Dr Ulf Wallin ED

Eating disorders professionals from across England, Wales and Ireland came together for a highly interactive eighth Newbridge House Masterclass.

The focus for this Masterclass was on multi-family therapy, with the day being led by Swedish specialists Dr Ulf Wallin and Karin Wallin of Psychiatry Skane, Lund.

Introducing the day, Professor Hubert Lacey, Medical Director of Newbridge House, spoke of the crucial importance of family therapy and the emergence of multi-family therapy in the treatment of anorexia in children and adolescents.

“We tend to think of this work as coming out of Anglophone world, specifically Maudsley and north America. However, there is a well-established family therapy model in Swedish clinical services with much in common but some key differences also to the Anglophone model. Today is an opportunity to take an international view.”

The day began with an exercise used multi-family in Psychiatry Skane described as family sculpting. One family depicts their current relationships by physically modelling the family group. This physical modelling is done by other participants in multi-family therapy, who are instructed where to stand and how to be by family members.

“It is valuable as an exercise in perspective shift; to really walk in another person’s shoes,” explained Dr Wallin. He spoke of the value of using physical modelling to explore family relationships. “If you ask a ten-year-old boy how he would describe Mum and Dad’s relationship, he is likely to shrug, but if you ask him to position them – how far apart, what direction are they looking in – he tends to become very engaged and focused.”

The model in Skane involves four days of multi-family therapy which take place with a maximum of seven families. The speakers described the importance of a “rocket start” which is a characteristic of the Nordic approach, where there is an emphasis on early intensity. Weight gain within one month of treatment is one of the most favourable prognostic factors for a good outcome, it was noted.

There was discussion of the dynamic within multi-family therapy. “It is a challenge to for you as a therapist; you have to become part of a team and ask yourself how much to control things. Sometimes you have to step back and trust what is happening between the families,” explained Karin Wallin. For example, on the programme, families now take more responsibility for mealtimes and together, calibrate what is a normal portion size. In Germany, the organising of meals is more directive and controlled by the therapists and in America, it is more pragmatic. “It is important to have a model that functions in your own cultural context, so there will be variation,” commented Karin Wallin.

The afternoon session including a wide-ranging debate on the relative merits and challenges of multi-family therapy, followed by detailed explanation of the model used in Skane.

Professor Lacey concluded the day by saying: “I would like to thank everybody who has attended today for being such an invigorating audience, contributing so much to discussions throughout the day. I also want to thank Karin and Ulf for imparting their very practical knowledge during what has been a very exciting and enjoyable day.”

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