Specialist Supportive Clinical Management (SSCM) for severe and enduring anorexia

What is SSCM?

SSCM was originally designed as a placebo comparative treatment in a clinical trial comparing cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) as a treatment for anorexia nervosa. The aim was for SSCM to be an outpatient treatment that could be delivered by a specialist eating disorder clinician, but which was not a recognised psychological therapy. Surprisingly SSCM was superior to both CBT and IPT at the end of treatment (McIntosh et al., 2005). In 2007 a further clinical trial compared an adapted form of SSCM to CBT in treating clients with severe and longstanding anorexia nervosa. Our founder and director, Dr Bryony Bamford, was instrumental in developing and delivering the adapted treatments that were investigated during this trial (Touyz et al., 2013). The results of this adapted form of SSCM in helping these clients with severe AN were extremely promising. Since then SSCM has continued to be used, and shown to be a valid and effective treatment for anorexia nervosa.

What does SSCM involve?

SSCM utilises clinical management skills, a sustained focus on improving eating disorder symptoms, and supportive therapy techniques to guide people towards meeting their own treatment goals. There is an additional focus not just on a client’s symptoms, but on improving their enjoyment and quality of life alongside their eating disorder symptoms. SSCM is a much more flexible approach than many of the other structured skills-based approaches offered for anorexia. Within each session, core symptoms and progress towards treatment goals are reviewed, however other than that the content of each session is dictated by the needs, feelings and desires of the client; the therapist contributes less of their own agenda.  SSCM is not based on a detailed psychological formulation or model, but uses a very practical, gentle and supportive approach. The role of the therapist is seen as being merely to facilitate, support and encourage the client to use skills and strengths that they already have, to move towards treatment goals.  In this sense SSCM builds on a client’s pre-existing strengths rather than providing clients with a new set of skills. The content of treatment is completely unique to each client and will be a combination of the client’s knowledge about what might work for them, and the clinician’s knowledge about what might help someone to recover from an eating disorder.

WHO MIGHT BENEFIT FROM SSCM?

SSCM is more suited to people who want a flexible approach, where they are free to create their own agenda and talk through issues that they are already aware of.  People who have engaged with a number of therapeutic approaches before with little success, who are less motivated to engage in an active therapeutic process, or who want to work slowly towards progress, rather than full recovery may benefit most from this approach. People who are acutely aware of their thoughts and are aware of all counter rational arguments but who are stuck with an anorexic ‘identity’ or paralysing fear of recovery may be better suited to SSCM, as it allows more flexibility to take a  slower pace and explore issues important to the client in a gentle way.