He calls it his accidental book. James Lock, associate professor of psychiatry and behavioral sciences and co-director of the eating disorders clinic at Lucile Salter Packard Children’s Hospital, was frustrated by the number of adolescent patients who relapse after hospitalization for the eating disorder anorexia nervosa. Then he heard about a unique therapy, developed in the mid-1980s at the Maudsley Hospital in London, that requires substantial involvement from patients’ families.
“When I read about it, I was a bit incredulous,” says Lock. Traditional anorexia treatments, he explains, often have a “bias against families,” regarding them as part of the problem. The Maudsley group, however, had successfully pioneered a “family therapy” in which parents worked as a team with health professionals to treat their child.
Lock and his colleagues received a grant from the National Institutes of Health to compare the effectiveness of the family therapy at durations of six and 12 months. With 86 subjects, it is one of the largest anorexia nervosa treatment studies ever, he says. As part of the project, the researchers created a manual for therapists to implement the treatment. “I wanted to write a manual that therapists could understand and do,” Lock says.
He spent so much time structuring the manual—setting forth what happens at each therapy session, then illustrating each step with examples—that at one point, he thought, “Maybe it’s a book.” And indeed it became one. Written by Lock, Daniel le Grange, Stanford psychiatry professor W. Stewart Agras and Christopher Dare, Treatment Manual for Anorexia Nervosa: A Family-Based Approach (Guilford Press, 2001) makes the Maudsley approach accessible to therapists worldwide.
The treatment requires parents to take control of food and weight out of the hands of their adolescent and expects them to determine the best way to feed their child. Siblings, too, are encouraged to find ways to support the patient. The ultimate goal is for patients to learn to manage their own eating.
The study’s results, which Lock characterizes as “robust,” will be available in April. Some anecdotal evidence of the treatment’s efficacy is already in. “What has so firmly convinced me is the fact that so many of [the patients] thank us when they recover and tell us that they couldn’t have done it any other way,” says Wendy Spettigue, psychiatric director of the eating disorders program at the Children’s Hospital of Eastern Ontario.
Lock is now working on a book for parents, due out in a year. This one, it seems, won’t be accidental.
