PARENTAL EMPOWERMENT IN THE FACE OF ANOREXIA NERVOSA CYNTHIA ROUSSO 24 MARCH 2017 IEDC

Transcription

1 PARENTAL EMPOWERMENT IN THE FACE OF ANOREXIA NERVOSA CYNTHIA ROUSSO 24 MARCH 2017 IEDC

2 PHSYICALLY HEALTHY EMOTIONALLY HEALTHY USE ADAPTIVE STRATEGIES TO MANAGE ANXIETY AND STRESS HEALTHY INTERPERSONAL RELATIONSHIPS HEALTHY RELATIONSHIP WITH FOOD, WEIGHT AND SHAPE DO ALL ROADS LEAD TO ROME?

3 SIR WILLIAM GULL ( ) The patients should be fed at regular intervals, and surrounded by persons who would have moral control over them; relatives and friends being generally the worst attendants. 19TH CENTURY

4 JEAN MARTIN CHARCOT ( ) It is necessary to separate both children and adults from their mother, whose influence, as experience teaches, is particularly pernicious. 19 TH CENTURY

5 BEHAVIOURAL APPROACH LENGTHY INPATIENT STAYS 20 TH CENTURY

6 MOVE TO OUTPATIENT MANAGEMENT INPATIENT ADMISSIONS FOR MEDICAL MANAGEMENT MOVE TO EVIDENCE BASED TREATMENTS 21 ST CENTURY

7 2004 FEW RECOMMENDATIONS BASED ON HIGH QUALITY EVIDENCE AND TREATMENT RECOMMENDATIONS BASED ON CLINICAL OPINION FAMILY INTERVENTIONS THAT DIRECTLY ADDRESS THE EATING DISORDER SHOULD BE OFFERED TO CHILDREN AND ADOLESCENTS DRAFT KEY PRINCIPLES OF EVIDENCED BASED TREATMENTS FOR EATING DISORDERS: 1) MAINTAIN LIFE AND AVOID DOING HARM 2) ENGAGE PATIENT, FAMILY AND CARERS IN THE PROCESS OF CHANGE NICE GUIDELINES

8 FAMILY THERAPY PROVIDED THE MOST CONVINCING EVIDENCE ON YOUNG PEOPLE. EVIDENCE

9 13 STUDIES DESCRIBING EVIDENCE BASED FAMILY INTERVENTIONS NO DIFFERENCES WERE FOUND IN EATING DISORDER FOCUSED FAMILY THERAPY COMPARED WITH ANOTHER FAMILY INTERVENTION SOME EVIDENCE THAT TREATING PARENTS SEPARATELY FROM YOUNG PERSON MAY BE MORE EFFECTIVE THAN CONJOINT THERAPY. EITHER MULTI-FAMILY OR SINGLE FAMILY USEFUL LITERATURE REVIEW FOR FAMILY INTERVENTIONS TO TREAT ANOREXIA NERVOSA

10 THE QUALITY OF THE EVIDENCE WAS MOSTLY LOW EVIDENCE WAS DOWNGRADED FOR IMPRECISION AND RISK OF BIAS STUDY NUMBERS RELATIVELY LOW MAJORITY OF COMPARISONS DID NOT ALLOW FOR META-ANALYSIS SINCE ONLY ONE STUDY WAS AVAILABLE QUALITY OF THE EVIDENCE

11 THE COMMITTEE AGREED THAT FAMILY THERAPY SHOWED THE MOST PROMISING RESULTS IN YOUNG PEOPLE WITH ANOREXIA NERVOSA COMPARED WITH CBT-ED AND ADOLESCENT FOCUSED THERAPY. TREATMENT

12 EATING DISORDER FOCUSED FAMILY THERAPY MAUDSLEY BASED THERAPY FAMILY BASED TREATMENT SYSTEMIC FAMILY THERAPY FAMILY WORK FAMILY INTERVENTION FAMILY THERAPY

13 IT WAS DIFFICULT TO DECIPHER WHICH TYPE OF FAMILY THERAPY WAS THE MOST EFFECTIVE (I.E. GENERAL VERSUS EATING DISORDER FOCUSED OR VARIATIONS IN THE MAUDSLEY-BASED THERAPY) GIVEN THE SMALL NUMBER OF STUDIES, BUT IT WAS AGREED (BASED ON COMMITTEE EXPERIENCE) THAT IT SHOULD BE EATING DISORDER FOCUSED. RECOMMENDATIONS

14 ASSUMPTIONS PHASE 1: PARENTS IN CHARGE AND RESPONSIBLE FOR WEIGHT RESTORATION PHASE 2: PARENTS HAND EATING CONTROL BACK TO ADOLESCENT PHASE 3: OTHER DEVELOPMENTAL ISSUES AGNOSTIC VIEW OF ILLNESS, SEPARATION OF CHILD AND ILLNESS, FAMILY MEAL(S) THERAPIST STYLE AND TRAINING ACTIVE, MOBILIZE ANXIETY, DEFER TO PARENTS, NON- AUTHORITARIAN, NON-BLAMING DELIVERED BY MENTAL HEALTH PROFESSIONAL WITH EATING DISORDER, ADOLESCENT AND FAMILY EXPERTISE INTENSITY AND FORMAT SESSIONS OVER 1 YEAR CONJOINT AND SEPARATED FAMILY BASED TREATMENT (FBT)

15 ASSUMPTIONS PHASE 1: ENGAGEMENT AND DEVELOPMENT OF THE THERAPEUTIC ALLIANCE. REFRAME FEEDING BY PARENTS AS CARING. DEVELOP A SYSTEMIC FORMULATION. PHASE 2: HELPING THE FAMILY TO MANAGE THE EATING DISORDER. MEALTIMES, PSYCHOEDUCATION PHASE 3: EXPLORING ISSUES OF INDIVIDUAL AND FAMILY DEVELOPMENT PHASE 4: ENDING TREATMENT, FUTURE PLANS THERAPIST STYLE AND TRAINING OPEN AND COLLABORATIVE DELIVERED BY ALL CLINICIANS ON THE TEAM WHO ARE SUPERVISED BY AN EXPERIENCED SYSTEMIC FAMILY THERAPIST INTENSITY AND FORMAT VARIES MAUDSLEY BASED THERAPY

16 ASSUMPTIONS INVOLVING FAMILIES IS HELPFUL TO BOTH PATIENT AND FAMILY INVOLVMENT MAY INCLUDE AN ASSESSMENT OF NEEDS, TRAINING, PSYCHOEDUCATION, NUTRITIONAL GUIDANCE, BEHAVIOURAL MANAGEMENT OR STRESS MANAGEMENT THERAPIST STYLE AND TRAINING DELIVERED BY A WIDE VARIETY OF MENTAL HEALTH PROFESSIONALS INCLUDING: CARE WORKERS NURSES PSYCHIATRISTS PSYCHOLOGISTS PSYCHOTHERAPISTS SOCIAL WORKERS INTENSITY AND FORMAT VARIES FAMILY WORK FAMILY INTERVENTION

17 FAMILIES ARE AN IMPORTANT RESOURCE FAMILIES DON T CAUSE THE ILLNESS PARENT S PLAY A CENTRAL ROLE IN MANAGEMENT PARENTAL ROLES CHANGE OVER TIME TO SUPPORT AUTONOMY HELPFUL TO EXTERNALIZE THE EATING DISORDER TREATMENT IS PHASED SIMILARITIES BETWEEN MODELS

18 ROLE OF PARENTS SYSTEMIC FORMULATION FAMILY MEALS DIETARY ADVICE/ MEAL PLANS DELIVERY DIFFERENCES BETWEEN MODELS

19 PARENTS CAN FEEL PARENTS CAN ANOREXIA IS POWERLESS TAKE CHARGE MANIPULATIVE SCARED CONFUSED HELPLESS ANGRY DE-SKILLED BE EFFECTIVE, SKILLED TREATMENT AGENTS SEPARATE ILLNESS FROM CHILD BE COMPASSIONATE NOT NEGOTIATE NOT BLAME THREATENING HARMFUL STUBBORN MALADAPTIVE SOLUTION WHY EMPOWER PARENTS

20 WE MAY DISAGREE ON THINGS BUT WE ALL AGREE ON SAVING YOUR DAUGHTER S LIFE STUBBORNNESS IS A PRE-REQUISITE FOR STARVING ONE S SELF TO DEATH SO LET S NOT LET THAT STOP US WHEN YOU ARE GOING THROUGH HELL, KEEP GOING OUTWIT, OUTLAST, OUTPLAY YOU CAN DO ANYTHING BUT YOU CAN T DO EVERYTHING THINGS I SAY TO EMPOWER PARENTS

21 In all affairs it s a healthy thing now and then to hang a question mark on the things you have long taken for granted. BERTRAND RUSSELL GROUP DISCUSSION

22 HOW IMPORTANT IS PARENTAL EMPOWERMENT IN YOUR WORK WITH FAMILIES? FUNDAMENTAL ASSUMPTIONS IN EMPOWERING PARENTS? HOW BEST TO HELP FAMILIES PROVIDE A CONTAINING FUNCTION? HOW TO FOSTER FAMILY STRENGTHS? WHAT MODEL OF FAMILY THERAPY DO YOU FIND MOST HELPFUL? WHAT HELPS WHEN FAMILY THERAPY ISN T POSSIBLE? HELPING PARENT S FEEL EMPOWERED IN THE FACE OF DSH? POTENTIAL DISCUSSION AREAS

23 REFERENCES 1

24 REFERENCES 2