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Unformatted text preview: Module 2 --- Article 4 TREATMENT HIGHLIGHTS EATING DISORDERS In the treatment of adolescents with anorexia nervosa, separated family therapy is found to be more effective than conjoint family therapy in families where there is a high level of parental criticism toward the adolescent. Forty adolescents with anorexia nervosa (39 females and 1 male) were randomly assigned to receive either conjoint family therapy or separated family therapy [see box below]. Both treatments were of a 1-year duration, and were conducted on an outpatient basis. Levels of critical comments (ie, expressed emotion [EE])1 in the family, along with several other variables, were assessed at the start of treatment, at 3 and 6 months, and at the end of treatment. Patients were considered to have had a good outcome if their weight was within 15% of average body weight, menstruation had returned (if female and of menarchal age), and there was no evidence of bulimic pathology (based on bingeing, vomiting, laxative use). An intermediate outcome was defined as the same as a good outcome, but without the return of menstruation, and with bulimic behavior occurring less than once a week, if at all. Overall, when the level of EE was not considered, patients receiving either form of family intervention showed improvement on a number of variables, including: bulimic symptoms, eating attitudes and behavior, mood, self-esteem, and obsessional phenomena.2 However, it was found that patients from high EE families were more likely to have better outcomes when treated in separated family therapy (8 of 10 patients had a good/intermediate outcome) than in conjoint family therapy (2 of 7 patients had a good/intermediate outcome). The authors conclude that this study adds to the growing body of evidence that suggests that family interventions are effective in the treatment of adolescent anorexia nervosa. The authors comment that “whole family meetings with families where there are high levels of criticism can be difficult and may perhaps diminish the effectiveness of treatment.”
1 A family was classified as having high EE if 3 or more critical comments were directed by the mother to the patient during a standardized clinical family interview. In correspondence with author Dare, it was noted that critical comments by mothers were used because that is what is conventionally used in studies of EE. However, he notes that the level of critical comments by fathers was similar to that of the mothers. When the level of EE was not considered, good/intermediate outcome was attained by 76% of patients receiving separated family therapy compared to 47% of patients receiving conjoint family therapy. The authors note that although the difference (p=.06) is not statistically significant, a previous study found similar results. However, participants in conjoint family therapy averaged greater improvement in several areas of psychological functioning, including: psychosexual adjustment, mood, and obsessional phenomena. 2 Eisler I, Dare C, Hodes M, Russell G, Dodge E, & Le Grange D. Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 41:727-736, 2000. Support: Medical Research Council. Family Therapy for Anorexia Nervosa
Both conjoint and separated family therapy, as conducted in the above study, begin by encouraging the parents to take control of the adolescent’s nutrition. Both forms of therapy include the following features: (1) stressing that the family is in therapy as a resource to help the adolescent, not because they are seen as the cause of the illness; (2) educating the family about the effects of starvation; (3) emphasizing that the compulsive quality of anorexic behavior makes it outside the patient’s control; (4) teaching the parents to improve the patient’s nutrition without criticizing or blaming the patient; (5) educating the family about the need for the patient, with support from the family, to take back control of his/her life as soon as possible; and (6) encouraging parents to show the patient that the parents have a life beyond the care of the children. In separated family therapy, the parents and patient are seen separately. The therapist discusses with the parents strategies for achieving nutritional change in their child. Parents are encouraged to take a firm position on eating. The patient is seen individually in supportive counseling. The content of the sessions includes discussion of issues directly related to eating problems, as well as issues related to the patient’s feelings, friendships, ambitions, and relationships with family members. In conjoint family therapy, the initial sessions are focused on engaging the whole family. The anxiety of the family around anorexia issues is carefully monitored and dealt with in a warm, nonblaming manner. The therapist ensures that each family member present at the session has an opportunity to be heard. Discussion among the family members is encouraged and cultivated. Family history is explored, with the goal of reinforcing positive coping strategies. The therapist strives to understand the family strengths and traditions as well as “habitual patterns of family organization, especially around growing up and leaving home. The therapy moves towards endorsing the process of parents and the children finding joint and separate individualized life styles.”
©Copyright 2011 MWK Publishing LLC; from The Complete Practitioner: Mental Health Applications (Vol. 4, No. 2 -- February 2001) For next article, go to next page. ...
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This note was uploaded on 02/10/2011 for the course PCO 4930 taught by Professor Neimeyer during the Spring '09 term at University of Florida.
- Spring '09