Family-Based Treatment & Eating Disorder Recovery

Family Eating Dinner

Family-Based Treatment (FBT), or the “Maudsley” method, is a specific approach to treating restrictive eating patterns, such as those seen in Anorexia, in children and adolescents.

At times, FBT may be utilized by families who have adult children struggling with restrictive eating. FBT is a manualized outpatient therapy designed to restore children and adolescents to health with the support of their parents. [1-3]

FBT can be thought of as an intensive outpatient treatment where parents play an active and positive role in order to accomplish three goals, accomplished in phasic order.

The family and child still work closely with their outpatient treatment team, generally consisting of a dietitian, therapist, physician, and psychiatrist (if indicated) all who specialize in the treatment of eating disorders. [1-3]

The Three Phases of Family-Based Treatment

Phase one helps restore the child’s weight to normal developmental levels expected given age and height. Parents are given responsibility for deciding what their child eats, how much is eaten, when it is eaten, monitoring all food intake, and generally curtailing physical activity, much like the treatment team would do on an inpatient unit.

The goal of FBT, however, is to allow patients to recover in their day-to-day environment with their support system around them, rather than separating them from their parents by sending them to an inpatient or residential treatment program. Siblings are given a supportive role in treatment and are not included in the parents’ job of weight restoration. [1-3]

Phase two returns the responsibility and control over eating gradually back to the child, to whatever extent is age-appropriate and normal for a particular family. Parents and family members are there to support and monitor the child to ensure progress towards normal eating. [1-3]

Phase three encourages the child’s return to normal development and establishing a healthy identity. The therapist ensures that the family is back on track with normal family life.

The family identifies upcoming developmental milestones and challenges that the adolescent must face, and the family identifies how to help the young person navigate these challenges without reverting to the eating disorder as a way to cope. [1-3]

FBT Satisfaction

family holding hands in Family-Based TreatmentIn a recent study looking at parent and patient satisfaction with FBT after five years, researchers found that, overall, mothers and fathers reported a high level of satisfaction with FBT.  However, the former patients’ satisfaction was moderate.

There were no significant differences between treatment satisfaction scores for mothers and fathers. However, the former patients’ treatment satisfaction scores were significantly lower than the parents’ scores on several of the items.

Correlations between eating disorder outcome parameters and treatment satisfaction were small, except for fathers’ satisfaction with treatment and weight outcome at follow-up. [4]

One challenge with FBT is the risk of parents experiencing “caregiver burden.” For this reason, it’s important that parents utilize both formal and informal supports to cope with the stress that comes along with implementing FBT. [1]

For this reason, FBT may not be a good fit for all families. It’s important to remember that FBT is just one path toward eating disorder recovery — the path to recovery is individualized and looks different for everyone.


Sources:

[1] Rienecke R. D. (2017). Family-based treatment of eating disorders in adolescents: current insights. Adolescent health, medicine and therapeutics, 8, 69–79. doi:10.2147/AHMT.S115775

[2] Le Grange, D., and J. Lock. (2005). The dearth of psychological treatment studies for anorexia nervosa. International Journal of Eating Disorders, 37, 2005, 79-91. Le Grange, D., and Eisler, I. Family interventions in adolescent anorexia nervosa. Child and Adolescent Psychiatric Clinics of North America, 2009, 18, 159-173.

[3] Le Grange, D., and J. Lock. Family-based Treatment of Adolescent Anorexia Nervosa: The Maudsley Approach. Retrieved from http://www.maudsleyparents.org/whatismaudsley.html on Aug 25, 2019.

[4] Halvorsen, I. And Rø, Ø. (2019). User Satisfaction with Family-Based Inpatient Treatment for Adolescent Anorexia Nervosa: Retrospective Views of Patients and Parents. Journal of Eating Disorders, Retrieved from https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-019-0242-6.


About the Author:

Chelsea Fielder-JenksChelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.

She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.


The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on August 30, 2019,  on EatingDisorderHope.com
Reviewed & Approved on August 30, 2019, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.