Introduction of skills for supporting people with eating disorders, professionals and carers unite. A talk provided for the Early Intervention in Eating Disorders Conference.

1. Introduction of skills for supporting
people with eating disorders,
professionals and carers unite
Karen Bagley - Systemic Psychotherapist
Ros Rea - Specialist Nurse Therapist
Carers - Miranda Portwood / Debbie Field and
Gillian Thomas

2. History
Anorexia nervosa was independently diagnosed by
two physicians, Charles Lasègue and
Sir William Withey Gull, in 1873, prior to
this doctors had described diseases very much
like it.
The term used was “anorexia hysteria” and linked it
closely to family dynamics and conflicts.

3. History
• Structural Family Therapy – Psychodynamic and
Behavioural Approach
• Addresses problems , through relationships and
subsets of family
• Psychosomatic family – concepts such as
enmeshment, overprotectiveness, rigidity, lack of
conflict resolution
• Therapist aims to disrupt dysfunctional patterns ,
to enable them to settle into healthier patterns.
• Family Meal
Salvador Minuchin

4. History
• Haley (1973) Strategic /Individual FT
• The role of the family unit
• Interventions to directly
attack the symptom role
• Paradoxical task

5. History
• Milan/ Post Milan Systems Therapy
• Family is constructed and organised
around the symptom
• Developing different communication patterns
to challenge beliefs. Reframing is used
• Hypotheses about the function
of the symptom
• Second order rather than first order change
• Therapist role to be reflected upon– neutral and curious

6. History
• Post Modern & Social Constructionist Models.
• Narrative Therapy
• Symptoms arising from a socially constructed view
• Therapist shares expertise- Families share expertise
• Unique outcomes, shy stories,
new stories, new meaning

7. Current view
• “There is a lack of any convincing evidence for the existence of a
link between a particular type of family functioning and AN….
• While there may be some family risk factors, these do not have the
force of
• Explanatory mechanism that identifies necessary conditions for the
development of the disorder” (Eisler et al 2010)
“Families are part of the solution,
not the problem”

8. The Beginning!

9. Perceptions held
• “Bewildered, blamed and broken hearted”
Parents view of Anorexia Nervosa
( Mac Donald M 1993)
• Prior to accessing services need to be mindful about perceptions held by
young people / families / carers and bring these into the room.
• BLAME / SHAME & GUILT
I felt so ashamed and guilty was this
my fault….. My daughter has now
explained how I can help her and the
professionals explain that families are
the solution and although I will always
battle with the guilt . It will not disable
me. I will provide her with support.

10. Co-production
• Co-production – means moving away from
the traditional relationship between
‘passive patients’ and ‘expert health
professionals’ to one where both parties
work together as active partners. (Health
Foundation 2012)

12. Stages of change
• Prochaska & DiClemente (1983)

13. Key Concepts
• Why do we not like change? Why is it so
difficult ?
• Crap day exercise

14. Readiness to Change
• In a blame free atmosphere introducing the idea
of carers changing their behaviour to support the
change they want to see in their loved one.
• Increase empathy and knowledge to support
ability to change their own behaviour and approach.

15. Video Resource
https://www.youtube.com/watch?v=UEysOExcwrE3.08-5.41

16. What do we do?

17. What we offer
• Co-production with Family
• Family Based Treatment Models
• Multi Family Group Therapy
• Carers Support Groups
• Carers Skills Workshops
• Sibling Support Groups
• Single Family Therapy

18. Evidence Base
Benefits for the Sufferer
• An improvement in the wellbeing and eating disorder behaviours of the sufferer (Goddard, et al.,
2011).
• Sufferers could identify positive caregiver behaviour changes targeted in the intervention
(Macdonald, et al., 2014)
• Sufferers reported that they found it helpful that their carers/parents understood more about the
thinking and emotional processes associated with an eating disorder (Grover, et al., 2011a;
Grover, et al., 2011b).
Benefits for the Carer
• A reduction in carer time spent care giving, caregiver burden and unhelpful care giving behaviours
(Hibbs, et al., 2015).
• Carers mood was greatly improved (Grover, et al.,2011a; Grover, et al., 2011b)
• Significant reductions in carer anxiety and depression, expressed emotion, burden of care and
accommodation to eating disorder behaviours and unwitting enabling as well as significant
increases in carer psychological wellbeing and self-efficacy (Treasure, et al.,2007b; Sepulveda, et
al., 2008a; Sepulveda, et al., 2008b).

19. Evidence Base
• Eisler (2005) concluded that after family treatment , and
then at follow up, between 6 month and 6 Years 60-90%
recovered fully
• “ FBT – AN is currently the best established treatment for
adolescents with AN” (Eisler Lock & Le Grange2010: p150)
• The effectiveness of family treatment was maintained in a
follow up study (Le Grange et al 2014)
• SFT BN I in US and I in UK Le Grange et al (2007) family
based treatment for BN effective.

20. What works
• Shifting the perspectives of professionals and
families
• Peer & Family feedback
• Skills in engagement
• Education
• Motivational Interviewing techniques
• Future orientated focus

21. I was angry about having to
come to MFT
My daughter stated she wanted
me to understand, I came
under duress…. It was the best
thing… I now have an
understanding and know how
important my role is
It was great being
with people going
through the same
thing. I did not
feel alone
My sister was
getting all the
support I felt
angry. I
understand more
and my parents
understand I still
need their support.
I felt so ashamed and guilty was this
my fault. My daughter has now
explained how I can help her and the
professionals explain that families are
the solution and although I will
always battle with the guilt . It will
not disable me. I will provide her
with support.

22. Skills
• Balloons
• Hands

23. Motivational Interviewing
• Open Questions
• Affirmations
• Reflection
• Summaries

24. Motivational Interviewing
• Partnership working, collaboration,
avoid expert role
• Respect clients perspective on the world and
their strengths
• Compassion, with clients interests and values
• View of encouraging best ideas from client

25. Where do we go from here?

26. Looking Forward
• Expanding perceptions and knowledge of all
professionals
• Ongoing evaluation
• Respond to the feedback
• How to recruit ongoing participation
• Further staff training - colleagues from other
services shadowing.

27. Any thoughts / questions?