Modified Maudsley - what's up with that?

The term "Modified Maudsley" is way too common. Unfortunately, it doesn't seem to mean what you think it means.
  1. It can mean "I'm a therapist who believes in the principles of Maudsley but doesn't use it strictly out of the book."
  2. Or "I involve parents in the treatment, but I don't put them in charge of food."
  3. Or even "I put parents in charge of food but I don't coach them or involve them in therapy."
  4. Or it can be what parents say when they're doing home refeeding without working with a professional at all - because they incorrectly think "Maudsley" *is* just refeeding.
  5. It can also be "I find the manualized Maudsley approach too reductionist but I don't blame parents and I do believe in re-feeding so I use "Modified Maudsley" as a shorthand."
  6. Infuriating use: "I hear this term all the time but haven't actually studied it or used it but it sounds nice and I'm nice, so I'm going to add it to all the other things I do without actually understanding it or how it might conflict with my other beliefs"
  7. There's another use, though, and this is what makes it really confusing, which is "We offer all the principles and tools of Maudsley but we ALSO offer other things at the same time - like access to a nutritionist, partial day treatment, a meal plan, cognitive behavioral and DBT techniques, support groups, and other therapies."
The word "Maudsley" is used in way too many ways - many incorrectly - already. So is "family therapy." "Modified Maudsley" just muddies the waters even more. I really want to send everyone to the Naughty Chair while I come up with some clear terms for all these things and then make everyone use them.

 If I were Queen:
  • "Normalized nutrition" would refer to an expected first step in ALL eating disorder treatment. It would include optimal weight normalization and cessation of compensatory behaviors.
  • "Family-Based Maudsley Treatment" would be a term only used for manualized FBT by Lock and le Grange. No modification. NOT "Maudsley" or "Family Based Treatment" which would both be banned as indistinct.
  • "Family Therapy" would also be banned as indistinct, and people would have to choose between "Family-Based Maudsley Treatment" and "Systems Family Therapy" or come up with new terms that don't sound anything like the above.
  • "Magic Plate" would be the concept that parents choose, prepare, serve, and monitor "normalized nutrition" with the help of professionals. This concept would not be limited to Family-Based Maudsley Therapy.
  • "Inpatient" and "Residential" treatment would be a place for "normalized nutrition" as well as other treatment tools and therapies.
  • "Skills-Based Learning" would be used for Treasure's model for carers.
  • "Evidence-based treatment" would refer only to treatment elements that have RCT data to support them.
  • "Opinion-based treatment" would be everything else, not because these may not be helpful but because they aren't studied and should be.
  • Recovery would be re-named Remission and defined as free of behavioral, medical, cognitive, and emotional symptoms of eating disorders - NOT just weight normalization.
That should clear things up so we at least were all using the same terms for the same ideas.


  1. I vote for universal use of your clear, concise definitions. It would help so much if everyone instantly knew exactly what everyone else was referring to. Instead, we make assumptions and have misconceptions that can have negative consequences.

  2. I feel quite overwhelmed by the thought of your coronation. Will you wear purple?

    Seriously, I am going to print this off and try and learn it.


  3. Agreed. Although I think you would make a better President then Queen!

  4. Oh, definitely a queen!
    The legislature is impossible to work with.......
    I have printed out your definitions and will go back into my posts and correct anything that doesn't fit yours.

  5. Long live the queen! Princess bride is a longtime family favorite! Amen laura! I too am disgusted with the field of professionals who twist language to hide the truth...

  6. But Laura, we (at Kartini Clinic) have been referring to what we do as "family based treatment" since long before Lock and Legrange began doing Maudsley, much less published on it.

    The main thing is that a therapist/program make it crystal clear what they do and why they do it, not that we achieve perfect harmony among "sound bites". IMO.

    And of course, you have heard me say" without weight restoration you get nothing"--and yet, even weight restoration is not everything.

  7. Julie, terms do matter. It is annoying that "family based treatment" could not have stayed as Kartini's approach but the truth is that the term is now associated with a manualized approach and is in the literature that way. We can't turn back the clock. The term Maudsley suffers just such a snafu now and it is a mess.

    But terms matter, and it isn't about soundbites. It is more like prescriptions: it matters whether you write Arkamine or Artamine. It matters when a parent calls a provider and hears "family therapy" and thinks it is "family-based therapy" and wastes three weeks waiting for an appointment that will be a false lead.

    As the clinician yourself you can control your practice and so terms don't matter - you are doing good work. But for me, speaking with laypeople and the press and trying to talk with clinicians about these issues it matters when people think they're talking about one thing and hearing about another. This happened at NEDA, where a Plenary was introduced as about "Maudsley" and was not, but for the rest of the conference I was hearing from people about that Maudsley thing I'm always going on about.

    I would really love Kartini to simply call its approach - which is far more than a therapy or a set of modalities - by a distinct name because it IS unique. I suggest: The Kartini Approach. Then manualize it, publish outcome data, offer trainings, start a movement.

  8. What is now called the "Maudsley approach" was first studied in the UK in the mid-eighties. Publication on it followed in 87. Although it was referred to as "family therapy" (and still is in the UK) the distinct treatment was certainly being done and written about, both in the UK and the US, since that time. Didn't Kartini open in 1998? This might seem like a minor quibble, but the claim of "we were doing it before they were" is a little bizarre.

    I find the annoyance over name "ownership" mystifying. (After all both the manuals refer to "A" family-based approach, not "THE" family-based approach.) I agree that it's important for clinicians to give a clear description of what they offer.

  9. I much prefer the term "recovery" to "remission" because the latter has a pessimistic connotation. "Remission" makes it sound like a relapse is only a matter of time. Patients need encouragement when they're in recovery because it's tough enough without the implication that their efforts are doomed to failure.

  10. Crimson, I sympathize, because I know some people do find remission to be pessimistic. But I think it is reality: the predisposition is still there if if the active illness isn't. Too many parents, and patients, think that all they have to do is get well and it will be over. The truth is you have to get well and STAY well. It isn't failure to have a risk of relapse. It isn't failure to relapse!

    Calling it remission does not mean relapse is a matter of time. It means living fully recovered is a TRIUMPH and to be celebrated.


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