Friday, March 28, 2008

Treatment Manual for Anorexia Nervosa: A Family-Based Approach

(James Lock, Daniel le Grange, W. Stewart Agras, Christopher Dare, and W. Agras)

This book is a treatment manual intended for therapists, not parents or sufferers. I read the book as a parent with no background in therapy, with the exception of seeing a therapist with my son who has anorexia. It's probably important to note this disclaimer before my review.

This treatment manual was written in 2000 with a paperback version released in 2002. The book, at it's core, uses methods introduced by the Maudlsey Hospital in the UK. At the time of the book's release, these ideas were pretty radical and differed from the approach and thinking of the majority of doctors and therapists. At the time, most parents were blamed and/or discouraged from participating in helping their child. Typical therapies tried to convince the anorexic patients to eat. The idea of this manual, that you involve the parents and help them to restore nutrition first and then address any psychological needs, was and still is a controversial idea. However, in the past few years, studies have shown a much higher rate of recovery with this approach than with traditional approaches.1

The book claims an "agnostic" point of view as to cause of eating disorders. However, I found some small indicators that suggested the authors were not completely without bias. Also, this book is now 8 years old. In a field where new research is being released regularly, this book probably needs an update. Even Maudsley and Locke's continued research has shown some changes that should be incorporated into the manual.

The book explains therapy for three stages of treatment for anorexia. After an introduction and a review of research, phase I is introduced and explained. A separate chapter documents an actual therapist, patient and family moving through the phase. Separate explanatory paragraphs are used throughout the chapter to reinforce the difference concepts contained in the phase. This same pattern is used for phases II and III. The book's concluding chapter describes a patient's treatment through all three stages.

This therapeutic manual emphasizes the need for family involvement. They, in fact, recommend that entire family be involved in each session (I'm not so sure this would have been practical for my toddler). Parents are encouraged and supported in refeeding their child. A move toward independent eating is encouraged in phase II. Phase III is used to discuss and explore moving beyond the anorexia into normal living and adolescence roles.

This book is probably a good starting point for therapists not familiar with family-based treatment or the Maudsley method. Additional reading would probably be necessary to bring the therapist completely up-to-date. I've heard that many parents, upon learning about the Maudsley method, will give this book to their therapists. This book is also a valuable resource for parents. It was helpful to see a starting-point, of sorts, for these new methods that are working so well with my son. With all the recommendations, I was expecting a perfect book. It's not perfect, but we've sure come a long way in the last eight years.

1- Evolving Treatments for Adolescents with Anorexia Nervosa: The Role of Families in Recovery By James Lock, M.D., Ph.D.

I bought this book on Amazon. I tried to find a second-hand copy for a better price, but could only find it for the same or more. I was able to buy a digital copy ($5.80) through Amazon. I had a lot of the book read, before the physical book arrived at my door.


Harriet said...

If you'd like to learn more about family-based treatment (the Maudsley method), please visit

--Harriet Brown
Co-Chair, Maudsley Parents

Jane said...

You might be interested in a video interview James Lock did a couple years ago. You can find a link on the Maudsley Parents Quick Reference page ( under "Dr. James Lock answers 5 questions about family-based treatment in print and on video" His response to questions 2,3 and 4 are particularly relevant to your topic.

The manual of course is meant as a training tool for therapists rather than as a practical guide for parents. As such, it might not be the most useful resource for them. That said, I didn't find it blaming of parents. I think any family is likely to be blindsided by AN and have trouble responding effectively at first (understandably enough) and this is where a Maudsley therapist can assist. Get the family on the same page, with parents working together and focused on restoring health can be a big help to them. In the early stages some parents need a fair amount of help to shift their thinking if they feel they ought to stay out of their child's care (unfortunately some parents are still told this) or struggle to externalize the illness (unfortunately some parents are still told their child must "choose to get well.")

Wendy said...

Thanks Jane & Harriet.

I read the interview by Lock ( Thanks for the link. Lock, in this interview, is responding to a different book, "How To Help Your Teenager Beat an Eating Disorder." I think this second book is updated and more clearly reflects Lock's position in not blaming parents. I hope I didn't come across too critical in my review. I think this is an important book that shifted ways of thinking about anorexia. I'm a Lock/Maudsley fan.