Why I no longer use the term "Maudsley Approach"

I know, I KNOW. I was one of the ones who worked VERY HARD to spread the term "Maudsley Approach" to describe what is now usually called Family-Based Treatment for eating disorders. There was a reason for that, which I'll describe below, but first I want to offer this New Year's Resolution:

2018 Resolution: STOP SAYING MAUDSLEY.

I do not expect everyone to agree with me. I do know that what I'm saying will annoy, piss off, and be misunderstood by some people.

Me at THE Maudsley
But when language has grown fuzzy, muddled, and starts to mean different things to people that they then repeat, we sometimes have to set it aside. One term can't mean so many things and be useful.

I've been on a mission in the past year or so to ask people to describe what they mean by "Maudsley" and the range of answers indicates it has little communication value. You can find any number of people who will give you these answers:
  • The Maudsley Approach is Family-Based Treatment
  • The Maudsley Approach is when parents feed their kids at home
  • Parents do the Maudsley Method using an online forum
  • Maudsley is also called MANTRA
  • The Maudsley Approach is the Maudsley Method
  • The Maudsley Approach is what families in the UK get
  • Maudsley is the use of animal analogies to help parents learn how to manage their children's ED 
  • Maudsley just means feeding patients
  • The Maudsley Approach is a self-help treatment
  • Maudsley is a motivational interviewing approach
  • The Maudsley Approach is offered at the Maudsley Hospital
  • Maudsley is required now for US patients
  • Force-feeding at home is part of the Maudsley Approach
  • The New Maudsley Method is an updated version of the Maudsley Approach
  • Maudsley is the only treatment that works
  • Maudsley is for children with anorexia nervosa only
  • Maudsley is a hospital in London
Only the last thing on that list is true.

I hear myths about "Maudsley" all the time. I collect them.

So how DID the term got associated with such a long list of mutually exclusive ideas? It was not because people AT the Maudsley hospital called manualized Family-Based Treatment: "The Maudsley Approach," in fact we have all been told that this is not a term enjoyed by the wonderful group of eating disorder specialists with offices at the historic Maudsley Hospital. It is a not a term that Drs. Lock and le Grange, who have co-written most of the literature and done most of the training for FBT, offered themselves. No one seems to agree on exactly how it happened, but the term got attached to the method by some Australians and then parents who were referring to where the original methods that led to the manualized FBT came from.

I had a specific reason for using the term "Maudsley," myself, when I started writing about it (my first book*), and collaborated with others to create the website Maudsley Parents. It was Google. Back in 2002, when our family fell down the rabbit hole into this world, there was no way to find or to lead parents to information about FBT. In fact, Googling "Family-Based Treatment" yielded only references to traditional Family Therapy, which at the time was focused on fixing broken families thought to cause eating disorders. A parent seeking information about what treatments worked best would be flooded with paid ads from treatment clinics who even now do not offer anything resembling a family-based or even family-friendly treatment. At the time, a parent seeking help for a loved one's eating disorder would not be told there was a method opposite to what they were being offered, one that both included and coached them, one that had a much higher chance of being successful. I was one of those parents.

But "Maudsley" was Googleable. It brought up references to FBT, only a few newspaper mentions, but for the parents we could pass a note to or reach to tell them the word, it led them to other parents, to a growing list of references in journals, and eventually to books on the topic. Using the term Maudsley allowed us to share, build, and connect.

But then, inevitably, the use got fuzzy. And "FBT" became Googleable.

Meanwhile, treatment providers skeptical about an approach that did not depend on causation myths, abuse suspicion, and psychodynamics caused backlash. Confusion about treatment that did not address commonly assumed "root causes" was considered irresponsible. Offense at a treatment that focused first on food, and trusted families, was routine.

Parents, too, misunderstood. Many spread the word on FBT as if parents did it on their own, not guided by a therapist. Parents, focused on the thing we can do, took up refeeding as if it was the only relevant part of FBT, and started to confuse what they were doing with FBT.

Innovators in the field began taking elements of FBT and adding it to what they provided, and called their hybrid approaches "Maudsley," causing confusion about what the research had established.

Other treatments, and help for families, started using variants of the term. A "New Maudsley Approach" was published that while it shared a non-blaming stance was for families with adult sufferers and a self-help, not a therapeutic approach. The hospital's name was used to describe a number of ideas developed there. Leading hospitals started offering FBT elements in their overall treatment. And one ED program had been around and using the term Family Based Treatment for their unique approach even before FBT was manualized.

What a mess!

I see people discussing FBT and other family-centered ideas every day, and tend to offend people when I say "what you are describing is not FBT." I know people find it obnoxious, and think that I'm saying what they are describing is inferior, wrong, or that I'm some kind of FBT-compliance nut. But my real reason for that statement is to prevent:
  • People criticizing FBT for things it is not
  • People praising FBT for things it is not
  • People thinking they are getting, and failing at, FBT when they have not yet had it available
  • People using FBT as marketing without actually being trained or interested in it
  • FBT becoming a generic term for anything that involves families
  • Families "doing Maudsley" at home thinking they are using an evidence-based model
  • Innovations on FBT, which are the next and important step, not being researched and examined clearly
  • Endless arguing because people aren't talking about the same things
I honestly don't care if a clinician or a family chooses FBT or not. It's just one manualized approach and there need to be many options. I actually have some real problems with the method, not that anyone's asked me. I just think families and payers and policy-makers need to have a clear picture of what they are pursuing, and what the evidence is that indicates its chances of success in what situations. We're stuck, as far as policy, often because of misunderstandings, not genuine differences.

There is a serious policy debate around all the issues connected to FBT. Let's commit to those debates, which influence training and funding and consumer choices and outcomes, using the terms clearly.

I no longer use the term Maudsley to describe FBT. I challenge you to join me!

If you are interested, I did an interview for NEW PLATES podcast with the authors of the FBT manuals and Help Your Teenager Beat An Eating Disorder, the parent guide to FBT. Listen here:

* A side note on my book, Eating With Your Anorexic. One, the title is meant as a joke, a play on how-to books that simplify very complicated processes. Two, I fought with the publisher, McGraw-Hill, on putting "Maudsley Approach" on the cover, but I was a small-town columnist and it was my first book and I didn't have the power to veto it. It is no longer the subtitle on the 2nd edition.


  1. YAY!!! Have you thought about posting this over at the FEaST ATDT forum???


Post a Comment

Popular Posts