‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

Abstract

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

“…In addition, Conti et al. () argue that the approach may offer little to the adolescent, since it ‘… sets up the task as adversarial where the aim is to vanquish the problem from a person's life; such an aim leads to increased vulnerability and fatigue and reduced personal agency …’ (Conti et al., , p. 422).…”

Commentary on: ‘Somebody Else's Roadmap: Lived Experience of Maudsley and Family‐based Therapy for Adolescents with Anorexia Nervosa’

“…The paper ‘Somebody Else's Roadmap: Lived Experience of Maudsley and Family‐based Therapy for Adolescents with Anorexia Nervosa’ by Conti et al. () is a welcome addition to the research on the role of Maudsley Family‐based Treatment (FBT) (Lock & Le Grange, ) for adolescents and children with anorexia nervosa. This is a very topical area with several recent commentaries and debates found, for example, in papers in the Australian and New Zealand College of Psychiatrists’ journal including a recent 50‐year retrospective of the field (Hay, ; Murray, Thornton & Wallis, ).…”

“…In this regard, it is distressing to read the account of the family‐based treatment in the paper by Conti et al. (), where the therapy was extended without there being significant improvement in the patient's illness state. This led to a sense of blame within the family, which is one aspect FBT aims to avoid.…”

“…However, the Conti et al. () paper describes such an instance where there were adverse effects and these should be more rigorously documented and identified in trials.…”

“…Conti et al. () have written a welcome paper raising issues for further consideration in the research and development of therapies, particularly family therapies, for children and adolescents with anorexia nervosa. It is hoped that this account will stimulate ongoing refinement of FBT and other family therapies to take greater account of individual familes and their needs.…”