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Exploring the Effects of a Family Admissions Program for Adolescents with
Anorexia Nervosa
Keren Fink
BPsych (Hons1)
A thesis submitted in fulfilment of the requirements for the degree Doctor of Clinical
Psychology/Master of Science (DCP/MSc)
School of Psychology
Faculty of Science
The University of Sydney
Sydney, New South Wales, Australia
2015
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Acknowledgements
First, I would like to thank all of the families and adolescents who participated in the
research. Thank you for so generously sharing your stories and experiences with me.
To my primary supervisor, Associate Professor Paul Rhodes, thank you for your
never ending support and guidance during the past three years. Your ongoing
mentorship, knowledge and patience have been invaluable. You have encouraged me
to challenge and push myself as both a researcher and clinician. I will be forever
grateful for all that you have taught me.
I also want to extend my deepest gratitude to the team at the Eating Disorders Service
at the Children’s Hospital at Westmead. Thank you for so warmly supporting me
through the whole research process, and for making this study possible in the first
place. In particular, I want to thank Dr Jane Miskovic-Wheatley – your dedication and
time has been so appreciated, and your humour has helped me stay sane along the
way. To Andrew Wallis, thank you for sharing your expertise and knowledge, and
making me feel a part of your team. You have been an amazing mentor during this
journey. I would also like to thank my associate supervisor, Professor Stephen Touyz,
as well as Dr Sloane Madden and Associate Professor Michael Kohn for all of their
support and feedback.
Most importantly, I want to thank my dear parents, family and friends. I would not
have been able to do this without your unwavering support and confidence in me.
Thank you in particular to all the girls – you have suffered listening to me during the
ups and downs of the last three years. And finally, to Tamar, clinical psychologist and
my mother, you set the path for where I am today.
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Contributions of the Candidate
The research presented in this thesis represents original work undertaken by the
Candidate, in conjunction with the School of Psychology at the University of Sydney
and the Eating Disorders Service at the Children’s Hospital at Westmead. Ethics
approval was granted by Hunter New England Human Research Ethics Committee
(HNEHREC) (see Appendix A for correspondence with ethics boards).
The Candidate was responsible for coordinating the research under the supervision of
Associate Professor Paul Rhodes and Professor Stephen Touyz at the University of
Sydney, and Mr Andrew Wallis and Dr Jane Miskovic-Wheatley at the Children’s
Hospital at Westmead. The Candidate took primary responsibility for all aspects of
the research including identification of thesis topic, research aims, study design, data
collection, database management, analyses, and interpretation of results. The
candidate wrote this thesis and maintains chief responsibility for this thesis.
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Statement of Authentication
This thesis is submitted to the University of Sydney in partial fulfilment of the
requirements of the degree Doctor of Clinical Psychology/Master of Science
(DCP/MSc). The work presented in this thesis is, to the best of my knowledge and
belief, original except as acknowledged in the text. I hereby declare that I have not
submitted this material, either in full or in part, for a degree at this or any other
institution.
Keren Fink 12/10/15
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Abstract
According to existing research, Maudsley Family Based Treatment (MFBT) is
the most efficacious treatment option for children and adolescents suffering from
Anorexia Nervosa (AN). Despite a wealth of evidence demonstrating the superior
efficacy of MFBT for these young individuals, it is being increasingly documented in
recent literature that a considerable minority of patients do not respond as expected to
treatment. A number of adaptations to traditional MFBT have been made to
accommodate these at-risk populations, one of which is the Family Admissions
Program (FAP) – a recent treatment program that has been developed by the Eating
Disorders Service at the Children’s Hospital at Westmead, with the specific aim of
providing high intensity and immediate support to particularly vulnerable families at
the outset of treatment. The FAP involves the adolescent and his/her family living in a
self-contained ward within the hospital grounds for two weeks post discharge,
whereby they complete a condensed form of parts of the first phase of traditional
MFBT.
The overall aims of this thesis were to provide a preliminary evaluation of the
FAP, looking specifically at how participants experienced the program and its effects.
The research consisted of two related qualitative studies. The first was a Narrative
Inquiry, in which 10 adolescents and their families were invited to recount their
journey with AN and what overall role they believed the FAP played within this.
Results from the Narrative Inquiry indicated that the FAP provided two important
mechanistic factors in families’ process of recovery from AN – a) an opportunity to
reconnect and come together in a way that was more effective in fighting against the
illness; and b) an experience, for parents in particular, that allowed for an increased
sense of confidence, insight and motivation to continue engaging with MFBT once
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back at home.
The second study used Interpretative Phenomenological Analysis to gain a
detailed account of the nature of four families’ experiences as they were currently
undergoing the FAP. Comparison was then made between how well the patients’
reflections aligned with clinical expectations and evaluations of their treatment in the
program. Analyses revealed that clinicians and families held corresponding
expectations and evaluations of their participation in the FAP, particularly those to do
with changes witnessed in the wider family unit and the new way in which parents
approached their management of the AN. Therapeutic intensity and proximity to the
hospital’s supports and services were two key factors of the FAP that both clinicians
and families noted as being particularly important in leading to these observed
outcomes. Overall, the findings of the thesis indicate that for families who are coming
to MFBT resource-poor, under relational strain and at an acute point of crisis,
treatment needs to be adapted in a way that can provide a higher level of intensity and
proximity to support, so that there can be a reconnection within the family unit.
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Table of Contents
CHAPTER 1 – INTRODUCTION 11
1.1 Background 11
1.2 Overview of the research thesis 12
CHAPTER 2 – LITERATURE REVIEW and AIMS 14
2.1 Overview of AN 14
2.2 Treatment options for AN 16
2.3 Development of MFBT 18
2.4 Empirical efficacy of MFBT 21
2.5 Manualisation of MFBT 25
2.6 Factors predicting treatment outcome 27
2.7 Augmentations of MFBT 30
2.8 Family Admissions in psychiatric settings 37
2.9 Rationale of the current study 40
CHAPTER 3 – METHOD 42
3.1 Family Admissions Program (FAP) 42
3.2 Research design overview 44
3.3 Study 1 – Constructionist Narrative Inquiry 45
3.3.1 Design 47
3.3.2 Participants 48
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3.3.3 Procedure 49
3.3.4 Data Analysis 50
3.4 Study 2 – Interpretative Phenomenological Analysis 50
3.4.1 Design 51
3.4.2 Participants 53
3.4.3 Procedure 54
3.4.4 Data Analysis 54
CHAPTER 4 – RESULTS 56
4.1 Study 1 – Narrative Inquiry 56
4.1.1 Progressive intensification of the AN 57
4.1.2 Fracturing of the family unit 59
4.1.3 Crisis point 62
4.1.4 Participation in the FAP 63
4.1.5 Ongoing process of recovery 68
4.2 Study 2 –Interpretative Phenomenological Analysis 70
4.2.1 Pre-treatment 71
4.2.1.1 Complexity going into the FAP 71
4.2.1.2 Hopes for change 72
4.2.1.3 Clinical aims 73
4.2.2 Post-treatment 74
4.2.2.1 Changes towards the AN 75
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4.2.2.2 Changes in the family 77
4.2.2.3 Changes in the adolescent 79
4.2.3 Key factors 80
4.2.3.1 Intensity 80
4.2.3.2 Proximity to supports 82
CHAPTER 5 – DISCUSSION 84
5.1 Major Findings 84
5.1.1 Review of thesis aims 84
5.1.2 Narrative Inquiry: Role of the FAP 85
5.1.3 IPA: Alignment between clinical and patient experience 87
5.1.4 Correspondence between the Narrative Inquiry and IPA 90
5.2 Clinical Implications 92
5.3 Strengths and Limitations of the research 95
5.3.1 Limitations 95
5.3.2 Strengths 97
5.4 Future directions and conclusions 98
REFERENCES 100
APPENDICES 115
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Description:According to existing research, Maudsley Family Based Treatment (MFBT) is the most efficacious Narratives are compositions that draw together.
