The inefficiencies in set shifting that are apparent in the adult AN literature do not appear to be as pronounced in children. This may suggest that set shifting difficulties in adult AN are the result of starvation or indicative of longer duration of illness. Larger studies are needed to confirm these impressions.
The experiences of six families involved in a 4‐day multi‐family therapy (MFT) group for adolescent anorexia nervosa were examined day by day. Participants completed daily records (journals and rating scales) of their experiences. Parents completed the parents versus anorexia scale pretreatment and post‐treatment. The researcher kept an observation journal of the MFT process. A week post‐treatment, adolescents and parents took part in separate focus groups. The participants’ insights into the illness increased rapidly from Day 1 to 3, while participants’ emotions fluctuated throughout the 4 days. Motivation for recovery was enhanced for four of the five adolescents and self‐efficacy improved for seven of 10 parents. In addition, some improvement in intra‐family communication was reported in five of six families. Change was facilitated by the sharing of experiences with other families in a similar situation, role play activities, the increased ability to express emotions and the perceived mutual learning and support.
Practitioner points
Sharing of experiences in intensive MFT for AN can help improve insight into the disorder and instill hope
Parents becoming ‘firm’ as well as supportive with eating may be the most useful practical strategy
Role plays can help increase empathy, motivation and mobilize families for action
Open expression of feelings works positively, promotes cohesiveness in the group even when this includes difficult emotions
MFT treatment context can be experienced as challenging but nevertheless supportive
Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa), and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered.
This familial high risk design indicated differences in family environment, parenting style, and in children of bipolar parents' perception of their family environment as it relates to their current mood.
Parenting training programmes (PTPs) aim to improve parenting skills and are widely offered in the UK. Despite evidence of efficacy, this paper hypothesises that PTPs may risk disempowering parents, children and even facilitators by prioritising professional expertise over lay knowledge. A Foucauldian discourse analysis examined six PTP manuals and identified discourses including victimhood, institutional salvation, scientism and collaboration. Power relations favouring government and professionals, and impacting outcomes and parental engagement were suggested to result from some of these discourses. Research into PTP engagement in terms of power relations and acknowledgement by policy‐makers of the impact of discourse was recommended.
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