Maudsley Family Therapy, also known as Family-Based Treatment or the Maudsley Approach, is a family therapy devised by Christopher Dare and colleagues at the Maudsley Hospital in London in 1985. It was originally intended for the treatment of anorexia nervosa in adolescents under the age of 18 in the home environment with therapeutic oversight by a trained professional. It was then adapted for use in the treatment of bulimia nervosa.[1][2][3] A comparison study of family to individual therapy was conducted with eighty anorexia patients. The outcome of the study showed family therapy to be the most efficient approach in patients under 18 and within 3 years of the onset of their illness. Conversely individual therapy was found to be more efficient in patients over 18.[4]
A key component of the therapy is parental oversight of the childs diet and eating behavior in the early phase of treatment. Maudsley Family Therapy is an evidenced-based approach to the treatment of AN and BN whose efficacy has been supported by empirical research.
In addition to AN and BN the Maudsley approach has been adapted for use in other eating disorders including those behaviors which lead to childhood obesity, such as binge eating, as well as for use in older patients.[5][6][7]
Family based treatment for both anorexia and bulimia nervosa has been manualized:
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There are three phases involved in the Maudsley method, the treatment usually lasts one year and involves between 15-20 sessions.
Phase I: Weight restoration:
In Phase I, the therapist focuses on the physiological, cognitive and emotional effects of malnutrition associated with AN. One major component of this phase is restoring the adolescent's weight or the "refeeding" of the patient. Considering the adolescent's physical appearance and menstruation for girls, the parents are encouraged to set their own goals on their child's weight and health. A key psychological aspect of phase one is externalizing the illness.
Estimated number of sessions (focused on the refeeding process): 3-10 or more. [8]
Phase II: Returning control over eating to the adolescent;
This phase involves the adolescent gradually taking control over their own eating again. It begins when the adolescent's weight is at 87% of his/her ideal weight.
Estimated number of sessions: 2-6 [9]
Phase III: Establishing healthy adolescent identity
Phase III begins when the adolescent is able to maintain their weight above 95% of ideal weight on their own and no longer engages in self-starvation. Treatment focuses on the psychological impact AN has had on the adolescent's identity and the formation of a healthy adolescent identity.
Estimated number of sessions: 4 [10]
Family-Based Treatment is a distinct form of Family therapy. FBT was initially developed for anorexia nervosa and later adapted for bulimia nervosa. Certification of family-based treatment therapists is available through Training Institute for Child and Adolescent Eating Disorders at either Stanford University in Palo Alto, California or the University of Chicago in Chicago, Illinois. Certification training requires basic and advanced workshops and 25 hours of supervised training on 3 cases during three treatment phases.