Family-Based Treatment (FBT) is a therapy approach that was created to treat adolescents with anorexia . Now, it is known as one of the most effective treatments for children and adolescents with eating disorders .
FBT is a treatment used in outpatient settings. Outpatient means that the person struggling with an eating disorder is not in the hospital or in a residential treatment facility where they are receiving support and supervision 24 hours a day.
FBT is a three-phase process where the ultimate goal is for the teen to stabilize their eating patterns so they can go on and live a healthy teenage life . Here are the three phases of FBT:
Family Based Treatment Phase One: Family Helps Restore the Child’s Weight
FBT is different than other eating disorder treatments because it relies on the family to be very involved. While other treatments include family members in family therapy sessions or by providing education to family, FBT is different.
Family Based Treatment therapists coach family members on how to help the child or teen restore weight . Coaching the family can include a few different things . It may involve providing education about the dangers of disordered eating, or it could include the therapist observing the family eating a meal together.
The purpose of a therapist watching a family meal is that it gives the therapist an idea of how the eating disorder impacts family meals and other family dynamics. Angela Florio, an eating disorder therapist, explained that sometimes an eating disorder can “take over” a family .
This means that family members may walk on eggshells to try not to trigger the person struggling, or regular parent-child boundaries may disappear as desperation sets in. For example, if a family has a rule that they only eat at restaurants once a month, parents may flex this boundary out of desperation to get their child to eat.
Over time, this can result in the eating disorder running the house. These dynamics become apparent to therapists when they observe family meals or during family therapy.
After completing these observations, a therapist can coach the family on how to set boundaries to take back control from the eating disorder. This means that the parents have the control over meals so that the child or adolescent can restore weight .
During this part of treatment, therapists work with parents to make sure they are not using this as a time to be critical or judgmental towards their child. This phase is meant to be approached from a place of compassion and support .
FBT Phase Two: Returning Control Over Eating
Families are not meant to have control over their child’s eating forever. During the second phase, individuals slowly regain control over their food choices. This phase still includes close monitoring to make sure that if eating disorder behaviors show up again, then parents may regain more control of their child’s eating again .
During this phase, therapists may begin working with the family on other relational issues within the family that may contribute to the eating disorder . For example, sometimes, people with eating disorders feel that they can’t talk to their parents about their feelings.
This can lead them to use disordered eating to cope. During this phase, an FBT therapist would start working on these issues with the family. This is important for preventing relapse.
Phase Three: Creating a Healthy Adolescent Identity
Adolescence is an important time for psychological and physical development. During this time of life, teens are learning to become more independent and are figuring out who they are. Part of this process is that parents and the teen have to learn how to navigate this.
There is a balance that has to be created between healthy teen independence and boundaries from their parent. This is important for every teen, but eating disorder recovery can get in the way of this. FBT would help a family figure this out while also helping the teen maintain a healthy relationship with food.
Resources: Couturier, J., Kimber, M., Barwick, M., McVey, G., Findlay, S., Webb, C., Niccols, A., & Lock, J. (2021). Assessing fidelity to family-based treatment: An exploratory examination of expert, therapist, parent, and peer ratings. Journal of Eating Disorders, 9(12), 1-9. https://doi.org/10.1186/s40337-020-00366-5  Le Grange, D. & Lock, J. (n.d) Family-based treatment of adolescent anorexia nervosa: The maudsley approach. Maudsley Parents. http://www.maudsleyparents.org/whatismaudsley.html  A. Florio, personal communication, February 5th, 2021.
About the Author:
Samantha Bothwell, LMFT, is a licensed Marriage and Family Therapist, writer, explorer, and lipstick aficionado. She became a therapist after doing her own healing work so she could become whole after spending many years living with her mind and body disconnected. She has focused her clinical work to support the healing process of survivors of sexual violence and eating disorders. She is passionate about guiding people in their return to their truest Self so they can live their most authentic, peaceful life.
The opinions and views of our guest contributors are shared to provide a broad perspective on 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 March 8, 2021, on EatingDisorderHope.com
Reviewed & Approved on March 8, 2021, by Jacquelyn Ekern MS, LPC