Caring for a Loved One with an Eating Disorder

The New Maudsley Skills-Based Training Manual

Jenny Langley, Janet Treasure, Gill Todd

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781351232579
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Caring for a Loved One with an Eating Disorder: The New Maudsley Skills-Based Training Manual provides a framework for carer skills workshops which can be used by anyone working with these conditions.

Based on the successful New Maudsley Model, which equips carers with the knowledge and skills needed to support those with an eating disorder, the book consists of two sections which will help facilitators to deliver skills workshops to carers. The first section provides the theoretical background, while the second uses exercises to bring the New Maudsley Model to life. The skills workshops provide a much-needed lifeline, giving carers an opportunity to meet in a safe, non-judgemental and confidential environment, and to learn to recognise that changes in their own responses can be highly beneficial.

With session-by-session guidelines and handouts for participants, Caring for a Loved One with an Eating Disorder: The New Maudsley Skills-Based Training Manual will be of aid to anyone working with someone coping with these conditions.

Section Two

Introduction

This section contains suggested exercises that facilitators can use within the group workshop setting, and which also could be used with families or individuals interested in learning the caring skills. Each module follows on from the previous one, starting with psychoeducation and then introducing the animal metaphors, the Transtheoretical Model of Change, motivational language and a five-step approach to planning for change. Finally, the exercises focus on contingency planning for difficult life events and looking forward and moving on.

To cover all of the suggested exercises, a series of workshops would require between 15 and 20 hours and an example based on a series of five 3-hour workshops amounting to 15 hours is set out below. It is always useful to offer follow-up practice sessions so that carers have the opportunity to revisit the model and practise their skills as their loved ones proceed on their recovery journey. Downloadable worksheets are available from (www.thenewmaudsleyapproach.co.uk). Using the worksheets facilitators can create their own workbooks tailored to their specific audience.

Several of the modules can be used as standalone ‘topical’ workshops and the exercises and skills can also be used in a support group setting to help carers to work through scenarios and problems that are raised.

Within each module there is a selection of suggested exercises and each exercise has a facilitator crib sheet containing useful background information. The carer tasks are highlighted in grey boxes and for many exercises we have included ‘virtual carer responses’ that are based on examples of carer responses from previous workshops. Scenarios are often included to illustrate the application of the skills. Learning points are summarised at the end of each exercise.

This model is designed to be flexible. As facilitators become more experienced, it is likely that they will start to create their own versions and adaptations of the exercises set out in this manual. It is imperative that carers are invited to bring their own scenarios to the workshops so that the learning is truly experiential.

Example of a series of workshops constituting 15 hours and delivered in five 3-hour sessions

Workshop 1 – duration 3 hours

Aims:

•To develop a greater understanding of eating disorder behaviours and to be fully aware of medical risk.

•To understand the importance of caring for yourself.

•To understand things that can maintain the eating disorder.

•To increase empathy with the eating disorder.

•To learn to externalise the eating disorder.

•To consider natural carer responses to the eating disorder – the animal metaphors.

•To start to think about the possibility of making small changes to caring behaviours.

This session covers much of the material in the first six chapters of the Skills-based Caring book.

Suggested exercises taken from Modules 1, 2, 3 and 6 of the Training Manual:

1.1Welcoming the carers

1.2Introductions

1.3Agreeing ground rules for the group

1.4Emotional response to caregiving

1.5The Readiness Ruler

1.6Working with a joint understanding – basic facts and recovery

2.1Considering causes and maintaining factors

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

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

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

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

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

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

2.8Building empathy for the sufferer – popping the balloon

2.9Externalising the illness, part three: visual exercise

3.1Exploring the animal metaphors

3.2Which ‘animals’ does Edi interact with at home and outside the home?

3.3Considering how Edi responds to the animals

3.4Creating productive partnerships

6.5Going to A&E in an emergency – including medical risk assessment

Note: it is unlikely that there will be time to do all the animal metaphor exercises and so it is useful to have a group discussion around the pros and possible cons of each animal response and then set the exercises as homework.

In a shorter session the facilitator might just choose a couple of exercises from Module 2. For example, 2.5 and 2.7 are very visual and memorable.

Exercise 6.5 is included here to highlight the fact that carers should be alerted to the importance of being aware of medical risk at an early stage. Specifically carers should be signposted to the key messages around medical risk in Module 6, Worksheet 6.5.

Workshop 2 – duration 3 hours

Aims:

•To understand the Stages of Change Model.

•To introduce the principles of LESS is more, OARS, ALVS and DEARS.

•To practise communicating using OARS (open questions, affirmations and green shoots, reflections and summary).

•Using MI when Edi is in pre-contemplation and contemplation.

This session covers much of the material in Chapters 7–11 of the Skills-based Caring book.

Suggested exercises taken from Modules 4 and 5 of the Training Manual:

4.1Stages of Change Model

4.2Decisional balance

4.3Readiness Ruler and DARN-C

4.4OARS (including LESS is more)

4.5Advice giving

5.1Emotional intelligence

5.2Emotion-focused relationships using attend, label, validate, soothe (ALVS)

5.3The reassurance trap and rolling with resistance

5.4Five key principles: DEARS, developing discrepancy, expressing empathy, amplifying ambivalence, rolling with resistance, supporting self-efficacy

5.5Ambivalence: empowering carers when Edi is in pre-contemplation or facing a lapse when in recovery

5.6Hopelessness: empowering carers when Edi feels it is all too much and may be expressing suicidal ideation

Note: this session is really powerful and carers go away armed with a new language as well as an understanding that they cannot rush the recovery process. Also, that they can use these M...

Table of contents

• Cover
• Endorsement
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• Section One
• Section Two
• Index