Treating several families at the same time can improve some aspects of a patient’s life.
The concept of multi-family therapy (MFT) for eating disorders, or treating more than one family at the same time and in the same setting, was first reported in the 1960s (Curr Psychiatr Ther. 1964;4:150). MFT is increasingly being used by eating disorder services worldwide.
MFT models differ significantly, depending on the country and services, but all are: (1) group-based, (2) involve several families working together with the support of a clinical team, and (3) most commonly delivered over several hours or several full days of treatment. During child and adolescent MFT, parents and siblings are typically invited to attend, whereas working with adults may also include partners, other significant people in the participant’s life, and/or parents/caregivers.
MFT has been associated with improved quality of life, better self-perception and self-image, improved self-esteem, reduced caregiver burden, changes in expressed emotion, and improved family functioning and communication.
Increased empowerment and confidence emerge
Results of a study of the feasibility, acceptability, and short-term treatment outcomes of a newly developed five-day treatment program for adults with eating disorders were recently reported by Drs. Julian Baudinet and colleagues from the Maudsley Centre for Child and Adolescent Eating Disorders and King’s College, London. The study centered on outpatient child and adolescent MFT models for anorexia nervosa (MFT-AN) (Curr Psychiatry Rep. 2024. 26:323).
Typically, MFT is offered in an outpatient context, although day and inpatient models have also been described. The briefest MFT models provide three to five consecutive days of MFT offered as a stand-alone intervention. The length of MFT treatment can vary. For example, the Maudsley model offers six to 10 days of MFT spread across six months to a year. Other programs offer up to 20 days or more of MFT given for several months or more.
Improved immediacy, intensity, and connections
The number of programs designed for adults with eating disorders is growing, and the concept of MFT has also been applied to patients with bulimia nervosa (J Eat Disord. 2022;10:91; Eat Disord. 2021; 29:351). Several services offer MFT for mixed eating disorder groups (J Eat Disord. 2021. 9:110). During child and adolescent MFT programs, parents and siblings are typically invited to attend, whereas adult models may also include partners and other significant people in a patient’s life.
These data also fit theoretically with qualitative data on young people and parental experiences of intensive day program treatment. While day programs are somewhat different from MFT, some include multi-family elements. Other similarities include the intensity, increased level of support, and additional hours of intervention per week. In both settings, the importance of immediacy, intensity, and connecting with others are all described by young people and parents/caregivers as key factors in supporting people to (re)engage in less intensive outpatient treatment.
Participants, and particularly caregivers, report feeling more empowered, more confident and more able to share their experiences in the MFT setting. Many also speak of the intensity and comparisons that arise out of the group process, and how this can generate and lead to the expression of strong emotions, which can be both a challenge and a benefit.
A five-day model of MFT has been manualized in a collaborative study at the University of California, San Diego, and Oslo University Hospital, Oslo, Norway. This is the Temperament-Based Therapy with Supports (TBT-S) service. This approach uses talk therapy to help individuals understand how their temperament affects their symptoms. All patients and support members rated the quality of the service as good or excellent, and dropout was low. Last, most participants (90% of patients and 96% of support members) felt that the new approach either met or exceeded their expectations (J Eat Disord. 2023. 11:156).
