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By Dr. Cris Haltom
This article was kindly reviewed by Dr. Daniel Le Grange, Director of the Eating Disorders Program in the Dept. of Psychiatry, University of Chicago. (Read also Part 1 and Part 3.)
The Maudsley Approach offers parents an empowered way to play a pivotal, positive role in restoring an adolescent with anorexia or bulimia to health.
If you will be or are, in treatment with your child using the Maudsley Approach, here are FIVE TIPS:
1. Be prepared to contribute CONSIDERABLE TIME AND ENERGY to your "nursing staff" duty to re-feed your child at home. Planning, decision-making and actual efforts to re-feed your child are potentially, but not always, exhausting early on. The effort will be well worth the outcome. Dr. LeGrange reported that sometimes parents need to stay at home from work with their child for a few weeks. During the school year parents may well need to plan to go to school to retrieve their child for a supervised lunch.
2. If your child is transitioning to self-feeding (Phase II), LETTING GO OF RE-FEEDING your child can be a challenge. You may mistrust that your child can follow through. You may feel frightened your child will deceive treatment team professionals and relapse. While these outcomes may occur, it is important to allow your child, once reasonable health is restored, to take more control over their eating. "Weaning" from parental efforts to return the child to health can be done over time. Measures to stem relapse can be advised by the treatment team, if necessary. At this point in treatment, hopefully parents will have gained confidence from the fruits of their labors in restoring their child's health.
3. If there are SIBLINGS AT HOME, they will be included in therapy. The Maudsley Approach engages siblings who are old enough to provide non-critical support and sympathy for an ill sister or brother. Encourage your ill child's sibling to remove themselves from the parental team's efforts to restore the child health. Rather encourage a sibling to be a non-judgmental supporter of your child with an eating disorder so a strong alliance is formed between siblings. For example, I have found that siblings can be a help in providing sympathy to the child with the eating disorder. A sympathetic sibling can commiserate about how difficult the re-feeding process is, including how difficult it is to contend with parental efforts to restore health.
4. Make sure to keep a healthy BOUNDARY AROUND YOUR MARRIAGE or partnership. You will be working as a parental dyad and need to build up your adult peer relationship with each other. Take time, when not directly involved in the refeeding and health restoration process, to engage in positive relationship building that is apart from your life with your children.
5. Be prepared to be patient with CAREFUL, DETAILED FOCUS on re-feeding and physical health indicators, e.g., weight, in the first phase of treatment. The process may seem tedious at times. For example, the therapist might be interested in having you, as a parent, reflect on what kind of milk went on your child's cereal or what kind of cereal you fed your child. One of the therapist's jobs is to empower parents to make clear, collaborative decisions about what meals and food consumption they think will help get the illness away from their child.
Eisler, I., Dare, C., Russell, G., Szmukler, G., Le Grange, D., Dodge, E. (1997) A five-year follow-up of a controlled trial of family therapy in severe eating disorders. Archives of General Psychiatry, 54, 1025- 1030.
Lock, J., Le Grange, D., Agras, W.S., Dare, C. (2001) Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York: The Guilford Press.
Russell, G.F.M., Szmukler, G.I., Dare, C., and Eisler, I. (1987) Archives of General Psychiatry, 44, 1047-1056.
Cris Haltom has a Ph.D. from Cornell University. She is a licensed psychologist in private practice in Ithaca, N. Y. Cris is an Approved Supervisor (#110) for the International Association of Eating Disorder Professionals. She is available for training, presentations, and workshops. She has published articles, co-edited a text book, appeared on cable television, taught workshops, and taught academic courses as adjunct faculty at Cornell University and other colleges.
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