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Resolving a disagreement in a clinical team: Overcoming conflicting views about the role of family therapy in an outpatient treatment programme for anorexia nervosa

  • Nathalie Godart
  • F. Perdereau
  • Z. Rein
  • F. Curt
  • I. Kaganski
  • R. Lucet
  • M. Corcos
  • J. Fermanian
  • M. Flament
  • P. Jeammet
Original Research Paper

Abstract

In the Adolescent Psychiatry Department at the Institut Mutualiste Montsouris, Paris, as is also observed in the literature, the outcome for anorexic patients can sometimes be catastrophic, regardless of treatments proposed. This disturbing finding led us to reassess our therapeutic treatment strategies, in an effort to improve patient outcome. The multidimensional treatment program implemented in the Department includes parent counselling, but not the whole family in a family therapy procedure. It has been demonstrated better outcome for patients who underwent family therapy in comparison to patients who underwent individual therapy. This raised the question of whether family therapy could improve our outpatient programme. This paper describes here how a research programme was developed to resolve a disagreement in our clinical team as to whether family therapy should be added to the existing care programme. The paper describes the difficulties encountered by our team, and the experimental design chosen to resolve the debate. Data will not be set out here.

Key words

Anorexia nervosa family therapy adolescence outpatient 

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References

  1. 1.
    Practice guideline for the treatment of patients with eating disorders (revision). American Psychiatric Association Work Group on Eating Disorders. Am. J. Psychiatry, 157, 1 Suppl., 1–39, 2000.Google Scholar
  2. 2.
    Godart N., Atger F., Perdereau F., Agman G., Rein Z., Corcos M., Jeammet P.: Treatment for adolescents eating disorders patients: illustration of a psychodynamic approach in the clinical practice. Eat. Weight Disord., 9, 224–227, 2004.PubMedCrossRefGoogle Scholar
  3. 3.
    Jeammet P.: The anorexic stance. J. Adolesc., 4, 113–129, 1981.PubMedCrossRefGoogle Scholar
  4. 4.
    Jeammet P.: From a fear of getting fat to a desire of becoming thin. J. Adolesc. Health, 13, 398–400, 1992.PubMedCrossRefGoogle Scholar
  5. 5.
    Jeammet P., Chabert C.: A psychoanalytic approach to eating disorders: the role of dependency. Adolescent Psychiatry. Annals of the American Society for Adolescent Psychiatry, 22, 59–84, 1998.Google Scholar
  6. 6.
    Jeammet P.: Links between internal and external reality in devising a therapeutic setting for adolescents who present with serious conduct disorders. In: Anastasopoulos D., Laylou-Lignos E., Waddell M. (Eds.), EFPP Clinical Monograph Series: Psychoanalytic psychotherapy of the severely disturbed adolescent. Karnac Books, 1999, pp. 25–57.Google Scholar
  7. 7.
    Hebebrand J., Himmelmann G.W., Herzog W., Herpertz-Dahlmann B.M., Steinhausen H.C., Amstein M., Seidel R., Deter H.C., Remschmidt H., Schafer H.: Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral. Am. J. Psychiatry, 154: 566–569, 1997.PubMedGoogle Scholar
  8. 8.
    Jeammet P., Brechon G., Payan C., Gorgé A., Fermamian J. Le devenir de l’anorexie mentale. Une étude prospective de 129 patients évalués au moins 4 ans après leur première admission. Psychiatr. Enfant, 2, 381–442, 1991.Google Scholar
  9. 9.
    Ben-Tovim D.I., Walker K., Gilchrist P., Freeman R., Kalucy R., Esterman A.: Outcome in patients with eating disorders: a 5-year study. Lancet, 357, 1254–1257, 2001.PubMedCrossRefGoogle Scholar
  10. 10.
    Selvini-Pazzoli M.: Self starvation from the intrapsychic to the transpersonal approach. London, Chaucer, 174.Google Scholar
  11. 11.
    Minuchin S., Baker L., Rosman B.L., Liebman R., Milman L., Todd T.C.: A conceptual model of psychosomatic illness in children. Family organisation and family therapy. Arch. Gen. Psychiatry, 32, 1031–1038, 1975.PubMedCrossRefGoogle Scholar
  12. 12.
    Stierlin H., Weber G.: Unlocking the family door: a systemic approach to the understanding and treatment of anorexia nervosa. New York, Brunner/Mazel, 1989.Google Scholar
  13. 13.
    Lock J., Le Grange D.: Family-based treatment of eating disorders. Int. J. Eat. Disord., 37, Suppl., S64–S67, 2005.PubMedCrossRefGoogle Scholar
  14. 14.
    Russell G.F.M., Szmukler G.I., Dare C., Eisler I.: An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch. Gen. Psychiatry, 44, 1047–1056, 1987.PubMedCrossRefGoogle Scholar
  15. 15.
    Dare C., Eisler I., Russell G., Treasure J., Dodge L.: Psychological therapies for adults with anorexia nervosa: randomised controlled trial of outpatient treatments. Br. J. Psychiatry, 178, 216–221, 2001.PubMedCrossRefGoogle Scholar
  16. 16.
    Eisler I., Dare C., Russell G.F., Szmukler G., Le Grange D., Dodge E.: Family and individual therapy in anorexia nervosa. A 5-year follow-up. Arch. Gen. Psychiatry, 54, 1025–1030, 1997.PubMedCrossRefGoogle Scholar
  17. 17.
    Robin A.L., Siegel P.T., Koepke T., Moye A.W., Tice S.: Family therapy versus individual therapy for adolescent females with anorexia nervosa. J. Dev. Behav. Pediatr., 15, 111–116, 1994.PubMedCrossRefGoogle Scholar
  18. 18.
    Robin A.L., Siegel P.T., Moye A.: Family versus individual therapy for anorexia: impact on family conflict. Int. J. Eat. Disord., 17, 313–322, 1995.PubMedCrossRefGoogle Scholar
  19. 19.
    Robin A.L., Siegel P.T., Moye A.W., Gilroy M., Dennis A.B., Sikand A.: A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. J. Am. Acad. Child Adolesc. Psychiatry, 38, 1482–1489, 1999.PubMedCrossRefGoogle Scholar
  20. 20.
    Fairburn C.G.: Evidence-based treatment of anorexia nervosa. Int. J. Eat. Disord., 37, Suppl, S26–S30, 2005.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaganski I., Rémy B.: Aspects familiaux, cliniques et thérapeutiques des troubles des conduites alimentaires. Confrontations Psychiatriques, 31, 1989.Google Scholar
  22. 22.
    Kaganski I.: La marmite familiale. Enfances et Psy, 8, 127–134, 1999.Google Scholar
  23. 23.
    Kaganski I., Lucet R.: Les larmes et le ventre. Revue Neuropsychiatrie de l’Enfance et de l’Adolescence, 47, 95–99, 1999.Google Scholar
  24. 24.
    Kaganski I.: Quoi de neuf dans le domaine des troubles des conduites alimentaires: Aspects familiaux cliniques et thérapeutiques des troubles des conduites alimentaires à l’adolescence. Prisme, 30106–117, 1999.Google Scholar
  25. 25.
    Kaganski I., Lucet R.: Guérir les souffrances familiales In: Angel P., Mazet P. (Eds.), PUF Ed, 2004.Google Scholar
  26. 26.
    Kaganski I.: La place de la nourriture dans les relations familiales. Enfances et Psy, 27, 45–52, 2005.CrossRefGoogle Scholar
  27. 27.
    Eisler I., Dare C., Hodes M., Russell G., Dodge E., Le Grange D.: Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. J. Child Psychol. Psychiatry, 41, 727–736, 2000.PubMedCrossRefGoogle Scholar
  28. 28.
    Danziger Y., Carel C.A., Tyano S., Mimouni M.: Is psychotherapy mandatory during the acute refeeding period in the treatment of anorexia nervosa? J. Adolesc. Health Care, 10, 328–331, 1989PubMedCrossRefGoogle Scholar
  29. 29.
    Beck A.T., Beamesderfer A.: Assessment of Depression: The Depression Inventory. Mod. Probl. Pharmacopsychiatry, 7, 151–159, 1974.PubMedGoogle Scholar
  30. 30.
    Collet L., Cottraux J.: The shortened Beck depression inventory (13 items). Study of the concurrent validity with the Hamilton scale and Widlocher’s retardation scale. Encephale, 12, 77–79, 1986.PubMedGoogle Scholar
  31. 31.
    Blatt S.J., Zuroff D.: Psychometric properties of the depressive experiences questionnaire. J. Pers. Assess., 55, 65–72, 1990.PubMedGoogle Scholar
  32. 32.
    Atger F., Frasson G., Loas G., Guibourge S., Corcos M., Perez Diaz F., Speranza M., Venisse J.L., Lang F., Stephan P., Bizouard P., Flament M., Jeammet P.: Validation study of the Depressive Experience Questionnaire. Encephale, 29, 445–55, 2003.PubMedGoogle Scholar
  33. 33.
    Garner D.M., Garfinkel P.E., O’Shaughnessy M.: The validity of the distinction between bulimia with and without anorexia nervosa. Am. J. Psychiatry, 142, 581–587, 1985.PubMedGoogle Scholar
  34. 34.
    Romo-Jimenez M.L., Bichindaritz I., Samuel-Lajeunesse B.: Measuring the development of eating disorders in a group of patients with the Eating Disorders Inventory (EDI). Ann. Med. Psychol., 153, 402–408, 1995.Google Scholar
  35. 35.
    Weissman M.M., Bothwell S.: Assessment of social adjustment by patient self-report. Arch. Gen. Psychiatry, 33, 1111–1115, 1976.PubMedCrossRefGoogle Scholar
  36. 36.
    Achard S., Chignon J.M., Poirier-Littre M.F., Galinowski A., Pringuey D., Van Os J., Lemonnier, F.: Social adjustment and depression: value of the SAS-SR (Social Adjustment Scale Self-Report). Encéphale, 21, 107–116, 1995.PubMedGoogle Scholar
  37. 37.
    Bagby R.M., Parker J.D., Taylor G.J.: The twenty-item Toronto Alexithymia Scale — I. Item selection and cross-validation of the factor structure. J. Psychosom. Res., 38, 23–32, 1994.PubMedCrossRefGoogle Scholar
  38. 38.
    Bagby R.M., Taylor G.J., Parker J.D.: The Twenty-item Toronto Alexithymia Scale — II. Convergent, discriminant, and concurrent validity. J. Psychosom. Res., 38, 33–40, 1994.PubMedCrossRefGoogle Scholar
  39. 39.
    Loas G., Fremaux D., Marchand M.P.: Factorial structure and internal consistency of the French version of the twenty-item Toronto Alexithymia Scale in a group of 183 healthy probands. Encéphale, 21, 117–122, 1995.PubMedGoogle Scholar
  40. 40.
    Derogatis L.R., Rickels K., Rock A.F.: The SCL-90 and the MMPI: a step in the validation of a new self-report scale. Br. J. Psychiatry, 128, 280–289, 1976.PubMedCrossRefGoogle Scholar
  41. 41.
    Fortin M.F., Coutu-Wakulczyk G., Engelsmann F.: Contribution to the validation of the SCL-90-R in French-speaking women. Health Care Women Int., 10, 27–41, 1989.PubMedCrossRefGoogle Scholar
  42. 42.
    Parker G., Tupling H., Browm L.B.: A parental bonding instrument. Br. J. Med. Psychol., 52, 1–10, 1979.CrossRefGoogle Scholar
  43. 43.
    Olson D.H., Portner J., Lavee Y.: FACES III. St. Paul, Minnesota, Family Social Science, University of Minnesota, 1985.Google Scholar
  44. 44.
    Tubiana-Rufi N., Moret L., Bean K., Mesbah M., Feard S., Deschamps J.P., Czernichow P., Chwalow A.J.: Validation in the French language of an evaluation scale for family functioning (FACES III): a tool for research and for clinical practice. Rev. Epidemiol. Santé Publique, 39, 531–541, 1991.PubMedGoogle Scholar
  45. 45.
    Morgan H.G., Hayward A.E.: Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule. Br. J. Psychiatry, 152, 367–371, 1988.PubMedCrossRefGoogle Scholar
  46. 46.
    Hamilton M.: A rating scale for depression. J. Neurol. Neurosurg. Psychiatry, 23, 56–62, 1960.PubMedCrossRefGoogle Scholar
  47. 47.
    Guelfi J.D., Dreyfus J.F., Ruschel S., Blanchard C., Pichot P.: Factorial structure of the Hamilton depression scale. Ann. Med. Psychol, 139, 199–214, 1981.Google Scholar
  48. 48.
    Liebowitz M.R.: Social phobia. Mod. Probl. Pharmacopsychiatry, 22, 141–173, 1987.PubMedGoogle Scholar
  49. 49.
    Yao S.N., Note I., Fanget F., Albuisson E., Bouvard M., Jalenques I., Cottraux J.: Social anxiety in patients with social phobia: validation of the Liebowitz social anxiety scale: the French version. Encéphale, 25, 429–435, 1999.PubMedGoogle Scholar
  50. 50.
    Sheehan D.V., Lecrubier Y., Sheehan K.H., Amorim P., Janavs J., Weiller E., Hergueta T., Baker R., Dunbar G.C.: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSMIV and ICD-10. J. Clin. Psychiatry, 59, Suppl 20, 22–33, 1998.PubMedGoogle Scholar
  51. 51.
    Endicott J., Spitzer, R.L.: A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch. Gen. Psychiatry, 35, 837–844, 1978.PubMedCrossRefGoogle Scholar
  52. 52.
    Endicott J., Spitzer R.L.: Schedule for Affective Disorders and Schizophrenia (SADS). Acta Psychiatr. Belg., 87, 361–516, 1987.PubMedGoogle Scholar
  53. 53.
    Goodman W.K., Price L.H., Rasmussen S.A., Mazure C., Fleischmann R.L., Hill C.L., Heninger G.R., Charney D.S.: The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch. Gen. Psychiatry, 46, 1006–1011, 1989.PubMedCrossRefGoogle Scholar
  54. 54.
    Goodman W.K., Price L.H., Rasmussen S.A., Mazure C., Delgado P., Heninger G.R., Charney D.S.: The Yale-Brown Obsessive Compulsive Scale. II. Validity. Arch. Gen. Psychiatry, 46, 1012–1016, 1989.CrossRefGoogle Scholar
  55. 55.
    Hantouche E.G., Lancrenon S.: Modern typology of symptoms and obsessive-compulsive syndromes: results of a large French study of 615 patients. Encéphale, 22, 9–21, 1996.PubMedGoogle Scholar
  56. 56.
    Magaña A.B., Goldstein J.M., Karno M., Miklowitz D.J., Jenkins J., Falloon I.R.: A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Res., 17, 203–212, 1986.PubMedCrossRefGoogle Scholar
  57. 57.
    Rein Z., Perdereau F., Curt F., Jeammet P., Fermanian J., Godart N.: Expressed Emotion and anorexia nervosa: the validation of the Five Minute Speech Sample in reference to the Camberwell Family Interview. Int. J. Eat. Disord., 39, 217–223, 2006.PubMedCrossRefGoogle Scholar
  58. 58.
    Wiersma D., DeJong A., Ormel J.: The Groningen Social Disabilities Schedule: development, relationship with I.C.I.D.H., and psychometric properties. Int. J. Rehabil. Res., 11, 213–224, 1988.PubMedCrossRefGoogle Scholar
  59. 59.
    Flament M.F., Godart N.T., Jeammet P., Fermanian J.: Predictive factors of social disability in patients with eating disorders. Eat. Weight Disord., 6, 99–106, 2001.PubMedGoogle Scholar
  60. 60.
    Cohalan M.: Being a therapist in eating disorder treatment trials: constraints and creativity. J. Fam. Therapy, 17, 79–96, 1995.CrossRefGoogle Scholar
  61. 61.
    Dare C., Eisler I., Cohalan M., Crowther C., Senior R., Asen, E.Y: The listening heart and the chi square: clinical and empirical perceptions in the family therapy of anorexia nervosa. J. Fam. Therapy, 17, 31–57, 1995.CrossRefGoogle Scholar

Copyright information

© Editrice Kurtis 2006

Authors and Affiliations

  • Nathalie Godart
    • 1
    • 2
  • F. Perdereau
    • 1
    • 2
  • Z. Rein
    • 1
    • 2
  • F. Curt
    • 1
  • I. Kaganski
    • 1
  • R. Lucet
    • 1
  • M. Corcos
    • 1
    • 2
  • J. Fermanian
    • 3
  • M. Flament
    • 4
  • P. Jeammet
    • 1
    • 2
  1. 1.Department of PsychiatryUniversité Paris-Descartes, Faculté de Médecine, Site Institut Mutualiste Montsouris (IMM)ParisFrance
  2. 2.Faculté de MédecineUniversité Paris-DescartesFrance
  3. 3.Department of BiostatisticsHôpital NeckerParisFrance
  4. 4.FRCPC University of OttawaCanada

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