Who is the website aimed at? Show Answer
- It is hoped that the skills and techniques presented here are of use to both carers and professionals. We also offer a series of 2 day workshops to professional groups who feel that their service would benefit from a more intensive learning format.
How do I use this website? Show Answer
The website has been designed to cater for a range of carer needs. We would suggest that for those unfamiliar with the intervention experiment firstly with the Basic Skillset. Once comfortable with these ideas, carers may then choose to investigate the more Advanced skills. The site is also intended for professionals working in the field of eating disorders. Thus, for both carers and professionals we offer the theory behind the skills training techniques along with general rationale for carer skills training. The site is intended to provide the reader with as much or as little information as they deem necessary for their particular needs.
My son is very ill with an extremely low BMI. Should equipping myself with skills be a priority right now? Show Answer
The intervention is not appropriate when there is an immediate danger to the sufferer. Click here for further details on medical risk.
What’s the difference between the Maudsley model and New Maudsley model? Show Answer
The Maudsley approach or Family Based Therapy is an evidenced-based approach to the treatment of anorexia nervosa and bulimia nervosa in adolescents, whose efficacy has been supported by empirical research (Dare, et al. 2001; Dare & Eisler, 1995; Lock, et al. 2001; Russell, et al. 1997). Comprised of three stages: weight restoration, returning control of the eating back to the adolescent and establishing healthy adolescent identity, it places responsibility for re-feeding and weight restoration onto parents. Whilst this can be empowering on the one hand, on the other hand, parents can also find the process challenging and time-consuming. Furthermore, the Maudsley model is aimed at Child and Adolescent sufferers and their families and does not include adult sufferers.
The New Maudsley model is aimed at families of all sufferers. It is an additional treatment protocol, intended to reduce stress and empower carers by equipping them with a similar skill set to that encountered in an inpatient setting. The new Maudsley model is intended to be used as an adjunct to treatment, as opposed to a treatment in its own right.
What evidence is there that the New Maudsley approach is effective? Show Answer
There is evidence to suggest that psycho-educational and guided self help interventions that offer skills and techniques to carers of people with eating disorders have met with high carer acceptability (Uehara, et al., 2001; Vandereycken, et al., 2005; Holtkamp, et al., 2005). Evaluation and development of the New Maudsley approach is an ongoing venture. There have been several phases of the project that have also indicated high carer acceptability (Sepulveda, et al., 2008a; Sepulveda, et al., 2008b; Goddard, et al., 2011). Recent results showed significant reductions in carer anxiety and depression, expressed emotion, burden and accommodation and enabling as well as significant increases in carer psychological wellbeing and self-efficacy. Carers also reported an improvement in the wellbeing and eating disorder behaviours of the sufferer (Goddard et al., 2011). Results of qualitative studies have also shown high acceptability from both carers (Macdonald, et al., 2011) and patients (Goddard, et al., 2010).
Data from a full multi-centre RCT, Carers Assessment Skills and Information (CASIS) project, that tested the effectiveness of carer skills training for families of adult inpatients, was associated with reductions in carer time spent care giving, caregiver burden and unhelpful care giving behaviours (Hibbs, et al., 2015). Patients had reduced eating disorders psychopathology and improved quality of life at 6 months post discharge and a marginally improved trajectory at one year. The ECHO group had marginally reduced service use with shorter inpatient stays and a longer time before readmission. Qualitative data from the same study showed that patients could identify positive caregiver behaviour changes targeted in the intervention (Macdonald, et al., 2014).
Isn’t this all just a cost-saving exercise on the part of the NHS? Show Answer
The National Institute for Clinical Excellence (NICE) recommend that most people with anorexia should be managed on an outpatient basis and that patients and where appropriate, carers, be provided with information on the nature, course and treatment of eating disorders. Guided self-help can support and educate carers about the nature of the disorder and equip them with necessary skills to address problems. Some of the advantages of self-help interventions to the carer includes overcoming inaccessibility to service centres, scheduling conflicts, child care demands and possibly, stigma. There is also often a shortage of experienced and trained therapists and this can be even more so with ‘specialist’ mental health problems such as eating disorders. Guided self help is one viable option that could help address such issues, both with patient and carer. Hospital treatment will always be required for a certain proportion of patients but, even then, it is important for the family to be prepared for the patient’s return home.
There seems to be a lot of information within this website. Can this not actually add to the stress felt by carers? Show Answer
We realize that the practical skills and underlying theory can represent a steep learning curve. We also know that professionals learning MI can take several years to become highly proficient providers. Consequently, we encourage carers to, first of all, experiment with the basic skill-set. It is important that carers be compassionate to their own needs and above all remember the adage “every mistake is a treasure”. We also urge carers to take some time out to recharge their batteries since self-care is a vitally important part of the recovery process. FEAST run a peer-to-peer support from other parents of children with eating disorders. The Around the Dinner Table forum is available 24 hours a day, 365 days a year.
This way of talking to each other does not feel natural. My daughter with the eating disorder agrees with me. How we make it work when we both feel like this? Show Answer
Motivational interviewing may be different to the way you usually communicate. However, with practice it can become to feel more natural. Carers who have taken part in our research projects often tell us that they have found reflective listening and open questions a useful means of communication in other areas of their lives, e.g. with extended family and friends and in the workplace. Living with an eating disorder does require more care in communication and attention to the bigger picture which does not feel natural to sufferers who are excellent at the detail involved in their eating disorder behaviours especially those around food weight and shape. We also find that it is a challenge for sufferers to be self confident in relationships and talking about these emotions are difficult and can feel unnatural. Also the New Maudsley Model places a great deal of emphasis on maximizing attention to praising any effort or intention when making small changes, again not necessarily normal everyday language.
Loved ones who suffer from eating disorders are often ambivalent about treatment and consequently put up resistance at the thought of their carers equipping themselves with psycho-educational information and skills, viewing this as a threat to the illness. It can be useful to reiterate your support and motivation in supporting the sufferer regain a happier and healthier future. Finally, if carers have found other approaches they deem more suited to their needs, or indeed, if their present approach is working, then we follow the adage: ”if what you’re currently doing is working for you, why change it!”
I feel like I’m the one who is being blamed for all of this, particularly…the onus seems to be on us to change. Shouldn’t any intervention be aimed at tackling change in the person with the eating disorder? Show Answer
Living alongside an eating disorder can be extremely stressful for close others. It is not uncommon, for example, for carers themselves to suffer from high levels of anxiety and depression frequently at clinical levels. Often the manner in which carers respond to the symptoms can play a role in maintaining or aggravating the symptoms and it is sometimes useful to use this information to reflect on one’s emotional responses in contemplating a route forward. Also, patients often find it helpful to share biologically based assessments with their families and explore any trait similarities. This can also help reduce the guilt and stigma often found in eating disorders.
Finally, it is always important to bear in mind that it is not the fault of the patient: they did not choose it. Likewise, it is not your fault: you did not cause it.