June 18, 2015 Marion MacDonald

Why There's No Maudsley at Mirasol

Maudsley Family TherapyNPR's Diane Rehm Show recently featured an interview with Clare and Elena Dunkle, authors of companion memoirs documenting Elena's struggle with anorexia nervosa. Also appearing on the show was Dr. Angela Guarda, Associate Professor of Psychiatry and Director of the Eating Disorders Program at The Johns Hopkins Hospital.

Dr. Guarda advises families struggling with anorexia to seek out a "good Maudsley trained therapist." "It's now pretty well established," she said, "that that is the technique that works the best for the most patients. It doesn't always work, but it works in over 70 percent of young patients. "

Also known as "Maudsley Family Therapy", the Maudsley Approach is a treatment for anorexia developed by Christopher Dare of London's Maudsley Hospital. Instead of isolating the anorexic in a residential treatment facility — what Maudsley advocates sometimes call a "parentectomy" — the child remains at home and her family assumes full control of her treatment with guidance from a therapeutic team.

Phase one of Maudsley Family Therapy focuses solely on weight restoration. A parent or other family member is present at every meal, enforcing adherence to the meal plan. In phase two, parents gradually pass control of meals to their son or daughter. Only in phase three, when the teen has stopped restricting food, does the emphasis shift to psychological and family factors underlying the illness.

Proponents often cite a 2010 Stanford University/University of Chicago Study as evidence that Maudsley is the most effective treatment for anorexia. According to this study of anorexic patients ages 12 to 18, a year after treatment, 49 percent of those in the Maudsley group were in remission, compared to 23% of those who received individual therapy.

So why doesn't Mirasol use the Maudsley approach in its teen eating disorder treatment program?

For starters, the study compared the Maudsley method to individual psychotherapy, as if those were the only two treatment options.

Family therapy is an important component of Mirasol's residential eating disorder treatment program. Family members are active participants in both our teen and adult residential eating disorder treatment programs. All clients participate in regular phone or videoconferencing sessions with family members. During our three-day family camp, family members and friends come to Mirasol to share the experience of intensive residential treatment with their loved ones.

But family therapy is only one piece of the puzzle. Anorexia, bulimia and binge eating can result from a bewildering variety of factors including a genetic predisposition. Teens with eating disorders struggle with feelings of shame, guilt, body dissatisfaction and a lack of control. The eating disorder may become the individual's attempt to regain control and cope with these intense emotions.

Imposing greater parental control over eating is not the best approach for a child who already feels powerless to take her place at the table. So long as the solution always comes from the outside, the teen cannot find the solution within. At the core of Mirasol's treatment philosophy is a profound respect for the individual, for the choices we make and for the connections we forge with ourselves and others. Through peer encouragement and cognitive and emotional restructuring, we help our clients learn to self-regulate, manage their emotions and care for themselves.

Our goal is to provide all our clients with the skills and tools they need to live successfully in the world, not just for a few months or years, after treatment, but for the rest of their lives.