From Treatment Models to Manuals: Maudsley Single- and Multi-Family Therapy for Adolescent Eating Disorders

Abstract

Eating disorder focused family therapy has changed significantly since the initial efficacy trials at the Maudsley Hospital in the 1980s and 1990s. While the core principles remain unchanged, after decades of research, clinical and theoretical advances, the model has developed considerably. This chapter describes some of the key changes including a more nuanced understanding of the therapeutic alliance across the course of treatment, the family meal, a broader conceptualisation of externalisation and the importance of integrating new knowledge about the way that temperament and neurobiology predispose and maintain the development of eating disorders. An account is given of how the model has been adapted for specific eating disorder presentations and different family contexts, particularly for families with high levels of criticism, emotional dysregulation or hopelessness. The second half of the chapter focuses on the interplay between these developments and the writing of and modification in treatment manuals and the different roles that manuals have in the clinical practice of the multi-disciplinary team, in training and supervision. We discuss the tension between the evidence that strict adherence to manuals may have a limited impact on outcome and the key role manuals play in the delivery and dissemination of evidence-based practice. Manuals need to find a way to remain current with a broad range of empirical evidence (i.e. not just the results of randomised controlled trials) and to find a balance between being instructive without being constrictive, building upon clinician and team experience, not dampening it, and remaining clear when and how to modify, review or stop treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved)