Multi-family therapy for bulimia nervosa: a qualitative pilot study of adolescent and family members’ experiences

Abstract

Background Multi-family therapy (MFT-BN) is a new treatment for adolescent bulimia nervosa with emerging empirical support. It extends the bulimia nervosa focussed family therapy model, by offering treatment in a group setting. Up to nine families work together with a team of clinicians over the course of 20 weeks. No qualitative study to date has investigated the experience of MFT-BN. This study aimed to explore this from the adolescent and parent/caregiver perspective. Methods Participants from two consecutive MFT-BN groups facilitated at the Maudsley Hospital in London, UK, were invited to participate in either a focus group or individual qualitative interview about the experience of MFT-BN. Of the 19 eligible participants (from 9 families), 15 (8 parents, 1 older sibling, 6 adolescents) consented and participated. Audio-recordings of interviews and focus groups were transcribed verbatim and analysed using reflexive thematic analysis. Results Three main themes were identified; (1) seeing and being seen, (2) holistic shift, (3) the unspoken. Participants reported overall shifts in cognitions, emotions, behaviours, and relationships both individually and within the family as a result of attending MFT-BN. Meeting other families with similar struggles and sharing experiences, skills and learning helped reduce isolation and promote change. There was also a sense from participants that some things did not, or could not, be spoken about in the group context and that more direct and challenging conversations might have been helpful at times. Discussion The current study identifies some of the perceived benefits and challenges of MFT-BN. The three themes demonstrate the holistic nature of change that can occur across the treatment, as well as the power and limits of the group therapy setting and process. Further research is needed to explore the experience of MFT-BN and its outcomes across a more diverse range of participants and treatment settings.

Perceived change mechanisms in multi‐family therapy for anorexia nervosa: A qualitative follow‐up study of adolescent and parent experiences

“…As the quantitative evidence base continues to build, less is known about the experience of MFT, particularly from the young person's perspective. Six studies have been published to date that investigate the experience of MFT for adolescent anorexia nervosa (Baumas et al, 2021;Coopey & Johnson, 2022;Engman-Bredvik et al, 2016;Voriadaki et al, 2015;Wiseman et al, 2019aWiseman et al, , 2019b and one for bulimia nervosa (Escoffié et al, 2022), although, only four of these include the young person's voice (Baumas et al, 2021;Coopey & Johnson, 2022;Escoffié et al, 2022;Voriadaki et al, 2015). Of the remaining three qualitative studies, two attempted to recruit young people, but all declined (Wiseman et al, 2019a(Wiseman et al, , 2019b, and one focused on the parent-only experience (Engman-Bredvik et al, 2016).…”

Multi-family Therapy for Eating Disorders Across the Lifespan

“…Based on data generated using observational, individual interviews and focus groups, MFT has been described as challenging and helpful, regardless of model, setting or age [1]. Specifically, people describe it as promoting understanding, identity development, mentalising and holistic recovery-oriented change [47,63,[68][69][70][71]. Benefits include participants (particularly caregivers) feeling empowered, more confident and more able to share experiences [45,[72][73][74].…”

“…The majority of programmes described in this paper are outpatient child and adolescent MFT models for anorexia nervosa (MFT-AN), although the number of adult studies is growing. Only recently have MFT models specifically for bulimia nervosa (MFT-BN) been developed [ 47 , 48 ]. Several services offer MFT for mixed eating disorder groups [ 36 , 46 , 49 •].…”