Anorexia nervosa is a characterised disorder which forms part of the wider spectrum of
eating disorders. It is a common pathology, particularly in adolescence, with a complex,
severe prognosis in both somatic and psychiatric terms, and significant psychosocial
consequences, particularly for family relationships.
The treatment of anorexia requires a multidisciplinary team of specialists who can offer
individual and family-based approaches. International recommendations highlight the
encouraging results of family therapy in the treatment of anorexia nervosa. Various types
of family approach exist, including "Family Based Treatments", which are a specific but
highly effective approach, particularly widespread in the United States. Multifamily
therapy (MFT), which involves bringing several families together to address the problem
of anorexia, has proved effective for several years now.
Since January 2019, multifamily therapy has been offered to adolescents aged 12 to 18 who
are being followed at the Maison de Solenn-Maison des Adolescents at Cochin Hospital for
anorexia nervosa, as well as their families.
Each group brings together 5 to 7 families and comprises 10 3-hour sessions, with 3 weeks
between each session. 2 groups are offered per year. Multi-family therapy therefore
involves 10 to 14 families per year. It complements the other approaches available in the
department.
Primary objective:
To be able to describe the therapeutic processes at work in these multifamily groups in
order to be able to better describe our therapeutic device and envisage possible
modifications. These processes would be broken down into four areas: MFT and its effects
on the anorexic symptom, MFT and its effects on the family, MFT as a group therapy and
ways of improving the MFT system.
Secondary objectives:
MFT and its effect on the symptom: to better describe and analyse the processes at
work in multifamily therapy that lead to symptomatic improvement in adolescents
through the perception of the adolescent himself, his parents or his brothers and
sisters.
MFT and its effects on the family: to describe in detail the psychotherapeutic
processes within the MFT system that are involved in changing family relationships.
MFT and its effects as group therapy: The context of group therapy is often a
powerful lever/motivator of change and the investigators are seeking to better
describe and understand the mechanisms at play in the group and how this influences
the family and the anorexic symptom.
Areas for improvement in MFT: Our study also aims to determine, in the context of a
multifamily group for anorexia nervosa, the therapeutic contexts (single-family,
intragenerational, multigenerational) and therapeutic mediations most conducive to
change, in order to improve our practice and therapeutic proposals.
The study is therefore being proposed to all the families who have taken part in the
multifamily therapy for anorexia nervosa, i.e. the adolescents being followed, their
parents and siblings.
The investigators propose to use a qualitative methodology aimed at collecting the
experiences of patients suffering from anorexia nervosa, their parents and their
siblings, using alternately, depending on the group, data collection by focus group or by
individual semi-structured interview according to a semi-structured interview guide
specifically designed by the research team. The data was collected 4 to 6 months after
the tenth and final session of the multifamily group.
The theoretical framework is qualitative and no statistical comparison is expected.
The investigators chose to use Interpretative Phenomenological Analysis (IPA) to study
the meaning that the subject constructs from lived experiences. IPA is a recognised
method of content analysis, particularly in health psychology.
Approximately 3 months after the end of a multifamily group on anorexia nervosa, the
investigators will contact the families by telephone or e-mail to invite the families to
take part in research interviews which will take place 4 to 6 months after the tenth and
last session of the multifamily group in which the family took part.
The investigators will arrange to meet the families in the department on the same day to
carry out an information interview, collect non-oppositions, interviews to collect
socio-demographic data and then individual semi-structured interviews or focus groups
(depending on staff availability).
The qualitative analysis of our research concerns the thematic analysis of the
participants' discourse (adolescent patients, parents and siblings of these adolescents),
so the main evaluation criterion concerns the extraction of sufficiently rich material
from the discourse to carry out this analysis.
