1st Edition

Multifamily Therapy Group for Young Adults with Anorexia Nervosa Reconnecting for Recovery

    324 Pages 24 B/W Illustrations
    by Routledge

    324 Pages 24 B/W Illustrations
    by Routledge

    Multifamily Therapy Group for Young Adults with Anorexia Nervosa describes a new and innovative family-centered outpatient Multifamily Therapy Group (MFTG) approach called Reconnecting for Recovery (R4R) for young adults with anorexia nervosa that is based on a relational reframing of eating disorders.

    Developed in concert with young adults and their families and informed by clinical observations, theory, and research, R4R is designed to help young adults and family members learn the emotional and relational skills required to avoid or repair relationship ruptures for continued collaboration in recovery. The book begins with an overview of anorexia nervosa, MFTG treatment approaches, and the development of R4R and moves into a session by session review of R4R including session goals, exercises and handouts. Protocols, case vignettes, and other materials help translate the theory and research underlying this multifamily therapy group model into practice.

    This treatment manual provides readers with explicit guidance in how to develop and conduct an outpatient R4R MFTG and a deeper understanding of the nature, purposes, and processes that characterize one.

    Chapter 1: Reconnecting for Recovery (R4R): A Relational/Motivational Multifamily Therapy Group for Young Adults with Anorexia Nervosa (Tantillo, McGraw, & Le Grange)

    Chapter 2: The Promise of Multifamily Therapy Group for Young Adults with Anorexia Nervosa

    Chapter 3: Development of the Reconnecting for Recovery (R4R) MFTG approach and this Manual

    Chapter 4: Getting Ready: Group Structure, Co-Facilitation, Recruitment, and Initial Phone Screening

    Chapter 5: Session 1: Engaging and Evaluating Young Adults with Anorexia Nervosa and Their Families: Assessment, Joining and Orientation

    Chapter 6: Session 2: Engaging and Evaluating Young Adults with Anorexia Nervosa and Their Families: Assessment, Joining and Orientation (continued)

    Chapter 7: Session 3: Anorexia Nervosa: A Disease of Disconnection - Introduction, recovery process, motivational interviewing principles, and the spiral of change

    Chapter 8: Session 4: Anorexia Nervosa: A Disease of Disconnection - Introduction, recovery process, motivational interviewing principles, and the spiral of change (continued)

    Chapter 9: Session 5: Biopsychosocial Factors for Anorexia Nervosa & Co-morbidity

    Chapter 10: Session 6: Biopsychosocial Factors (continued), Disconnection and Functional Analysis Skills

    Chapter 11: Session 7: Strategies to Promote Mutual Connections

    Chapter 12: Session 8: Anorexia Nervosa and the Family Context: Rules and Relationships

    Chapter 13: Session 9: Identifying Points of Tension and Disconnections Related to Anorexia Nervosa, Recovery and Relationships

    Chapter 14: Session 10: Nourishing and Empowering the "We" in Relationships

    Chapter 15: Session 11: Waging Good Conflict in Connection

    Chapter 16: Session 12: Moving from Disconnection to Connection: Building Strong Connections to Work through Tension and Disconnections Related to Adulthood and Recovery

    Chapter 17: Session 13: Relapse Prevention and Maintaining Good Connection

    Chapter 18: Session 14: Relapse Prevention (Continued) and Preparing for Termination

    Chapter 19: Session 15: Relapse Prevention (Continued), Termination, and Next Steps for Continued Connections in Recovery

    Chapter 20: Session 16: Relapse Prevention (Continued), Termination, and Next Steps for Continued Connections in Recovery

    Chapter 21: What is Next? Training, Dissemination, Clinical Practice and Research


    Mary Tantillo, PhD, PMHCNS-BC, CGP, FAED, is professor of clinical nursing at University of Rochester School of Nursing, director of the Western New York Comprehensive Care Center for Eating Disorders, and founder of The Healing Connection Inc.

    Jennifer Sanftner McGraw, PhD, is professor of psychology and department chair at Slippery Rock University and founder and director of the Slippery Rock chapter of the Reflections Body Image Program.

    Daniel Le Grange, PhD, holds a distinguished professorship in the department of psychiatry at the University of California, San Francisco and is director of the eating disorders program in the Division of Child and Adolescent Psychiatry.

    Santo Caruana, Artist and young adult in recovery from an eating disorder.

    Marie Bieber RD, CSP, CDN, Registered dietitian specializing in eating disorders in private practice and on the Western New York Comprehensive Care Center for Eating Disorders Project ECHO TM team.

    "R-4-R is a wonderful book. Written by renowned experts it oozes compassion, hope, humanity, humour and lashings of clinical wisdom whilst at the same time being scholarly and grounded in the latest evidence.  Its approach to multi-family treatment of anorexia nervosa views this illness through a theoretically informed relational lens as a disorder of intra- and interpersonal disconnection and uses education and skills building to repair these relationship ruptures and facilitate growth of the individual and the people close to them. The case stories and therapeutic dialogue are detailed and realistic: individual characters leap off the page and their struggles and dilemmas always ring true. I learnt so much from this book. An absolute gem. This is a must-read for any clinician working with people with anorexia nervosa and their families."

    Ulrike Schmidt, MD, PhD, FRCPsych, FAED, professor of Eating Disorders, King's College London and consultant psychiatrist, Maudsley Hospital. National Institute of Health Research senior investigator

    "Congratulations to Tantillo, McGraw and Le Grange for this exceptional, must read book for providers of young adults with Anorexia Nervosa and their caregivers.  R4R MFTG consists of 16-sessions grounded in well known theoretical frameworks, particularly Relational-Cultural theory.   In each chapter, the authors provide a step-by-step guide of the structure and processes of delivering R4R MFTG in a variety of different contexts. Through detailed examples, analogies, metaphors, and handouts, providers will be well prepared to deliver this intervention to young adults with AN and their families.  This book not only acknowledges the intense emotions experienced by the young adult with AN, but also the tumultuous emotions experienced by caregivers.  The authors empower providers to use an optimistic healing and recovery approach that supports all involved in battling against the Anorexia Nervosa. By honouring and giving a voice to the experiences of young adults with AN and their families, those impacted by AN will become more powerful and resilient than the eating disorder."

    Gina Dimitropoulos, MSW, PhD, associate professor of Social Work, University of Calgary and research lead for the Calgary Eating Disorder Program


    "A beautifully written, innovative tour de force, a good read, and an inspiring contribution based on a multi-family therapy group approach to the complex, challenge of treating anorexia nervosa. The authors provide an elegant description of the biopsychosocial nature and associated treatment of anorexia nervosa developed in concert with the participating young adults and their families. From the biology of anorexia nervosa to problems with emotion, and internal and external disconnection, the authors provide unusual insight into human function and dysfunction. We can all benefit from their empathy and their wisdom. While termed a manual, this book is much more. Grounded in theory, it adds a relational/family lens to effective individual approaches, reports the evidence supporting this multi-family therapy group method, AND it provides an eminently practical manual describing the treatment in detail. Multifamily Therapy Group for Young Adults with Anorexia Nervosa is a MUST read for any therapist working with young adults, as it provides invaluable insight into the importance of families as crucibles for the development of self, identity, and a meaningful life. Tantillo, McGraw and Le Grange show us how to take a group of struggling families and create a community that supports young adults’ recovery from anorexia nervosa and associated suffering. This approach, Reconnecting for Recovery, is simply brilliant!"


    Susan H McDaniel, PhD, ABPP, Dr Laurie Sands distinguished professor of Families & Health, vice chair, Department of Family Medicine, University of Rochester Medical Center


    "I am delighted to provide an endorsement for this much needed treatment manual. Whilst carers of children and adolescents are now routinely included in their loved ones’ treatment programmes, I regularly meet carers of young adults who despair that they are being excluded because their child has reached a magical age of 18. This manual will fill a huge void and empower eating disorder specialist teams around the world to offer a programme to families of young people aged between 18 and 40, in a multifamily group setting. This model draws on the well-researched motivational Interviewing principles and stages of change theory and then goes a step further to include Relational-Cultural Theory, which asserts that AN is characterized by a number of internal and interpersonal disconnections that can obstruct collaborative caregiving and recovery. Participants are guided to explore in detail all aspects of internal and interpersonal disconnection that can be caused by anorexia nervosa. Acknowledging and discussing these in the group setting then empowers the family to work as a team to rebuild connections, potentially to avoid further disconnections, and disempower the eating disorder. In turn the young adult can then mature and grow in a healthy, happy and age appropriate manner. The manual guides the therapy team through a clearly set out programme of 16 sessions, with an array of useful handouts and clinical vignettes, whilst also allowing the therapists to pace with the needs of the participants of their multifamily group."

    Jenny Langley, Author of The New Maudsley Training Manual, Boys Get Anorexia Too and New Maudsley Carer Skills Workshop facilitator and trainer 


    "This ground-breaking book completely reverses once-standard negative and judgmental dogma about families and eating disorders. Dr. Tantillo and her colleagues present brilliant insights into the inherent need for affected families to move from the inter- and intra-personnel disconnections caused by an eating disorder toward creating, repairing or strengthening connections at various levels. Clearly detailed are the "how-to-steps" for families to forge powerful healing connections. By actively addressing the misunderstanding, shame, blame and guilt that often separate individuals in a family into units of 'I' or 'You' when the disorder is active, multi-family group therapy facilitates movement toward a collective 'WE'in recovery. Moreover, multi-family therapy groups allows mutual support and practical advice to be shared across affected family units."

    Richard E. Kreipe, MD, FAAP, FSAHM, FAED, professor emeritus, Division of Adolescent Medicine, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center


    "This is an important contribution to the field of eating disorders written by well respected, experienced clinicians in the field. This treatment manual covers the Relational/Motivational multifamily therapy group approach for young adults with anorexia nervosa developed from clinical experience and in collaboration with families. This book gives excellent insight into the challenging fields of adolescent and young adult mental health, and will provide useful guidance for clinicians, researchers, students and trainees. Involving families in the treatment is hugely important in our field and the practical aspects of knowing how to do so will help colleagues implement this important work in their clinical services."

    Kate Tchanturia, PhD, FAED, FBPS, FHEA, consultant clinical psychologist, Eating Disorders, professor of Psychological Medicine, King’s College London


    "Reconnecting for Recovery (R4R) is a user-friendly manual that helps clinicians learn a multi-family approach for the treatment of young adults with anorexia nervosa. The treatment is unique and well matched to the needs of individuals with anorexia nervosa whose illness often leads to isolation from family, friends, and school or professional life. The authors offer a model of eating disorders as illnesses characterized by internal and social disconnections, and a set of strategies that help affected families work together to help their loved ones achieve recovery. Tantillo and her team of authors have brought together impressive clinical expertise, recommendations from stakeholders, and the evidence base relevant to family-based treatment to provide a practical book chock-full of skill-building exercises for families."

    Evelyn Attia, MD, professor of Psychiatry, Columbia University Irving Medical Center; director, Center for Eating Disorders, New York-Presbyterian Hospital


    "Tantillo, Sanftner and Le Grange coherently provide clinicians with a rationale and method to comprehensively take a multifamily therapy group framework and feature a motivational and relational approach for young adults with anorexia nervosa, Reconnecting for Recovery (R4R). The authors step into a complex illness with a well-structured treatment that brings severed facets of the illness together by reconnecting multiple dimensions to move recovery forward. The manual is practical and easy to follow. It takes what is hard to do therapeutically and makes it doable."

    Laura Hill, PhD, International Eating Disorder Consultant