emphasize the importance of being encouraging, and being tough without criticizing the child. The therapist will also model this behavior as he or she interacts with the entire family. During this phase, the therapist often educates the family on the dangers of malnutrition, helping them understand why it’s important for the patient to begin eating healthily again.

Phase 2
Phase 2 marks the transfer of responsibility for eating choices from the parents to the child. At this point, the child will be cooperating enough with her parents that she will begin to be more responsible for determining when and how she will eat. Weight gain is also encouraged during this phase.

Some family counseling will occur during this phase as well, but only as it pertains to the patient’s eating disorder. For example, if one parent is continually critical of the child’s resistance to eating, that will be addressed.

Phase 3
In the final phase, the patient and therapist begin addressing issues pertaining to adolescence and their effects on the eating disorder. This phase could be called a “phase-out” phase, because its goal is to fully restore the teen back to a “normal” life. The teen is encouraged to explore and develop more independence, and to re-establish normal boundaries between himself and his parents.

The Maudsley Approach is named for Maudsley Hospital in London, U.K., where the treatment was first developed.

Opponents of this approach criticize the fact that the patient is never encouraged to address the root causes of the eating disorder but is instead simply encouraged to begin eating again. Doctors who have been using this out-patient treatment method say, however, that those issues surface of their own accord, as the adolescent re-learn proper eating habits.