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

Abstract

ObjectiveMulti‐family therapy (MFT‐AN) is a promising group‐based treatment for adolescent anorexia nervosa. This study aimed to explore how young people and parents perceived change to occur during MFT treatment.MethodsYoung people (10–18 years) diagnosed with anorexia nervosa or atypical anorexia nervosa and their parents who completed MFT‐AN alongside family therapy for anorexia nervosa within the preceding 2 years were eligible for this study. Semi‐structured qualitative interviews were conducted. Recordings were transcribed verbatim and analysed using reflexive thematic analysis.ResultsTwenty‐three participants (8 young people, 10 mothers and 5 fathers) completed interviews. Five main themes were identified; (1) Powerful connection, (2) Intensity, (3) New learning and perspective shifts, (4) Comparisons, and (5) Discharge is not recovery. There was a strong sense that being with others in a similar position in an intense environment were key factors in promoting change. Comparisons were inevitable and could promote insight and foster motivation, but could also be unhelpful at times. Participants spoke about how recovery continues beyond service use and requires ongoing attention and support.ConclusionsThrough the mechanisms of connection, intensity, new learning and comparisons change is perceived to occur in MFT‐AN. Some of these are considered unique to this treatment format.

How young people perceive change to occur in family therapy for anorexia nervosa: a qualitative study

“…These interventions are often provided when things ‘feel stuck’ in FT-AN. In both multi-family therapy and intensive day programme treatment the importance of trust, containment and increased support are seen as important in enhancing treatment response and helping families break maintenance factors (Baudinet et al 2023a ; Baudinet et al, in press ; Colla et al 2023 ; Gledhill et al, 2023 ). Perhaps one marker of the need for intensive treatment is when one or more of the generated themes in the current study are not able to be activated in standard outpatient FT-AN.…”

Transition support for patients admitted to intensive treatment for anorexia nervosa: qualitative study of patient and carer experiences of a hybrid online guided self-help intervention (ECHOMANTRA)

“… 28 However, some caution is warranted as some participants noted that it triggered perfectionist traits. The positive feedback particularly about the joint (patient and carer) groups resonates with the literature pertaining to multifamily groups in the child and adolescent setting 29 and that endorsing their value in adult settings also. 30 , 31 Feedback also adds to the literature highlighting the important support offered by people with lived experience.…”

Parents’ perspectives of anorexia nervosa treatment in adolescents: a systematic review and metasynthesis of qualitative data

“…I feel good about it” [ 25 ] “Some things you can only talk about with others who experienced it” [ 31 ] “Attending the parenting courses was very helpful…” (Nilsen 2021) On home therapy: “I felt energised…” [ 26 ] On MFT: “…if it came from my child, I would not have understood. I understood better through the words of another young person” [ 34 ] “…seeing…[what] people had triumphed over or their views being slightly different was quite…interesting and helpful” [ 35 ] Experience of treatment modalities: Negative experiences On FBT: “The focus seems to be all on the food aspect” [ 21 ] “Really what you need is someone who sees the whole person…” [ 30 ] “…they didn’t appear to be doing very much or to be talking about the whys and wherefores” [ 24 ] “When things aren’t going well, you kind of blame yourself” [ 33 ] “When we were on our own… we could have been more honest” [ 21 ] “I really don’t know where you could find family therapists that specialize in treating anorexia in Hong Kong…such kind of support is totally unavailable” [ 36 ] On in-patient treatment: “there was a lot of moping around….” [ 21 ] “How thin must one become to receive treatment? Actually, she lost weight just to meet their BMI criteria” [ 40 ] Compulsory treatment/control “…I think if their life is at risk… someone has to make the decision…” [ 22 ] “…She isn’t strong enough to make a decision about her” [ 21 ] “If you give treatment in early stages… you are prolonging the time they can get well” [ 21 ] “I think if someone is going to starve themselves to the point where they are dying… you must be allowed to die quietly, kindly” [ 22 ] “I think probably it was good for her to know that somebody else was in control…” [ 23 ] “…you don’t have much choice, because in any case you don’t know what to do any more.” [ 37 ] 3.…”

“…“…seeing…[what] people had triumphed over or their views being slightly different was quite…interesting and helpful” [ 35 ]…”

“…Ten studies focused mainly on the experience of family-based treatments [ 23 , 25 , 29 , 32 – 35 , 41 , 42 , 44 ], including a FAP [ 29 ].…”