What is the Maudsley Method?
The Maudsley Method is an outpatient family-based treatment for adolescent eating disorders. The distinguishing characteristic of this treatment is that parents are recognized as key resources who are integral participants in the recovery process. The Maudsley Method is an intensive outpatient treatment that proceeds through three phases determined by the patient’s progress. The approach was first developed by clinicians and investigators at the Maudsley Hospital in London, for the treatment of adolescent anorexia nervosa. This treatment draws on a number of different family therapy models and since its initial development for adolescent anorexia nervosa, it has been adapted to the treatment of children, adolescents, and young adults with a wider range of eating disorders, including bulimia nervosa and eating disorder not otherwise specified. As the Maudsley Method is an outpatient approach, it is suitable for individuals who are medically stable.
What are the benefits of this approach?
First and foremost, the Maudsley Method is one of the few eating disorder treatments available that has demonstrated efficacy in controlled clinical trials. The keys to its success are likely the active involvement of all family members and the direct targeting of eating disorder symptoms from the outset of treatment. Importantly, the Maudsley Method takes an agnostic view of the development of eating disorders and is non-blaming of parents or families. It has the distinct advantage of involving all family members and recognizing that each member can play an important role in the recovery process. While clinicians may be expert in eating disorders, parents are identified as experts in their children and in treatment they are empowered to re-establish their footing as parents. Eating disorders often involve private behaviors or secret thoughts that feel shameful and embarrassing to disclose. The Maudsley Method challenges this by separating the illness from the patient and giving the family permission to talk openly about something that is quite difficult, in turn preventing avoidance and facilitating recovery.
How can parents identify clinicians who specialize in the Maudsley Method?
There are a number of Internet resources for identifying clinicians who specialize in this treatment approach. One that is particularly helpful is: www.maudsleyparents.org, which reviews the Maudsley Method and enables parents interested in or practicing the approach at home to connect with one another. A link to clinicians who practice the Maudsley Method internationally is available under “Find Treatment.”
What is the course of treatment with the Maudsley Method?
The Maudsley Method proceeds through three treatment phases carried out over 6-12 months on average. These phases include: weight restoration/re-establishment of healthy eating; returning control over eating back to the adolescent; and establishing healthy adolescent identity. In Phase I, parents are mobilized to “take charge” of the adolescent’s eating in order to restore weight and/or reduce binge/purge behaviors. Food is viewed as the medicine necessary to restore health and with therapist coaching, parents unite in establishing a zero-tolerance policy for self-starvation in the home. As the adolescent shows increased acceptance of healthy eating patterns, Phase II begins, focusing on helping the parents to transfer control over eating back to the adolescent. When a healthy weight is achieved and eating disorder behaviors are at a minimum, Phase III can begin wherein developmental issues are discussed with the goal of establishing a healthy adolescent identity and preparing for future challenges.
As comprehensive care of individuals with eating disorders requires a team, the Maudsley Method is often principally carried out by a psychologist or other mental health clinician but should also involve coordinated care with a primary care physician (pediatrician, adolescent medicine) and may also involve a psychopharmacologist or consultation with a nutritionist. Families have an opportunity to make great strides through the Maudsley Method, and it is not uncommon for adolescents to participate in further treatment (e.g., individual therapy) subsequently.
Kamryn T. Eddy, Ph.D.
Assistant in Psychology, Massachusetts General Hospital
Instructor, Harvard Medical School