The Maudsley Model of family based treatment is an outpatient treatment that involves the family working together over 1 year to defeat the Anorexia their child is experiencing. It is suitable for children and adolescents who have short course of illness (less than 3 years) and are under 19 years of age. The Maudsley model has 3 clearly defined phases.
Phase 1: Re feeding the Patient
Phase 1 of treatment focuses on the eating disorder. The parents are charged with re feeding their young person. Therapy focuses on food related issues and behaviours that are preventing the young person putting on weight. Each session the young person is weighed and the direction of weight gain (loss or gain) dictates the direction of the session. Typically the therapist will spend time with the young person by themselves at the weigh time and use this time to enhance engagement.
The therapist’s job is to help the parents work together to defeat the anorexia and the siblings in the family are to support the young person while their parents control food and eating. This is the prime structural change that is made in the family. Session 2 of the therapy involves the family bringing a picnic lunch to the session and the session is an enactment and helps the family feed their young person with the therapists help.
The therapist also helps the family to directly face the anorexia (and thus the conflict this will cause) because without putting weight on the child is at risk of medical complications. Co morbid problems such as anxiety or depression can be treated directly with medication but are seen as a secondary priority to the eating disorder.
By the therapist focusing on food and eating with a monotonous persistence the parents get a message that their child will only get well through weight gain. When food and eating concerns are resolved and the parents are confident that they can deal with all food related areas and the young person has gained 87% (Lock et al, 2001, p.175) of ideal body weight phase 2 of treatment begins.
The most notable changes for the young person at the end of phase 1 is both weight gain and a more stable emotional state. In phase 1 sessions are weekly and this may last for many months or may be as few as 10 sessions.
Phase 2: Negotiations for a New Pattern of Relationships
As the family enters phase 2 the mood of sessions should become lighter as the parents are feeling more in charge and the young person is less captured by the anorexia. The young person is still weighted each session and still has some weight to put on. The challenge now is for the young person to take back 'normal' adolescent control of food and their life at a pace they can handle without relapse. The therapist continues to support the parents with food issues but will also focus more on the adolescent and how effectively they are managing their own thoughts and feelings. The continuing separation of anorexia and young person helps with this process. Likewise for the parents they now need to begin to reinvest in their lives and relationship after the intensity of phase 1.In Phase 2 meetings are every 2- 3 weeks apart.
Phase 3: Adolescent Issues and Termination
This is the briefest phase of treatment and aims to ensure that the young person has taken up a taken hold of their adolescent world again. Likewise the parents can now relax and reinvest in their lives and relationship. Adolescent issues that may have been present at the development of the eating disorder may now be explored if still required. If other family or couple issues need to be addressed then referral or recontracting therapy may be required to address these issues. At the end of phase 3 about 1 year will have passed. This phase may only be a few sessions spread 6 weeks apart.
To date their have been 4 randomised controlled trials of Maudsley Family Therapy. The first (Russell et al, 1987) compared the Maudsley Model to individual therapy and found that family-based treatment was more effective for patients under 19 years of age with less than three years duration of illness. Ninety percent of these patients achieved a normal weight or the return of menses at the end of treatment including at 5 year follow-up (Eisler, et al, 1997).Two further randomised trials compared standard Maudsley treatment with a modified version where the patients and parents were seen separately (Le Grange et al 1992, Eisler et al, 2000). In these trials approximately 70% of patients returned to a normal body weight (>90% IBW) or experienced the return of menses at the end of treatment, regardless of which version of the model was employed. Results from a more recent randomised control trial suggest that results are maintained with the manualisation of the Maudsley approach (Lock & Le Grange, 2001). There is also evidence that a short (6 months) and a long course (1 year) of treatment results in a similar positive outcome (Lock et al, 2005). Finally, the outcome using family based treatment appears just as positive for children (9-12 years old) as it does for adolescents (Lock et al, 2006).