Adolescent-Focused Therapy for Anorexia Nervosa: A Developmental Approach

From pioneering family-based treatment developer James Lock, this is the first comprehensive guide to adolescent-focused therapy (AFT) for anorexia nervosa (AN), an evidence-based individual approach. AFT is an effective alternative to family-based treatment that may be a better fit for some patients. Lock explains how AN serves as a maladaptive response to developmental challenges of adolescence. He presents a manualised framework for helping adolescents find more adaptive coping strategies, manage difficult emotions, and develop greater autonomy and a stronger sense of self, while reducing risky behaviours and restoring weight. AFT emphasises the therapist–patient alliance and involves parents in a supportive role. Rich case material and sample dialogues illustrate how to implement each phase of the approach.

AFT is recognised as a best practice for the treatment of anorexia nervosa in adolescents by the U.K. National Institute for Health and Care Excellence (NICE).

Table of Contents

Introduction

1. What Is the Problem?: Anorexia Nervosa sample
2. What Is AFT and Why Should You Use It?: An Overview
3. A Primer on Diagnostic Assessment for Adolescents with Anorexia Nervosa
4. Overview of Adolescent Development to Guide Case Conceptualization in AFT
5. AFT Toolbox for Therapists
6. Phase I of AFT: What’s Going On Here?
7. AFT for Adolescents with Anger and Control Issues
8. AFT for Adolescents with Depressive Symptoms and Poor Self-Esteem
9. AFT for Adolescents with Deficits in Identity Formation
10. AFT for Adolescents with Fears of Growing Up
11. Concluding Comments: Challenges in Disseminating and Implementing AFT for Anorexia Nervosa

References

Index

"This is a well done and timely book….It is well laid out, well presented, and has, especially in the latter chapters, a great deal of dialogue between therapist and patient to clarify and highlight points made. Even though AFT has developed from a psychodynamic base, it will be comfortable reading for those with a more behavioral background….This book could be used in any graduate program where eating disorders are part of the curriculum. The book could also be helpful reading for any practitioner currently involved with or with an interest in developing increasing expertise in this field."
- Child and Family Behavior Therapy

"Although family-based treatment is the first-line approach to adolescent AN, not all parents are comfortable with it, and some prefer an individually focused treatment. AFT, shown to be effective in clinical trials, is a useful alternative to family-based treatment. Lock presents the main elements of AFT clearly and effectively, with helpful clinical vignettes. All those who treat AN should read this book in order to provide the full range of treatments for their patients."
- W. Stewart Agras, MD, Department of Psychiatry and Behavioral Sciences (Emeritus), Stanford University

"AFT is supported by empirical evidence, but, until now, only limited resources were available to guide clinicians in implementation. This much-needed manual provides a detailed description of AFT, replete with case material that brings the approach to life. The book will be of use to a wide range of readers, from students who want to learn more about this evidence-based treatment to seasoned therapists seeking to add another effective treatment to their clinical repertoires. The availability of a treatment manual can also facilitate clinical research, ultimately adding to our understanding of adolescent eating disorders."
- Renee D. Rienecke, PhD, FAED, Director of Research, Eating Recovery Center/Insight Behavioral Health Centers; Department of Psychiatry and Behavioral Sciences, Northwestern University

"Perhaps not surprisingly, families have proven to be the most valuable resource in helping adolescents with AN. However, there are situations where an individual treatment strategy may be more appropriate and helpful. Moye and Robin’s early work on ego-oriented individual therapy put individual treatment for AN on the map, and AFT represents this approach's further refinement. Lock, a leading treatment developer for eating disorders in young people, provides an excellent clinical guide to the practical steps required to implement AFT."
- Daniel Le Grange, PhD, Benioff UCSF Professor in Children’s Health, Department of Psychiatry, University of California, San Francisco; Emeritus Professor of Psychiatry and Behavioral Neuroscience, The University of Chicago

"Lock provides a rationale and a step-by-step approach for using AFT. The manual describes AFT from a biopsychosocial perspective that takes stages of adolescent development into account to tailor treatment according to individual needs. While AFT has its roots in developmental–psychodynamic theory, it nevertheless can be aligned with the assumptions of the medical model. This is key to reduce stigma and introduce more transparency to treatment of AN. The well-structured manual provides detailed examples of how AFT can target specific problems in meeting developmental milestones during adolescence. This is a very useful guide for applying AFT with adolescents for whom family-based therapy has not been a feasible option."
- Guido K. W. Frank, MD, Department of Psychiatry, University of California, San Diego; UCSD Eating Disorder Center for Treatment and Research