The Clinician's Guide to Collaborative Caring in Eating Disorders

The New Maudsley Method

Janet Treasure, Ulrike Schmidt, Pam Macdonald, Janet Treasure, Ulrike Schmidt, Pam Macdonald

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781135241377
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Caring for a loved one with an eating disorder is a difficult task; carers often find it hard to cope, and this can contribute to the maintenance of the disorder. The Clinician's Guide to Collaborative Caring in Eating Disorders shows how active collaboration between professional and non-professional carers can maximise the quality of life for both the sufferer and all other family members.

The book provides straightforward guidance for clinicians who work with families and carers. It suggests ways of ensuring that interpersonal elements that can maintain eating disorders are minimised and indicates skills and knowledge that can be taught to the carer for both managing their personal reaction to the illness, and for providing a practically and emotionally supportive environment that is conducive to change. The appendices of the book contain a Toolkit for Carers, a series of worksheets designed to help carers recognise their own unique caring styles.

This book is worthwhile reading for all health professionals working with people with eating disorders. It is relevant across a variety of settings and client groups including inpatients, out-patients, community and day patients.

Part I
Introduction to collaborative care between carers of people with eating disorders and professional services

We begin by providing a general overview in Chapter 1 of what to expect in the book – its goals, aims and target audience. The reader is introduced to the concept of how, when and in what way carers can participate in treatment along with a discussion on the essential links between professionals, carers and people with eating disorders. The chapter closes with an overview of the book’s overall aims, which are first and foremost to provide a clear manual that describes the content and various forms of working collaboratively with families.

Although it is beyond the scope of this book to provide detailed analyses of the underlying causal processes of eating disorders, Chapter 2 nevertheless offers basic general details on the clinical presentations of eating disorders and their causal processes. We look at family factors as moderators of treatment outcomes and cite numerous examples of evidence-based guidelines for the interested reader to investigate further.

In Chapter 3 we listen to the voices of two carers, whose daughters have since recovered and who themselves continue to work tirelessly in promoting the collaborative caring cause. In this chapter, they describe the experiences and needs of carers by drawing not only upon their own infinite experience, but also on that of the countless other carers they have worked with throughout the past several years.

Part I closes with a chapter giving an ethico-legal account of working with carers in eating disorders.

Chapter 1
Introduction

Janet Treasure

It is generally acknowledged that involving the families of adolescents with eating disorders is essential good practice. There is less certainty about the involvement of families of adults. The degree of involvement of parents and partners in outpatient treatment for adults depends on several factors:

• the interest of the patient and/or family member or close other

• practical considerations such as whether the person with the eating disorder lives with their family or close other or at least has close contact with them

• the progress of treatment

• the level of risk.

Thus, it is possible for many patients to recover from their eating disorder with individual therapy alone. However, the more ill the patient, the higher the risk and the less willing or able the person is to care for their own nutritional need, the more the help of the family is needed to participate in treatment.

What this book is about

In this book we discuss an approach to working with family members that can be used across both the age and diagnostic spectrum. This form of intervention can be used for the full range of severity and in a variety of settings and services that may be employed: self-guidance, distance support, carer group workshops and day patient, outpatient and inpatient settings. It should, therefore, be of value to a range of professionals who work in each of these settings.

This approach has been developed with key stakeholders including carers and people with eating disorders themselves. In the book we discuss the ethics and the theories that underpin the approach. Finally, we describe how to implement the various interventions.

It is usually helpful to involve families and other carers in the initial assessment, if possible. Part of the assessment process involves a consideration of the needs of carers themselves. Further help is offered as needed. At minimum, information about the illness and how best to manage it, is offered with guidance offered in person, or via telephone or email.

A more intensive intervention can be given in the form of workshops held for groups of up to twelve carers. These can be used by family members and partners of people with anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified. These involve twelve hours of training delivered in two-hour sessions. The advantage of this form of delivery is that there can be more time and focus on the acquisition of skills and there is the opportunity for peer support and learning.

A more intensive intervention is a three-day workshop held with two or three families. This was developed to facilitate the transition from inpatient care to community care and to moderate the risk of relapse, which occurs in over 50 per cent of patients. In the case of the more severe patients, it is important to adopt a holistic approach by undertaking ‘bridging’ work with both family members as well as any local services that the individual may encounter in the community. In severe cases the problem is multidetermined and so management and treatment needs to address the multiple risk factors that contribute to the problem, some of which are in the social network. A multisystemic approach with a careful and ecologically based functional analysis of identified problems can be helpful which may need some form of outreach work. Such an approach has been found to be effective for adolescents with serious emotional disturbance (Henggeler et al., 2002).

Who should read this book?

This book has been written primarily for all health professionals who work with people with eating disorders in any setting such as inpatient, outpatient, community or day patient. The model of working that we advocate involves active collaboration between professional and non-professional carers, working together to maximise the quality of life for all family members. The basic aim is to provide families with the knowledge and skills that can help them not only manage their own reaction to the illness but also provide an environment (emotionally and practically) that is conducive to change.

As discussed earlier the needs of family members or other carers do not differ from the needs of health professionals working with this patient group, in terms of information about the illness and skills used to manage it. The unhelpful patterns of interactions that are set up within families resemble those that occur within our specialist eating disorder teams. These reactions form as a consequence of the powerful mixed emotions that the symptoms evoke in anyone and in any place where there is prolonged contact with people with eating disorders, such as inpatient, day patient and even out-patient settings. Consequently, we anticipate that this book will be useful for all professionals working with people with eating disorders, even if the main focus of their work is not with families.

Family members may also find that reading the book is helpful in order to deepen their understanding of the illness. Family members tell us that they are desperate for reliable information about how to help their loved one. The commitment, energy and resourcefulness of family members are astounding. Yet all of us, health professional or not, can soon become discouraged if our attempts to help seem to get nowhere.

How, when and in what way can carers participate in treatment?

Carers often provide the initial impetus in guiding their loved one towards treatment. Moreover, they remain a consistent presence throughout the illness and into recovery. During a process that can extend over many years, they shoulder the burden of continuing care while coping with the transitions between different forms of services and treatment.

The form and content varies of how, when and what information and skills are required. We have distilled this information into a book specifically written for carers (Treasure et al., 2007). It provides a detailed practical guide for carers (parents and professionals) involved in the day-to-day management of such cases. This book can be used as a basic outline of the curriculum for carers.

Links between professionals, parents and people with eating disorders

Family members often find themselves stigmatised and treated as if they had contributed to the problem. Parents can be excluded by some services from participating in caring for their daughter while she is in more ‘expert’ hands. Family members are often puzzled and confused because there can be profound differences in the ethos of specialised treatment teams. The parents’ role and the expectations made of them in such settings may vary greatly. In some child and adolescent teams, for example, there may be a minimal interest in working with the individual but this position can abruptly reverse once their child turns 18 and is linked into adult services.

Aside from practical and management issues within this period of transition, there is wide variability in the treatment method and ethos within the different services. Often the family is the central focus of attention in Child and Adolescent Services. Adult services have more of a focus on individual responsibility and the family may be excluded from...

Table of contents

• Contents
• Contributors
• Preface and acknowledgements
• Part I Introduction to collaborative care between carers of people with eating disorders and professional services
• Part II Introduction to the theoretical underpinning
• Part III Different forms of intervention
• Part IV Special cases
• Part V Conclusion and appendices
• Appendix 1 Toolkit for Carers
• Appendix 2 Eating Disorders Symptom Impact Scale (EDSIS)
• Appendix 3 Accommodation and Enabling Scale for Eating Disorders (AESED)
• Index