Several people whom I respect have asked me to do something I find hard: stop calling what we do at Kartini Clinic “Family based Treatment”. That term, they aver, should be reserved for “certified” Maudlsey practitioners.
This gripes me on two accounts:
Firstly, we have been calling what we do “family-based treatment” since at least 2000. When I left my practice of general pediatrics to begin seeing only children with all conditions of disordered eating, I was influenced by several observations I had made of pediatrics and (especially)adolescent medicine as they were then practiced (1985-1998).
One consistent observation was that parents were cut out of treatment, by design. To an extent this was peculiar to eating disorder treatment and reflected the widely held belief that there were “anorexogenic” families who caused their child’s disorder in the first place. To a certain extent, however, it reflected a much more pervasive belief by doctors that they were owners of all wisdom and parents were people who were seeking such wisdom. Pediatricians dispensed parenting advice along with immunizations and antibiotics even when such advice reflected their own personal beliefs and was at complete variance with the cultural and/or religious beliefs of the families they were seeing. Doctors encouraged parents to instruct their children tell them (the doctor) things they would not tell their own parents.
OK, sometimes teenagers will tell a doctor or therapist what they won’t tell their parents, but it seemed like a shaky basis for routine communication to me. In the end, the real advocates for any child are (or should be) that child’s parents, not their physician. When your doctor is the strongest advocate you have as a child, you have a sad childhood; it’s not a good sign. I resolved to involve the parents in their child’s treatment from the start of Kartini Clinic, and we still do. Even young adults must sign a release prior to engaging in treatment, one which allows us to share psychological and medical information with their parents.
I visited Stanford University in the late 1990’s—early in designing my program—because I grew up around Stanford and because several of my most admired physician colleagues worked there. I have written elsewhere about the debt of gratitude I owe Stanford Adolescent Medicine for their advocacy and generosity in sharing ideas. At that time Stanford relied heavily on their very talented and involved nutritionist/dietician to guide re-feeding.
But I wanted to try something else.
I disliked talking to a colleague about a patient who, in response to my questions about the caloric level, answered “I don’t know. The dietician does that.” I wanted a different level of accountability for me and any doctors who worked with me. I felt that the doctors should primarily set the weight and physical restoration goals while the family therapist helps the family and child to achieve them. From day one our parents were entirely in charge of food at home. The job of the family therapist at Kartini Clinic—then as now—was not primarily to “fix a dysfunctional family” (since most of our families are very functional) but rather to take the meal plan/treatment plan and help to make it work for a particular child in her/his particular family. We have always felt that parental unity with team was the most important prognosticator of good outcome. As we have told anyone who will listen: at Kartini Clinic we treat patients in the knowledge that families do not cause eating disorders and children do not choose to have them.
So we called our treatment method “family-based treatment.”
Secondly, the concept of “certifying” Maudsley therapists bothers me. I don’t care how many studies have been done proving that “Maudsley”, as proposed by Lock and Legrange can be an effective approach; all that means is that conscientious practitioners must be aware of such data and information/experience and learn from it. I think there is altogether too much “certifying” and “re-certifying” in medicine and psychology and to a certain extent it is a self-perpetuating racket: endless club membership dues which support a superstructure of administration that does not add to a more perfect understanding of the illnesses involved. There. I’ve said it.
However, I began this blog by saying that the people who request that I no longer use the term “FBT” for what we do are people I respect. So I am trying to listen. I do think it is easier to have meaningful conversations when we are able consistently to define our terms. So I think that from now on we will begin to refer to what we do as the Kartini Method. Unimaginative, but probably accurate—unless any of you have a better idea?
