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.
Similar content being viewed by others
References
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.
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.
Jeammet P.: The anorexic stance. J. Adolesc., 4, 113–129, 1981.
Jeammet P.: From a fear of getting fat to a desire of becoming thin. J. Adolesc. Health, 13, 398–400, 1992.
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.
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.
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.
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.
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.
Selvini-Pazzoli M.: Self starvation from the intrapsychic to the transpersonal approach. London, Chaucer, 174.
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.
Stierlin H., Weber G.: Unlocking the family door: a systemic approach to the understanding and treatment of anorexia nervosa. New York, Brunner/Mazel, 1989.
Lock J., Le Grange D.: Family-based treatment of eating disorders. Int. J. Eat. Disord., 37, Suppl., S64–S67, 2005.
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.
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.
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.
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.
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.
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.
Fairburn C.G.: Evidence-based treatment of anorexia nervosa. Int. J. Eat. Disord., 37, Suppl, S26–S30, 2005.
Kaganski I., Rémy B.: Aspects familiaux, cliniques et thérapeutiques des troubles des conduites alimentaires. Confrontations Psychiatriques, 31, 1989.
Kaganski I.: La marmite familiale. Enfances et Psy, 8, 127–134, 1999.
Kaganski I., Lucet R.: Les larmes et le ventre. Revue Neuropsychiatrie de l’Enfance et de l’Adolescence, 47, 95–99, 1999.
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.
Kaganski I., Lucet R.: Guérir les souffrances familiales In: Angel P., Mazet P. (Eds.), PUF Ed, 2004.
Kaganski I.: La place de la nourriture dans les relations familiales. Enfances et Psy, 27, 45–52, 2005.
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.
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, 1989
Beck A.T., Beamesderfer A.: Assessment of Depression: The Depression Inventory. Mod. Probl. Pharmacopsychiatry, 7, 151–159, 1974.
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.
Blatt S.J., Zuroff D.: Psychometric properties of the depressive experiences questionnaire. J. Pers. Assess., 55, 65–72, 1990.
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.
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.
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.
Weissman M.M., Bothwell S.: Assessment of social adjustment by patient self-report. Arch. Gen. Psychiatry, 33, 1111–1115, 1976.
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.
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.
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.
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.
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.
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.
Parker G., Tupling H., Browm L.B.: A parental bonding instrument. Br. J. Med. Psychol., 52, 1–10, 1979.
Olson D.H., Portner J., Lavee Y.: FACES III. St. Paul, Minnesota, Family Social Science, University of Minnesota, 1985.
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.
Morgan H.G., Hayward A.E.: Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule. Br. J. Psychiatry, 152, 367–371, 1988.
Hamilton M.: A rating scale for depression. J. Neurol. Neurosurg. Psychiatry, 23, 56–62, 1960.
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.
Liebowitz M.R.: Social phobia. Mod. Probl. Pharmacopsychiatry, 22, 141–173, 1987.
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.
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.
Endicott J., Spitzer, R.L.: A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch. Gen. Psychiatry, 35, 837–844, 1978.
Endicott J., Spitzer R.L.: Schedule for Affective Disorders and Schizophrenia (SADS). Acta Psychiatr. Belg., 87, 361–516, 1987.
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.
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.
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.
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.
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.
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.
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.
Cohalan M.: Being a therapist in eating disorder treatment trials: constraints and creativity. J. Fam. Therapy, 17, 79–96, 1995.
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
These authors contributed equally to the paper.
Rights and permissions
About this article
Cite this article
Godart, N., Perdereau, F., Rein, Z. et al. Resolving a disagreement in a clinical team: Overcoming conflicting views about the role of family therapy in an outpatient treatment programme for anorexia nervosa. Eat Weight Disord 11, 185–194 (2006). https://doi.org/10.1007/BF03327570
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03327570