Family Training vs. "Family Week"

"family therapy" "family-based therapy" "Family Week" "family training" "Maudsley approach..."

They are not all the same thing.

An opinionated, and irreverent, primer:
"Family-based therapy" and "Maudsley approach" are almost the same thing. These terms refer to a approach that puts nutritional rehabilitation first, and parents in charge. The family is not the problem - the illness is the problem. FBT is the manualized, research term. Maudsley is the hospital where the concepts originated but is also a place where other approaches have originated. Many people associated with FBT don't like the term Maudsley, and some people at Maudsley don't like the term Maudsley approach, either!

(I use the term Maudsley because parents looking for this type of treatment need a term to use, and a name that googles.)

"Family therapy" for EDs is an older and looser term that can include the above. Originally the idea was that the illness was an expression of problems within the family that the therapy seeks to identify and fix. That idea was supposed to have been abandoned, but many clinicians did not get the memo.

"Family Week" is a standard feature of ED residential treatment where families are invited to come to the center and be spanked for all the things you did wrong and be schooled in what you must now do - but mostly: not do.

I'm a fan of approaches that train the caregivers instead of the patient until a later stage of recovery where the patient can take that on. Here are a few that lean that way:

University of California at San Diego boasts a state-of-the-science program directed by no less than Dr. Walter Kaye, the researcher who is going to crack the very DNA code of this illness for us.

Dr. Nancy Zucker at Duke U. gives you homework and hope when you attend her parent training.

A quick look at the web site for the Kartini Center in Oregon will convince you that if you step up - they'll back you up.

The Boswell Center in Florida combines hands-on with virtual reality by giving you intensive multi-disciplinary support and then follow you home via camera phone support.

Stephanie Millstein is empowering the parents of Michigan in a supportive group setting. (Beaumont Hospital, Royal Oak, 248-551-2385).

Multi-family group training is also offered at the Maudsley in London, at the Westmead in Sydney.


  1. Ah... Laura, thank you for this!

    Now how do we go about getting these extraordinary folks to connect, train, and branch-out their programs in EVERY state; so that families can access these services and support without breaking the bank?

    And also, how do we get additional backing, as parents, to continue asking our local medical/psych/- heaven forbid- IP/OP "treatment facilities" communities to implement these practices and offer these programs for families/parents? Many in the medical community are still dragging their feet, and it doesn't help feeling like one is a lone voice- where is everyone else on this?

    Cheers~ Tracey

    "Tune the vina neither high nor low, and we shall dance joyfully as we go. Stretch its strings too tight, they break; slacken them and no music they make."

    Prince of Dharma-Ranchor Prime

  2. Stephanie rocks my socks!

    I would like more professionals to be flexible in their approach, but above all, put nutrition first. I'm for whatever helps. But nothing can help until you (or your child) eats. Every meal, every snack, every day. Therapy for me during this time was priceless, in part because I had been suffering for long enough that I knew the general routine and was ready to make the change.

    My new favorite idea for research: helping adult sufferers refeed, specifically those who don't/can't/whatever live at home.

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  4. Thank you much for the kind words and support.

  5. Thanks to the generous backing family and Beaumont Hospital we are able to continue to offer this type of programming. We are hoping to be doing a more global professional training in early 2008 and I am looking forward to presenting at NEDA this year in the Treatment Track on "Learning Maudsley/Family Based Therapy for treatment of children, adolescents and perhaps beyond" and looking forward to reconnecting with friends and meeting new people in California! Thank you again.... Stephanie

  6. Laura, this is a great simple summary. I know when we considered residential for my duaghter we thought the "family" week was to help us to take care of her when she returned home--noooooo-it was the exact opposite. Maybe one day this will change so that parents who need intesive treatment for their children won't have to put up with the child learning that the "family dysfunction" caused thier illness. Ultimately, we decided to keep slogging through refeeding at home but I know for many families because of multiple reasons this isint possible during some stages of the disease and it is horrendous that they have to make the heartwrenching decison to have thier child cared for in another setting and then to have the child, the parents and the siblings bombarded with these negative messages. I challenge any one of the experts running these centers to go through refeeding with thier own child-invite a traditional eating disorders expert into the mix to observe their family--and not be told their fmaily is dysfunctional. Who wouldnt be dysfunctional when 75% of the professional are telling you to back off and let your duaghter starve while she figures out what is bothering her, your dinner tables are a battle zone, your other children are scared, and the child battling the disaese is alternatly withdrawn and combative. What families need is support, skills and research driven methods to help thier child achieve full health and deal with any co-morbid conditions. The family may also need suppoort including therapy to deal with the traumatic effect this has had on thier lives--but not because they caused the disease!!!

    With love and admiration to you Laura for all you are doing for so many children and families


  7. Does anyone else find it the least bit hypocritical that the Boswell Center website advertises, in juxtaposition to their ED program, a program to induce weight loss in "overweight" kids?

    It seems to me a simply silly idea to have ED-affected individuals in the same building as kids being told that they "must" lose weight by means of "eating healthily" and "living actively".

    With all due respect for the good work that they do in the ED arena: that's just BS.

  8. Anonymous,

    Boswell treats eating disorders across the spectrum, as do most of the larger centers like Remuda, Milestones, UCSD, Yale-Rudd, and Mirasol.

    I've thought a lot about the question, over the years, of how the obesity and "overweight" stuff relates to EDs. Mostly, I've avoided the issue in order to stay focused on AN and BN and EDNOS.

    But lately I'm seeing that it is impossible to parse it. The issues are related. Our diet culture - an irrational response to an aesthetic issue - causes a great deal of harm. Restrictive diets hurt everyone.

    So to be an advocate for good eating disorder treatment I must also stand up against any environment that encourages restrictive, moral, and anti-medical associations with children's eating and health.

    I agree with you, unreservedly, that teaching kids to diet would be at cross purposes with eating disorder recovery. I think talking about weight as a proxy for health is quantifiably wrong. And I think some treatment centers are doing just that. But the good ones, and I think Boswell is one of them, are trying to REPAIR the damage of our dieting culture by reconnecting with hunger, fullness, energy, and joy - not appearance. That is needed across the spectrum of eating disorders, sadly, because we've got a silly, sad culture swimming in bad medical advice!

  9. Using a "state of the science program" is not a substitute for experience. The UCSD program is very new, and I've found that much of the staff there knows little about eating disorders beyond what the most basic brochure says. I'm not trying to bash the program, because I have seen it do good for a lot of people - but as someone who has received a lot of treatment and went through their program, I found it to be the least helpful of all. I have friends who feel similarly - their approach is sound. However, their staff are sometimes downright naive. You wouldn't believe the kinds of tricks girls could pull in their to manipulate their weight that would be caught in an instant anywhere else, nor all the food games. I think that more than the "science" of the program should be evaluated.

  10. This is a bit of topic, but I am desparate for support...

    We have a recovering very young (under 14) anorexic daugther, who has been fully weight-restored for months. Yet, we are in month SIX of treatment at Kartini in OR.

    We are highly-educated, caring, devoted parents who are not afraid to adovcate for our child. Yet, we are worn out, skeptical, forlorn and confused about whether to continue along the course of blindly following Phase I treatment plan, which is of undefined duration and without insurance coverage. We are told by Kartini that all of the treatment plan is "medically necessary" and none of it may be substituted elsewhere. THere is zero flexibility.

    To continue along this course seems counterintuitive as a parent. It's been a long, tedious, and freighenting journey. Our daughter is slowly healing, but we feel it is time to move on, take ther training wheels off the bike and teach our child to ride it again.

    But, we fear that if we do not strictly comply with the doctor's orders, and our daugther hits relapse (as most do), we will have isolated the very team of providers who saved her in the first place.

    My question is -- how does a parent know when it is time to follow her own intuition, which seems to be growing increasing skeptical of what Kartini's team of doctors has coined as "medically necessary"?

  11. Anonymous,

    Your question would be great on the Parent Forum - I think the wise parents there might have some support or ideas:


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