family therapy for people with eating disorders

from medicalnews a few days ago:

bulimia treatment success doubles when parents involved in therapy

mobilizing parents to help an adolescent overcome the disorder can double the percentage of teens who were able to abstain from binge eating and purging after six months.

a team based at the university of chicago medical center showed that almost 40 percent of participants in family-based treatment had stopped binging and purging compared to only 18 percent of those who received supportive psychotherapy, the standard therapy. six months after treatment, almost 30 percent of participants who received family-based treatment were still abstinent compared to only 10 percent of participants who received supportive psychotherapy, which focuses on issues underlying the eating disorder.

“parents are in a unique position to help their adolescents,” says study author dr daniel le grange, associate professor of psychiatry and director of the eating disorders program at the university of chicago, “yet treatment typically excludes them from the process. now we have the evidence that we need to bring them back in.”

in family-based treatment, parents and at times even siblings attend clinic sessions with the patient. parents play an active follow-up role at home, encouraging their adolescents to eat as normally as possible, then monitoring them during and after meals to make sure they eat and are not tempted to purge.

although the family-based approach produced superior results, the research team is uncertain whether it was the family involvement or the focus on eating behavior found in family-based treatment that was responsible for the improved outcomes.

first i was surprised that this was treated as news. after all, the very first time i read about the treatment of eating disorders was in a book by salvador minuchin, family kaleidoscope, written in 1986. in it, minuchin makes it quite clear that often, eating disorders are a problem that necessitates involvement of the whole family.

apparently, though, it looks like le grange’s program is at least partly based on minuchin’s work. the new findings also seem to be related specifically to bulimic adolescents. interestingly enough, young persons with bulimia had hardly been studied; the belief was that onset of bulimia was between 18 and 24.

see here for an overview of research on families of persons with anorexia and here for some thoughts on families of persons with bulimia.

isabella mori
counselling in vancouver

8 thoughts on “family therapy for people with eating disorders

  1. Alina Popescu

    This is a very interesting article. And I think it should be republished in countries where eating disorders are only now becoming a major problem and where parents lack the knowledge and awareness to consider them a real issue. Romania is such an example. No real studies, no real treatments, no real concern.

    I would really like to see a similar study for anorexic teenagers to be honest. Thank you for the link with details on this subject and if you have more to recommend, I would really appreciate it.

  2. Alina Popescu

    This is a very interesting article. And I think it should be republished in countries where eating disorders are only now becoming a major problem and where parents lack the knowledge and awareness to consider them a real issue. Romania is such an example. No real studies, no real treatments, no real concern.

    I would really like to see a similar study for anorexic teenagers to be honest. Thank you for the link with details on this subject and if you have more to recommend, I would really appreciate it.

  3. Laura Collins

    Although similar in name, “family therapy” and “family-based therapy” are very different.

    The Minuchin model has been eclipsed and while it helped form the later concept of “family-based” treatment they have one important difference:

    Family-Based (also called Maudsley) treatment is absolutely not about families causing the illness. It is about mobilizing the family as the best ally against the illness.

    It is not about fixing the family.

    For families interested in learning more about FBT and Maudsley please visit the parent-led web site, Maudsley Parents.
    Families do not cause eating disorders, but they really can be part of the solution.

  4. Laura Collins

    Although similar in name, “family therapy” and “family-based therapy” are very different.

    The Minuchin model has been eclipsed and while it helped form the later concept of “family-based” treatment they have one important difference:

    Family-Based (also called Maudsley) treatment is absolutely not about families causing the illness. It is about mobilizing the family as the best ally against the illness.

    It is not about fixing the family.

    For families interested in learning more about FBT and Maudsley please visit the parent-led web site, Maudsley Parents.
    Families do not cause eating disorders, but they really can be part of the solution.

  5. isabella mori

    laura – thanks for your comment.

    i think by now most experts in the field would agree that anorexia, like other mental health issues, is a complex issue. i totally agree, saying that families “cause” eating disorders would be a very simple-minded way of looking at things.

    i personally would not want to be part of any family therapy that was about “fixing” the family.

    family therapy of whatever stripe always needs to be about increased respect, communication and collaboration among family members and should never be about blaming.

    as for what constitutes best treatment – maudsley or otherwise – i am with scott miller whose extensive research shows that treatment modality only plays a small role in predicting therapy effectiveness.

    and thanks for your comments, too, alina. please feel free to look through my eating disorders category and follow the links there. you’ll find interesting information there.

    here are a few more sites you may want to look at:

    http://www.theage.com.au/news/fashion/models-anorexia-comments-spark-debate/2007/01/25/1169594425057.html

    http://www.lifespan.org/services/mentalhealth/articles/eating/anx_causes.htm

    http://www.med.umich.edu/depression/BrightNights/EatingDisordersandDepression07.htm

  6. isabella mori

    laura – thanks for your comment.

    i think by now most experts in the field would agree that anorexia, like other mental health issues, is a complex issue. i totally agree, saying that families “cause” eating disorders would be a very simple-minded way of looking at things.

    i personally would not want to be part of any family therapy that was about “fixing” the family.

    family therapy of whatever stripe always needs to be about increased respect, communication and collaboration among family members and should never be about blaming.

    as for what constitutes best treatment – maudsley or otherwise – i am with scott miller whose extensive research shows that treatment modality only plays a small role in predicting therapy effectiveness.

    and thanks for your comments, too, alina. please feel free to look through my eating disorders category and follow the links there. you’ll find interesting information there.

    here are a few more sites you may want to look at:

    http://www.theage.com.au/news/fashion/models-anorexia-comments-spark-debate/2007/01/25/1169594425057.html

    http://www.lifespan.org/services/mentalhealth/articles/eating/anx_causes.htm

    http://www.med.umich.edu/depression/BrightNights/EatingDisordersandDepression07.htm

  7. Dylan Emrys, MA

    I think this is a great article, and am also surprised that it is “new” news.

    I work with families and individuals, and it is essential to mobilize the entire family for concerns such as bulimia.

    I also work with infants, and help parents see how some issues have their origin very early, and can be prevented. In either case, it’s a family issue.

  8. Dylan Emrys, MA

    I think this is a great article, and am also surprised that it is “new” news.

    I work with families and individuals, and it is essential to mobilize the entire family for concerns such as bulimia.

    I also work with infants, and help parents see how some issues have their origin very early, and can be prevented. In either case, it’s a family issue.

  9. isabella mori

    hi dylan – nice to meet you here!

    i like how you use the word “mobilize” – because what’s holding families back, i believe, is often a sort of paralysis. it’s not that people are unwilling or disinterested in helping, it’s just that we can be so stuck in our dynamics!

  10. isabella mori

    hi dylan – nice to meet you here!

    i like how you use the word “mobilize” – because what’s holding families back, i believe, is often a sort of paralysis. it’s not that people are unwilling or disinterested in helping, it’s just that we can be so stuck in our dynamics!

  11. Therapist Seattle

    How do we tackle bulimic adoloscents when the family itself is obese. Some families have a tendency to overeat and overfeed children, starting at infancy. Some cultures do believe in fat children make healthy children. It’s a little more complex for a therapist to handle if the family doesn’t think the child has an eating disorder. Likewise with overly beauty conscious parents who constantly underfeed children to keep them skinny. Lean need not necessarily be fit too.

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