My partner's daughter is 12 and was admitted to the hospital with anorexia nervosa. Both her mother (my partner) and father are in shock but coping with the immediate crisis. The parents separated more than a year and a half ago and the two girls spend one week at each parent's home. I have been reading about the Maudsley approach but it seems to be geared towards a traditional nuclear family. Am I missing something? Or is there another approach that is geared specifically towards families that are more complicated?
Renee Hoste, PhD responds:
Evidence is accumulating to suggest that the Maudsley approach can be effective for those with a nontraditional family structure. A recent study from the University of Chicago showed that single-parent families were just as effective as two-parent families in helping their children recover from bulimia nervosa. Anecdotally, we have found that many families with separated, divorced, or remarried parents can join together to help their child recover from his or her eating disorder. Logistically it is certainly more challenging when two households are involved, but as long as all parents can be on the same page, at least temporarily, families seem to be able to make this work. If conflict between parents prevents sessions from being optimally productive, the therapist can meet separately with each parent or set of parents. The goal is to ensure that even if the child is spending time in two different households, the expectations for eating will be the same regardless of where she is. If parents are truly unable to work together to guide their child through the recovery process, it may be preferable for the child to stay with just one parent or set of parents during the first phase of treatment.
The Maudsley approach does not take a rigid view of what constitutes a family. As we wrote in a recent article:
"Another term worth mentioning in relation to the Maudsley approach is 'family'. In the context of this treatment approach, as in many other settings, 'family' is not merely dictated by biology or law. The family engaging in Maudsley treatment can be composed of parents, step-parents, long-term significant others, siblings, grandparents, aunts, uncles, etc. Each week, the therapist will want to meet with everyone who lives with the individual with the eating disorder. Also, the therapist might want to meet with people who are involved in caring for/feeding the individual, but who do not live with the individual with the eating disorder. For instance, if grandparents care for the child/adolescent after school, or if there are no siblings and support is needed from close friends, it could be important for these other individuals to join a few sessions to learn more about the Maudsley approach. All caregivers are enlisted to be on 'the same page' with one another in the way that the disorder is viewed and treated, and siblings play an important role as well as supportive peers."
Getting everyone on the same page when they aren't under the same roof might pose some special challenges, but bear in mind that even in two-parent families there can be disagreements and conflict. Remembering the common ground--surely, all parents love their children and want the best for them, no matter what their disagreements--is a good start. Working with a good therapist can help caregivers figure out how to work together and make the most of each individual’s strengths to get the job done. This is true for traditional as well as less traditional families.
Renee Hoste, PhD
Dr. Hoste is Clinical Assistant Professor and Director of Clinical Services and Research for the University of Michigan’s Comprehensive Eating Disorders Program. She serves as Clinical Advisor to Maudsley Parents. Read more about Dr. Hoste here.