Table of Contents

Contents

Preface

Section One

Chapter 1 Introduction and background to skills-based caring

Chapter 2 Practical issues for running the workshops

Chapter 3 Facilitator delivery style, values and spirit

Chapter 4 Facilitator guide to Motivational Interviewing and emotional processing

Section Two

Introduction

Module 1 - Starting off and setting the scene for recovery

1.1. Welcoming the carers

1.2 Introductions

1.3 Agreeing ground rules for the group

1.4 Emotional response to caregiving

1.5 The Readiness Ruler

1.6 Working with a joint understanding – basic facts and recovery

Module 2 - Psychoeducation and developing empathy

2.1 Considering causes and maintaining factors

2.2 Considering ambivalence with a focus on the benefits of an ED

2.3 Understanding the trap of an eating disorder: the toxic effect of prolonged starvation and repeated habits

2.4 Building empathy for the challenges of weight restoration – the metabolism effect

2.5 Building empathy for the sufferer – coping strategies and the crap day exercise

2.6 Externalising the illness, part one: how have Edi’s personality traits changed through ED?

2.7 Externalising the illness, part two: introducing the red balloon/ blue balloon metaphor

2.8 Building empathy for the sufferer – popping the balloon

2.9 Externalising the illness part three: visual exercise

Module Three – How the Eating Disorder Impacts on Interpersonal Relationships

3.1 Exploring the Animal Metaphors

3.2 Which 'Animals' Does Edi Interact with at Home and Outside the Home?

3.3 Considering How Edi Responds to the Animals

3.4 Creating a Productive Partnership

Module Four – The Cycle of Change and Introduction to Communication Skills

4.1 Stages of Change Model

4.2 Decisional Balance

4.3 Readiness Ruler and DARN-C

4.4 OARS (including LESS is More)

4.5 Advice giving

Module Five – Advanced Communication Skills

5.1 Emotional Intelligence

5.2 Emotion-Focused relationships using Attend, Label, Validate, Soothe (ALVS)

5.3 The Reassurance Trap and Rolling with Resistance

5.4 Five Key Principles: DEARS, Developing Discrepancy, Expressing Empathy, Amplifying Ambivalence, Rolling with Resistance, Supporting Self-efficacy

5.5 Ambivalence Empowering Carers When Edi is in Pre-Contemplation or Facing a Lapse When in Recovery

5.6 Hopelessness: Empowering Carers When Edi Feels it is All Too Much and May be Expressing Suicidal Ideation

Module Six – Working as a Herd of Elephants – Collaboration Between All Carers

6.1 Making the Most of Family and Friends network

6.2 Partners, Single Parents and the Exhausted, Isolated Carer

6.3 Siblings and Peers

6.4 Making the Most of the GP Appointment

6.5 Going to A&E in an Emergency – including Medical Risk Assessment

6.6 Collaborating with School/ Work/ University

6.7 Building Empathy with the Care Team – the Changing Places Task

6.8 Encouraging Collaborative Care Using Motivational Language with the Care Team

6.9 Letter-writing to Repair Ruptured Relationships

Module Seven – Exercises for Carers to Plan for Change

7.1a Simple Reflection Exercises

7.1b Carers Reflecting on the Impact of ED on their Everyday Lives and Role-Modelling Self Care using SMART Baby Steps.

7.2 A Five-Step Approach to Planning for Change, Incorporating using a Spider diagram and Planning SMART Baby Steps

7.3 Completing the Accommodation and Enabling Scale for Eating Disorders

7.4 Accommodating Scenario – Using OARS and the ABC Model

7.5 Enabling Scenario – Using the ABC Model to Create a Menu of Options

7.6 Carers Managing Their Own Emotional Responses

7.7 Considering the Concept of Reasonable Risk

7.8 Coping Strategies for Carers – Maintaining a Heathy Balance

Module Eight - Coaching Edi to Make Their Own Changes

8.1 A Five-Step Approach to Plan for Behaviour Changes

8.2 Using the ABC model to Understand a Behaviour and Consider a Menu of Options

8.3 Using DARN-C to Elicit Change Talk

8.4 SMART Planning for Behaviour Change

8.5 When the Carers Face Unexpected Resistance

8.6 When the Carers Face Chronic and Unrelenting Resistance

Module Nine – Reclaiming Core Family Values and House Rules and Boundaries

9.1 Reclaiming Normal Core Family Values

9.2 Considering house rules and boundaries that are non-negotiable.

9.3 Talking is a Good Consequence

9.4 Core Values and Boundaries – Adult Sufferers

Module Ten – Managing Undereating, Re-Feeding and Overeating

10.1 Eating is Non-Negotiable for Everyone

10.2 Carers Understanding that Re-feeding is a Huge Task

10.3 The Key Steps to Restoring Regular Eating Patterns

10.4 The Nutritional Risk Ruler

10.5 The Nutritional Risk Ruler – When Medical Risk is Very High

10.6 Talking About Gaining Weight

10.7 Communication around Mealtimes – Calm and Warm

10.8 Meal Support

10.9 Communication and Coaching for Rigid Rules and Compensatory Behaviours Including Overeating and Purging

10.10 Refusal to Eat with the Family – Using the ABC Model to Create a Menu of Options

Module Eleven – Managing Longer-Term Difficult Behaviours and Stumbling Blocks

11.1 Tolerance of a Healthy Weight

11.2 Body Image Issues

11.3 Self-Harm

Module Twelve – Relapse, Contingency Planning And Moving on

12.1 Timeline Example for Edi

12.2 Forward Planning for Difficult Life Events, the Carer Perspective

12.3 Ups and Downs of Recovery

12.4 Looking Forward and Stepping Back

Index

About the Author

Jenny Langley is an experienced carer, trained by Gill Todd RMN, MSc to deliver the New Maudsley Carer Skills workshops in the community. She was awarded the Royal College of Psychiatrists Carer Contributor of the Year in 2016.

Gill Todd was Clinical Nurse Leader for Eating Disorders at the Bethlem and Maudsley NHS Foundation Trust. Now retired from the NHS, she runs carers' skills workshops and trains facilitators to run the workshops.

Janet Treasure is a leading figure in the field of eating disorders. She is a psychiatrist at South London and Maudsley Hospital, and is an international expert with extensive academic and clinical experience.

Reviews

"Caring for someone with an eating disorder is, without a doubt, a critical part in support of the recovery of the sufferer. Therefore, guiding and taking care of the carer have taken front-row seats in this process. The authors are leading authorities in this domain and Caring for a Loved One with an Eating Disorder, based on their The New Maudsley Model, is a very helpful session-by-session guide to participants and facilitators of skills workshops in order to train, equip, and support carers in their difficult task. This book is not only an outstanding go-to guide for carers and those who support carers, but it also will provide much-needed information to all clinicians who wish to better understand and support families and friends who are taking care of a loved one with an eating disorder." - Daniel Le Grange, Ph.D., FAED, Benioff UCSF Professor in Children's Health, Director, Eating Disorders Program, Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, San Francisco, Emeritus Professor of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL."Recognition of the importance of bringing carers and loved ones into treatment and attending to the burden on close family members has transformed the care of people with eating disorders across the age range and across the stages of the illness. This manual, born of years of personal and clinical experience of working with adults with eating disorders and substantiated by research, is an accessible guide for facilitators keen to put this knowledge into action through support of parents and carers based on the highly acclaimed Skills Based Caring for a Loved one with an Eating Disorder (The New Maudsley Method). Bursting with practical and creative ideas, peppered with top tips to help negotiate the challenging emotional nature of the work, and all underpinned by theory and research evidence in an easy to understand form, it provides a step by step yet flexible guide and toolkit for practitioners in delivering skills workshops for carers." - Dr Dasha Nicholls, Reader in Child Psychiatry, Imperial College London Chair, Eating Disorders Faculty, Royal College of Psychiatrists"The New Maudsley Model of sharing skills with carers has the potential to transform services and improve clinical outcomes. Building on the self help book, this is a brilliantly concise guide to delivering carer skills workshops, with session by session facilitator crib sheets, exercises and worksheets. More than anything, it’s the collaborative, empathic & non-judgemental style of delivery and interaction that matters - and it is this style that is described and attended to invaluably throughout the book. Helpful to all of us in our day to day work with carers." - Dr Frances Connan, PhD, Consultant Psychiatrist and Clinical Director for Vincent Square Eating Disorder Service"This ground-breaking book fills an important gap by providing a step by step guide for initiating and facilitating a skills workshop for caregivers of people of all ages living with eating disorders. With compassion, warmth, straightforward & non-blaming language, this must-read book provides both professional and non-professional carers with theories, practical strategies and hands on exercises to enhance communication and promote relational change. It brings hope about the possibility of transformation for all affected by eating disorders."- Gina Dimitropoulos, MSW, PhD, RSW, RMFT, social worker, family therapist and professional carer, University of Calgary"This is a book that the field has desperately needed—a clear yet comprehensive guide to navigating an area too often relegated to being overwhelming in its complexity. With the key element of empowering carers, championed by Langley and her co-authors, it provides a set of tools that professionals, carers, and sufferers may all use to steer and enhance recovery—concrete steps and worksheet-guided exercises, backed by research and theory, and delivered with understanding and compassion. Highly recommended." - Dr Joanne Dolhanty, PhD, CPsych, Developer of Emotion Focused Skills Training for Parents & Families."The New Maudsley Skills-Based Training Manual is THE game changer for carers, clinicians and multi-family group leaders. The modules truly bring The New Maudsley Approach to life and I can’t wait for our team to try out all the new exercises in our multi-family program." - Roxanne Rockwell, PhD. Licensed Clinical Psychologist, Assistant Clinical Professor and Director of Adolescent Eating Disorder Services at the University of California, San Diego. "Caring for a Loved One with an Eating Disorder: The New Maudsley Skills-Based Training Manual is the new and exciting companion to Skills-based Learning for caring for a loved one with an Eating Disorders. It is exactly what you need if you are training and supporting carers of sufferers with eating disorders. Based on research and the unique expertise of Janet Treasure, Jenny Langley and Gillian Todd this manual provides ideas and exercises that are user-friendly and invaluable." - Dr Nadia Micali MD, MRCPsych, PhD, FAED, Senior Lecturer and Honorary Consultant Psychiatrist, Eating disorders and Adolescent Mental Health (ED&AMH) research team , Child and Adolescent Mental Health, Palliative Care and Paediatrics Section, Population, Policy and Practice Research Theme, UCL Institute of Child Health"In this book, Janet, Jenny and Gill gather many years of experience working with carers in workshops and other settings and bring a comprehensive theoretical and experiential background based on the New Maudsley Model for professional and non-professional carers to effectively support someone with an eating disorder in their path to recovery. Through the contents of each chapter of the book, carers will be able to acquire theoretical and practical abilities from a unique approach that includes skills from the transtheoretical model of change, motivational enhancement therapy, cognitive behavioural therapy and emotional processing techniques to help their loved one to be able to overcome this illness and deal with the setbacks. Caring for a Loved One with an Eating Disorder: The New Maudsley Skills Based Training Manual is a "must have" for anyone who is part of the "care team": it is a step-by-step guide to implement carer workshops and also a treasure of useful tools that gently leads carers to transform their caregiving experience into the main healing resource to support their sufferers and make their change possible." - Carolina López, PhD, Clinical Psychologist, Assistant Professor of the Department of Pediatrics and Child Surgery, East Division, Faculty of Medicine, University of Chile. "We have successfully used and tested the "New Maudsley Model" in a German-speaking Austrian population with anorexia nervosa including the Succeed DVD.
This new manual will extremely foster a quick dissemination of this successful treatment model to all supporting carers in need, giving them step-by-step advice how to care best. Warmly recommended!" - Prof Andreas Karwautz, MD, Vienna, Austria"When faced with the often frightening and daunting task of caring for a loved one with an eating disorder, there is no better resource than this which explains how to help others to do so in such a clear and thoughtful way. The authors outline how to set up workshops which share information and professional skills with carers, provide practical solutions to challenges based on their extensive experience of delivering these workshops and offer a thorough template for a series of workshops which have in the past received excellent feedback from carers in attendance. I shall be drawing on this resource in my own practice." - Dr Amy Harrison, Family Therapist, South London and Maudsley NHS Trust Eating Disorder Service