The family-based treatment model is recommended in the National Institute of Clinical Excellence (NICE) guidance, for psychological treatment of anorexia nervosa in young people.  The eating disorder service recommends that it is combined with multi-family therapy. This treatment model offers sessions separately from family members, as well as sessions together with family members.   

There are typically 20 sessions over a period of a year. Reviews are planned for the first month and then every three months.  The main theme/values in the model are; the importance of the family helping the person recover, and an ethos of no blame or shame to be directed at any family member.  

Psycho-education is provided about the effects of malnutrition, the risks and advice about nutrition. Parents take on the temporary role of supporting the person to manage their eating with our teams support.  

This is a three phase approach. The first phase is to ensure we achieve a good therapeutic relationship with all family members. In the second phase we aim to work together to ensure parents move towards offering independence appropriate to the persons stage of development. In the final phase we explore any concerns the person and their family may have and plan for relapse prevention.  

This model aims to support all family members and sessions will be planned around this.  

Multi-family therapy

The eating disorder service has been offering multi family therapy (MFT) for nine years. MFT itself, has existed for over thirty years and has proved to be effective in a number of fields; one of which is eating disorders. The National Institute of Clinical Excellence, cites MFT as a valuable therapy in treating adolescent anorexia nervosa.

The MFT programme is conducted over four days. The programme requires this length of time as it provides in-depth psycho-education and interventions, as well as ways to enable the family to plan for a future without an eating disorder. The team consists of a family therapist, dietician, nurses, specialist practitioners and occupational therapists. Each team member is highly qualified and skilled in their respective areas. Families who have recovered, also attend to relate their experiences and answer any questions. There are three/four further days, to provide different interventions at each stage of the recovery journey. These follow up sessions are spread over a number of months.

The participants consist of several families working with staff from the eating disorder team. They will share research and knowledge, and participate in interventions on a structured programme. The programme is designed to address individual family’s specific problems.

This model is combined with single family therapy. As an eating disorder impacts on the whole family. It is therefore essential that all family members understand the illness in order to help their loved one move forward. This will assist them to overcome this life-threatening illness as quickly as possible.

Example family statement:

Initially I did not want to talk about the illness; I was worried about privacy, time off work…however, I am so glad I attended; I no longer blame myself. I know I am no longer alone. I was able to get all my concerns listened to and questions answered.

Example patient statement:

Initially I did not want to take time away from studying… I was concerned about my weight and shape compared to others… However, it has increased my family’s understanding, and they no longer blame me or themselves. I no longer feel alone.

Multi-family pre-session information

Our service has created a flow chart of resources, designed to help support your knowledge and understanding about eating disorders and equip you with some initial skills to help you start this recovery journey with your young person. These resources are based on what parents have told us they have found helpful, particularly at the start of their journey within our service.

For the best experience and aimed to not be too overwhelming, we have divided each section into steps for you to look at one at a time. If you are completely new to eating disorders, we’d advise you to start at step one and complete this before moving onto the next step.  If there is a topic you would value to know more about sooner, then please do follow your own knowledge instincts.

Multi-family therapy is an evidence-based treatment programme for young people with an eating disorder and their families. It brings together a group of families (typically 4-8) who share a similar problem, and involves attending an intensive, therapeutic group treatment programme.

A key focus of multi family therapy is bringing families together to overcome any sense of isolation, and to develop a sense of knowing what it’s like to be in the same boat. It’s a place where families can share what they’re finding difficult, but where they can have an opportunity to try out new things. Multifamily therapy can facilitate new ways of thinking about behaviours, leading to positive improvements.

There’s an opportunity for parents to meet on their own as parents, and young people to meet on their own within facilitated groups. Through group therapy, family therapy, creative activities and psychoeducation, it encourages everyone to have a chance to gain different perspectives, helping to promote change and gain a sense that recovery is something that’s achievable.

Before starting multifamily therapy, there is an opportunity to attend an information session to learn more about the programme and ask questions.

Feedback that we’ve had from families who have attended group programmes has been incredibly positive, feeling that they’ve had an opportunity to be heard by other people who know what it’s like. They feel more confident and empowered against the eating disorder, having developed a toolkit of skills and techniques to beat it.

Example family statement

Initially I did not want to talk about the illness; I was worried about privacy, time off work… however, I am so glad I attended; I no longer blame myself. I know I am no longer alone. I was able to get all my concerns listened to and questions answered.

Example family statement

Initially I did not want to take time away from studying… I was concerned about my weight and shape compared to others… However, it has increased my family’s understanding, and they no longer blame me or themselves. I no longer feel alone.

Recommended books

There are a range of books that are available to support you in learning about eating disorders and develop skills to help your loved one overcome this illness. The following books particularly support the multifamily therapy programme approach:

  • Skills Based Caring for a Loved one with an Eating Disorder by Janet Treasure, Grainne Smith and Anna Crane
  • Anorexia and other eating disorders: How to help your child eat well and be well by Eva Musby.

Supportive websites and online support groups

We find that parents/carers really value the support and coaching techniques they can receive from support groups, whether this is within our service or from external organisations. There are free and paid options available, and we’d encourage you to book onto a course that you feel is right for you. The list below is not exhaustive, and we will aim to update options as we hear about them.

  • Charlie Waller trust is a mental health charity which is currently offering parent/carer’s New Maudsley skills workshops. Follow the link below to book onto the next available on-line course
  • Beat Eating Disorders is a UK charity supporting you and your young person who is suffering from an eating disorder. services they offer include helplines, online support groups, information resources and training
  • FEAST: Families Empowered and Supporting Treatment for Eating Disorders. FEAST is a global network community of and for parents. It provides support and education on a wide range of topics to support eating disorder recovery. FEAST also offers a free ‘first 30 days’ course, which aims to transform parents into empowered caregivers in 30 days. People who register for this program will receive one lesson per day, delivered to their inbox, over the course of 30 days. Each lesson is focused on a different topic related to eating disorders and caregiving. There are resources offered on every topic to provide a deeper and more robust understanding of what eating disorders are, how they are treated, and how families can best support their loved one.

Parents have told us it can be helpful to know more about the biological basis of eating disorders. This can help you understand more about what your young person might be experiencing when they attempt to eat and explains why they might be struggling when it comes to mealtimes.

The clip: Eating Disorders from the Inside Out: Laura Hill at TEDxColumbus by TEDx Talks - can provide a useful insight. 

An essential starting point in treatment is supporting you to focus on improving the nutritional intake of your young person. This is to stabilise and improve their physical health, and to begin to challenge eating disorder thinking and behaviours.

We find that our parents and carers have good nutritional knowledge; however an eating disorder can affect your confidence when it comes to making food choices, and following through with them.

We’re aware that establishing new eating routines is challenging both for yourself and your young person. There are many supportive strategies that can help with this, and you will be guided towards some of these resources in step four.

The following Information is designed for you to select topics that will be relevant and supportive to you during treatment. For any further specific nutritional information please link in with your health professional or dietitian within the team.

Supporting the practical aspects of meal and snack times is often a daunting task for parents and carers.

The following YouTube videos offer some guidance on practical techniques and supportive phrases that you could use to help your young person at mealtimes:

 

Supporting your young person with exploring and practicing techniques to managing their emotions and well-being is an important part of the journey ahead.

We are also very aware of how important well-being is for you as parents and carers. The following information is designed to help you explore strategies that could be helpful. Read our wellbeing and coping strategies information.

Supportive apps

Virtual Hopebox:

  • NHS app for mental health and wellbeing uses principles of CBT (cognitive behavioural therapy)

  • Distraction techniques, inspirational quotes, relaxation techniques and coping tools.

Headspace: 

  • Mindfulness/meditation

  • Monthly fee - but free trial and free with Spotify Premium for students.

Calm:

  • Meditation, improve sleep and reduce anxiety

  • Free to download, however costs associated with a subscription service for some elements. 

Smiling Minds:

  • Mindfulness and meditation app

  • Free of charge.

Being inspired by others who have recovered from an eating disorder, can be supportive and maintain hope.

From research and our own experience, this is what young people have found to be important in their recovery journeys:

  1. Building positive relationships to support change. Young people describe support from their parent(s) and people who are close to them as a key factors in helping them face their eating disorder thoughts and emotions, that would feel too overwhelming to manage alone
  2.  Support to understand their eating disorder and recognise the impact it has. For some this is a gradual process, for others understanding the impact the eating disorder has on themselves and others is important. Understanding that eating disorders are illnesses, rather than difficult behaviours has helped
  3. Creating a home and treatment environment where the illness cannot be avoided and the need to work through it. This has been described as parents creating a supportive environment in which eating is seen as the only way forward
  4. Keeping a focus on life outside of an eating disorder: This can maintain hope for recovery with goals to work towards. It can be a good reminder that the current restrictions on their lives that an eating disorder brings are only temporary.

Reference: how young people perceive change to occur in family therapy for anorexia nervosa: a qualitative study. Baudinet et al. Journal of Eating disorders (2024) 12:11.

The following YouTube videos offer insight into individual’s personal journeys and how they have reached a recovered place.

Recovered voices

Balanced eating and meal planning