Family Based Therapy
The Maudsley approach can mostly be construed as an intensive outpatient treatment where parents play an active and positive role in order to:
• Help restore their childʼs weight to normal levels expected given adolescentʼs age & height;
• Hand the control over eating back to the adolescent, and;
• Encourage normal adolescent development through an in-depth discussion of these crucial developmental issues as they pertain to their child.
Phase 1: Weight restoration The Maudsley Approach proceeds through three clearly deﬁned phases in treating Anorexia. In Phase I, also referred to as the weight restoration phase, the therapist focuses on the dangers of severe malnutrition associated with Anorexia, such as hypothermia, growth hormone changes, cardiac dysfunction, and cognitive and emotional changes to name but a few, assessing the familyʼs typical interaction pattern and eating habits, and assisting parents in re-feeding their daughter or son.
Phase 2: Returning control over eating to the adolescent This phase of treatment focuses on encouraging the parents to help their child to take more control over eating once again.
Phase 3: Establishing healthy adolescent identity Beginning when the adolescent is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has abated the treatment focus starts to shift to the impact Anorexia has had on the individual establishing a healthy adolescent identity.
Individual Psychodynamic Therapy
The most commonly used treatments—psychotherapy and medication—are delivered at various levels of inpatient and outpatient care, and in various settings depending on the severity of the illness and the treatment plan that has been developed for a particular patient. Patients must be medically stable to be able to participate meaningfully in any type of psychological therapy. Psychodynamic interventions for eating-disordered patients can provide a unique pathway to understanding the illness. Placing emphasis on the unique personal history of the individual and finding a safe haven in which to process that history are cornerstones of psychodynamic treatment.
Dialectical Behavior Therapy
DBT was developed by Marsha Linehan in the early 1990s to help clients struggling with pervasive difficulties managing emotion. It is a therapy that has now been shown effective in treating eating disordered behaviors in large part because these behaviors are so tied to trying to cope with emotions.
Comprehensive DBT consists of individual therapy with a therapist who has received specific training (more than a few hours in a workshop) in the treatment, ongoing consult for the therapist, phone coaching, and skills training.
The "gold" standard for DBT training is completion of a 60 hour course called an "intensive." For multiple reasons, provision of comprehensive DBT can be challenging and this treatment is offered in few places in SW Michigan (Interact of Michigan being one). DBT-informed may mean that the therapist practices on a team but also provides aspects of the treatment in another setting (like a private practice). This would usually include integration of the DBT skills (mindfulness, emotion-regulation, distress tolerance, and interpersonal effectiveness) into therapy as well as behavior tracking and contingency management. A DBT-informed practice would also place a high importance on the therapy relationship and providing the client with validation and acceptance.
Intensive Outpatient Treatment
Intensive out-patient treatment is slightly less intensive than residential treatment, but more intense than out-patient treatment. A patient's needs will change during the course of recovery, Many programs are now affiliated with a day hospital program so that patients can "step-up" and "step-down" to the appropriate level of care depending on their clinical needs.
Residential programs provide a treatment option for patients who require longer term treatment. This treatment option generally is reserved for individual who have been hospitalized on several occasions, but have not been able to reach a significant degree of medical or psychological stability. Most inpatient programs for eating disordered individuals treat patients with anorexia nervosa, bulimia nervosa, binge eating disorder, or variants of these disorders.
There are many residential treatment programs across the United States. Decisions on where to go for residential treatment are made with consideration of several factors (insurance, affordability, location proximity, etc.) and discussions between the patient, family members, and all providers involved in treatment.