266 Treating Eating Disorders
et al., 1997). A further study showed that family therapy was more effective
than individual therapy for severely ill patients, a third of whom had been
ill for 10 years or more and who had an average age of 26 at assessment
(Dare and Eisler, 1995). In addition, family therapy has also been shown
to be more effective than routine nonspecific care for adult anorexics
(Dare et al., 2001) and for adolescents when compared to supportive psy-
chotherapy (le Grange et al., 2007). The evidence for the effectiveness of
family therapy is, however, contradictory. For example, one study indicated
that family therapy was not as effective as family counseling (reported in
Dare and Eisler, 1995). Similarly, Tierney and Wyatt (2005) carried out a
systematic review of interventions for adolescents with AN, most of which
used some form of family-related approach. They concluded that clear con-
clusions could not be drawn as to the effectiveness of family approaches
to treating AN due to small sample sizes. Lock et al. (2006) explored the
predictors of both dropout and remission following family therapy (either
short or long term) in an adolescent sample. The results showed that dropout
rates were highest in those assigned to long-term therapy and in those with
other comorbid psychiatric problems. Further, remission, defined as a body
weight of greater than 95 percent and an improvement on eating disorder
symptoms, was related to being younger, having fewer family problems, and
the absence of psychiatric comorbidity. Pereira, Lock, and Oggins (2006) also
explored predictors of successful outcomes following family therapy and
reported a central role for a strong therapeutic alliance. In particular, a strong
alliance with the adolescents predicted early weight gain and a strong alliance
with parents prevented dropout. Family therapy has therefore been shown to
be effective for young and older patients with both anorexia and bulimia.
The evidence for this, however, is not robust and is sometimes contradictory.
Problems with family therapy for eating disordersThe potential problems with family therapy are as follows:
- A referral for family therapy can be understood as a diagnosis which
blames the family for the problem. Both patients and their families can
be reluctant to accept such an approach. - Patients may see the problem as their own, not the family’s. They may
see no need for their family to be involved in treatment. - Parents are often keen to help in whatever way they can but may fear
that the therapy will find them culpable.