Maudsley Family-Based Therapy (MFBT) is an evidence-based treatment for anorexia nervosa (AN) and has emerging evidence to support the treatment of bulimia nervosa (BN). MFBT was developed by Christopher Dare and colleagues at the Maudsley Hospital in London (1). MFBT is a short-term, highly structured therapy that involves the entire family. MFBT is based on the belief that the family plays an important role in resolving the eating disorder and that recovery can be done while at home and in the patient’s natural environment.
MFBT is based on the idea that AN is a family illness. The family is seen as playing a role in the development and maintenance of the eating disorder. The therapist helps the family to understand the eating disorder and to develop a plan for recovery, which usually includes meal support, parental involvement, and education about AN.
MFBT has been shown to be the most effective treatment for children and adolescents with anorexia nervosa. Research shows that 70-90% of patients that achieve healthy weight by the end of their treatment maintain recovery five years post-treatment (3). Emerging research is showing that MFBT has similar effectiveness with children and adolescents with bulimia nervosa as well (2). MFBT is can often be an alternative to partial or inpatient programs.
How does the MFBT work?
MFBT is a three-phase treatment that can span from 6 to 12 months (Lock and Le Grange, 2013). MFBT teaches parents how to take charge of the refeeding process to aid their child in becoming weight restored, enhance understanding of the eating disorder and modify dynamics that might be contributing to the eating disorder and restore age-appropriate roles and responsibilities to the patient and the family.
Phase One: Weight Restoration
The goal of this phase is to conduct an initial evaluation with the family, set the landscape for treatment (i.e., refeeding, weekly weigh ins, and the roles of each family member), and aid the patient’s parents in understanding and engaging in practices for efficiently refeeding their child to facilitate weight restoration process. From the first point of contact the therapist imparts on the family the seriousness of their situation (i.e., having a child with anorexia nervosa) and the need to work quickly to get the child's weight restored. The entire family is asked to attend the initial family therapy session. The therapist provides the family with directives, encouragement, specific advice, and feedback based on the family's unique needs and challenges in the refeeding process. The therapist tasks the parents with refeeding and asks any siblings to be a source of support and encouragement. Additionally, the therapist teaches the family how to separate the eating disorder from the patient through externalization.
Phase Two: Returning Control of Eating to the Adolescent
Once the parents are in control of the eating disorder and the patient is gaining weight and approaching their ideal body weight, then it is time to consider moving to phase two. Typically, the parents gradually increase independence as the patient gains mastery over each meal or snack. Throughout this phase, the therapist and the family collaborate to set realistic goals, problem-solve any challenges, and return age-appropriate opportunities and meals to the patient. At the conclusion of phase two the patient is fully weight restored and has had all age-appropriate meals and opportunities (e.g., going out to meals with friends, having sleepovers, exercising, spending the day at a friend’s house) returned to them.
Phase Three: Establishing a Healthy Identity
Once the patient has maintained a stable weight independent of parental monitoring of meals, then phase three begins. Phase three is short and typically consists of helping the family to return to previous activities and ways of being, such as assuming healthy identities and roles in the family and their individual lives. Special attention is given to the parents to reestablish a healthy relationship with the patient, themselves and each other that does not include the ED as the basis of interactions. The therapist also helps the family to develop healthy communication and coping skills and transitions them out of therapy.
Who is the Maudsley Method right for?
The Maudsley Method is right for children and adolescents with anorexia nervosa or bulimia nervosa who are medically stable enough to receive outpatient treatment. The treatment is also used for children and adolescents who have just been discharged from inpatient treatment or are part of a partial or inpatient treatment program that includes the family in the process.
What are the benefits of Maudsley Family Therapy?
The Maudsley Method has been shown to be effective in helping children and adolescents recover from anorexia nervosa. Unlike inpatient programs for refeeding, MFBT allows for the patient to remain at home, work through challenges while continuing to be exposed to daily stressors and maintain social support and connection through contact with their friends and family. MFBT allows the patient and family to heal and refeed the patient under “usual circumstances” rather than facing triggers and day-to-day stressors throughout the recovery process, which is a major advantage of MFBT.
Maudsley family therapy has been shown to be effective in the treatment of AN. If you are considering MFBT for your child, I encourage you to talk to your therapist or pediatrician about the pros and cons of this treatment option.
1. Lock, J., & Le Grange, D. (2013). Treatment manual for anorexia nervosa: A family-based approach (2nd ed.). New York:
Guilford Press.
4. Hurst, K., Read, S., & Wallis, A. (2012). Anorexia nervosa in adolescence and Maudsley family-based treatment. Journal Of
Counseling & Development, 90, 339-345. doi:10.1002/j.1556-6676.2012.00042.x
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