‘Communities of concern’ in the family-based treatment of anorexia nervosa: towards a consensus in the Maudsley model

Abstract

The Maudsley model of family-based treatment for anorexia nervosa, first developed in the mid-1980s, has been the subject of a number of randomized controlled trials over the past 20 years, each demonstrating its efficacy. In the past 5 years, the model has developed into two streams with the emergence of a multiple family therapy format in the United Kingdom and Europe and the consolidation of single family practice in the United States, including the publication of a treatment manual. While the benefits of multiple family therapy have not yet been experimentally demonstrated, its potential lies in the solidarity that can be promoted between families in their fight against the anorexia. In this paper, we will argue that the standard manualized version of the Maudsley model might also be augmented to incorporate strategies that introduce a role for a wider community, specifically by employing practices derived from a model of generic family therapy called narrative therapy.

Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review

“…The ''termination phase'' is seldom clear-cut as many experienced families decide to stay a while longer to coach new families and consolidate their own skills, a practice similar to that of Rhodes et al's [48] ''community of concern.'' It is a period of appraisal of what has been and what remains to be accomplished, and of the family's ability to continue on its own.…”

“…The CTTA Multiple Family-Based Therapy model has been inspired primarily by the Maudsley FBT and the Maudsley-based MFT model [47,48]. The Maudsley FBT approach is a specific form of brief single family therapy based on the notion that adolescents suffering from ED are not in a position to make decisions about food and eating [44].…”

“…The adolescents are encouraged to express their views, disagreements, needs, and feelings. Parents are invited to distinguish between the child and his illness, using ''externalization'' techniques and minimizing expressed emotions of criticism and hostility [48]. During the third phase (a monthly one-day treatment module, over a four-month period), emphasis is placed on the psychosocial and psychological development of each individual family member.…”

“…The group runs as an open-ended group, meaning that new members are periodically introduced into the group (twice over the MFT cycle), while more experienced members or veterans may take a ''parent-to-parent consultant'' role [48] before leaving the group, thus providing hope and expertise to new arrivals.…”

Collaborative care between professionals and non‐professionals in the management of eating disorders: a description of workshops focussed on interpersonal maintaining factors

“…Meanwhile, the form of family work has been modified and has included: separated family therapy (parents seen in parallel to the adolescent ; multifamily groups of various forms either including the offspring (Colahan & Robinson, 2002;Geist, Heinmaa, & Stephens, 2000;Scholtz & Asen, 2001) or not (Uehara et al, 2001). A recent addition of this journal had articles discussing modifications of the standard model of working with families either by including narrative approaches (Rhodes, Gosbee, & Madden, 2005) or by adding family work as a supplementary module for adolescents under 18 treated with a CBT approach (Dalle Grave, 2005).…”