ABSTRACT
The families of people with anorexia present varying levels of difficulty for the therapist. The attachment frame of reference provides a way of thinking about this in terms of parental vulnerabilities. The therapeutic operations described in the family-based treatment manual are not sufficient to maximise outcomes. In order to improve the approach we can draw on the techniques of structural and strategic techniques used in early studies but now largely set aside. An implication of the attachment approach is that therapists need to talk to families about the secure base issues at the outset. The first move in family therapy with anorexia has to be to make sure that parents can keep the patient safe by insisting on refeeding. The therapist is forced into a crisis intervention approach before he or she has time to get to know the family well or intervene at length to build a more secure relationship with the parents.
