Avoid being 'tyrannised' by the evidence : reflections on family-based treatment in adolescent anorexia nervosa

Murray et al. (2012) have argued forcibly for a ‘united and consistent’ team approach in the use of family-based treatment (FBT; Lock et al., 2010) for adolescents and children with anorexia nervosa. This position is, I think, irrefutable. As in applying any therapeutic program, all members of the team need to be in agreement and supportive of each other. This is particularly so in the care of people with anorexia nervosa who struggle with resistance to change. Ego-syntonic features of the illness are strong and ambivalence in therapists can easily undermine an already fragile therapeutic engagement. FBT is demanding of time and persons and is at the least challenging if not at times confronting for families. For most, it is, however, likely to be successful, and to be at least as effective as any other approach. Properly applied it has all the features Frank (1972) listed as common to an effective psychotherapy; namely, an intense, emotionally charged confiding relationship with a helping person, a rationale for the therapy, including an explanation of the patient’s cause for distress and method for relieving it, new information concerning the patient’s problem(s) and alternate ways of dealing with it/them, strengthening expectations of help, provision of success experiences and facilitation of emotional arousal.