Jack and Susannah Pierce (names changed) from New Britain, Pa., are caring, supportive parents. They have been on a rollercoaster since their daughter Wendi, now 15, was diagnosed with anorexia almost a year ago. “It was a vicious cycle,” says Jack. “She was hospitalized twice due to very low weight. As soon as she was discharged from the hospital she’d lose all the weight and we’d be back to square one.”
Wendi has anorexia, a disorder characterized by the refusal to maintain body weight. People with anorexia severely restrict food intake due to the mistaken belief that they are “fat,” although often they are severely malnourished.
In researching treatment options, the couple heard about Family Based Treatment (FBT) also known as the Maudsley approach. Their outpatient therapist, who was equally concerned with the Wendi’s lack of progress, had also heard about FBT, and a partnership began. They abandoned traditional individual therapy and began to work together in a radically different way. Jack and Susannah supervised all of Wendi’s meals and snacks. This included daily trips to Wendi’s school to eat with her at lunchtime. Their therapist helped coach them in interacting with Wendi in a firm yet supportive way.
“It wasn’t easy,” Susannah says. “There were some nights when I was ready to give up. Many times Wendi refused to eat. There were times when we spent hours at the table. “I think that when she finally was able to see that we were serious, and were not about to let her die, she began to eat.”
FBT has been around since the 1990s but is still relatively underutilized. This may change with the publication of another study supporting its efficacy.
The research, published on October 4 in the Archives of General Psychiatry by James Lock and Daniel LeGrange, followed 121 young men and women with anorexia, ages 12-18. The teens were randomly assigned to receive individual psychotherapy or FBT. Patients were considered in full remission if they reached 95 percent of normal body weight. At the conclusion of the study, 49.3 percent of FBT patients were in full remission, whereas 23.2 percent of individual psychotherapy patients were in full remission. The two treatments were equally effective in helping patients achieve partial remission, defined as a body weight of 85 percent of normal.
Dr. Ellen Davis, cofounder of Woodland Forge in Phoenixville, Pa., is a strong advocate for FBT. “I used to practice traditional psychotherapy with patients with anorexia,” she says, “The recovery time for most adolescents was between 2-3 years. It’s much quicker with FBT. With a younger adolescent I can move them to the point where a parent will say ‘I have my kid back’ in 9-10 months. It’s an amazing approach.”
There are three stages to FBT. The first stage focuses on weight restoration. In this stage parents are solely responsible for food preparation, and eat every meal and snack with the adolescent. When weight begins to reach a healthier level and there is no resistance around eating, control over meals is gradually returned to the teen (phase two). Phase three is more akin to traditional therapy and addresses the psychological, environmental or family issues that contributed to the eating disorder.
FBT is a relatively new treatment and families often have to be proactive in searching for treatment providers familiar with FBT. That said, there are a number of outpatient therapists in the Philadelphia area who are skilled in FBT, and most are identifiable with a simple phone call.
Woodland Forge offers ongoing outpatient therapy using a FBT model. They also offer a Family Intensive. The Intensive is Sunday through Tuesday 9:00 AM to 2:00 PM. Dr. Davis and Dr. Gonçalves work with one family to assess what has been fueling the eating disorder and to redirect the adolescent’s eating. They coach parents during breakfast and lunch and help them learn how to supervise eating in the face of adolescence resistance. They also provide consultation to the family’s outpatient therapist and treatment team. To find out more about Woodland Forge, click here.
Comments
Wow -- this sounds like a great approach. Why aren't more people using it?
I have seen other things written about this therapy and am glad to know more. My daughter had anorexia and like the parents in the article, we did not know what to do. She was hospitalized multiple times and it was a vicious cycle. I wish I would have known about this, although it does sound like it's very demanding to supervise all the meals. Thanks for an informative piece.
We too sought out this therapy after 7 hospital stays and we were able to stabilize my daughter's weight and mood and behavior very quickly. There is a mistake in this article though-it says stage III is about addressing the psychological, environmental or family issues that contributed to the eating disorder. However, that isn't true at all, stage III is about resuming normal teenaged development, moving toward independence. The biggest contributer to an eating disorder is a genetic tendency toward anxiety. In a susceptible person, not eating seems to calm their anxiety and this gets out of control. The environment can trigger anxiety of course and sufferers need to learn to manage their anxiety in more positive ways but it's a mistake to think that the environment is the root cause of this illness.
Hi there -- thanks for your feedback and I'm glad the approach helped. As for the "mistake," I appreciate your feedback, but that information was provided by Drs Lock and LeGrange at a recent Sheppard Pratt conference. I'm sure there are many variations on how FBT is done. Please spread the word about this great apprach.
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