Family-Based Treatment (FBT) is an important evidence-based treatment for anorexia nervosa in adolescents. Originally conceived at the Maudsley Hospital in London, and often referred to as the Maudsley Model, it was further developed by James Lock, MD, PhD and Daniel le Grange, PhD in the United States. FBT is an intensive outpatient treatment involving the entire family whereby parents play a primary and critical role in all of the following tasks:
- managing the restoration of the child’s weight to a healthy place and supporting the blockade of eating disordered behaviors
- helping the child to re-establish age-appropriate control and management over their own eating
- re-focusing the family on healthy adolescent development and relationships separate from the eating disorder
FBT is a highly focused treatment that is presented in three stages. It emphasizes behavioral change and supports a gradual increase in autonomy for the adolescent. As a psychologist who supports and guides families through this treatment, I thought that it might be helpful for those who are considering FBT to have a primer for the treatment. In thinking about what may be helpful to be aware of when considering FBT, I reflected on the first session I have with each family and thought about all of the crucial messages I try to convey during that time. Below, I’ve decided to share the three messages that, in my perspective, stand as the most important tenets of understanding and implementing FBT.
- For adolescents struggling with anorexia nervosa, family support can be the most effective tool for making change. At its core, FBT recognizes that parents are capable of helping their child recover and the therapist’s role is to support them in this goal. When a child is confronted with any serious crisis or illness, investment and nurturing from the family is considered a critical asset and anorexia nervosa is no exception to this. Despite lingering misconceptions about a parental role in the development of eating disorders, FBT is built on the knowledge that parents do not cause eating disorders and that they are, in fact, integral to the recovery process. It is our job as therapists to recognize the strengths and qualities of each family and consider how FBT can be applied within each unique family system. Simply put, the aim of FBT is to empower parents to help their child overcome the eating disorder. In other words, the therapist serves as a consultant who joins with families as they apply skills they already possess.
- Eating disorders have genetic and biological underpinnings. As such, adolescents with anorexia nervosa have little control over their illness. Furthermore, periods of malnutrition and starvation can trigger a self-perpetuating cycle of anorexic symptoms that can cause considerable disruption and suffering for the whole family. But to be clear, it is the eating disorder, not the child, which has caused such an interruption in life. Anorexia nervosa is a devastating illness, the biological, physiological and psychological consequences of which can cause individuals to think and behave in self-destructive ways. It is important that the family works together as a team to help fight the illness and to keep it from embedding further in their child’s life. FBT therapists assist parents in distinguishing between their child and their child’s illness. This distinction helps the family to avoid blaming the child for disruption and stress that is actually a result of the illness, and also makes it easier for parents to take action when they realize they can nurture their child while simultaneously battling against the illness. As a result, energy can be better spent fighting the anorexia, not fighting with their child who is likely already suffering a great deal.
- Because of #1 and #2, FBT requires serious hard work and commitment. I am very upfront with families involved in FBT that they will be their child’s primary support AND that eating disorders are insidious and overwhelming illnesses. FBT is not easy. Fighting a devastating illness that has convinced your loved one they are not sick and that they don’t need help, is going to be a lot of hard work. And while it can be grueling, it is also worth it. When we hosted author Harriet Brown as a guest speaker in 2010, we asked her to share her family’s experience in doing FBT with her daughter, and she spoke to this difficulty and to the benefits of this tenet: “When we took on FBT, we took on both the responsibility and the power to intervene. That was a tremendously liberating step. The worst part of my daughter’s illness for me was standing by helplessly, watching her suffer and starve. The notion that my husband and I could help her required a huge mental paradigm shift—but once we made it, we were much more effective.”
In the beginning, FBT will require a lot of energy- energy to monitor your child’s behaviors, energy to learn different behavioral responses, energy to deal with the emotional and interpersonal changes that may come about through this work. I warn my families about the commitment that it takes and I’m honest about the dedication needed. But I also talk to families about the benefits of short-term work to outweigh the devastating long-term effects of an eating disorder and I share with them the facts. I talk to them about the serious and significant risks of anorexia- physically, emotionally, cognitively- and I have found that families most often agree that avoiding these risks is worth putting in the work. I tell them that FBT has been shown in research (and in my office) to be the most efficacious treatment for adolescents with anorexia that we know about today.
After committing to and sticking with the treatment, I see families eventually begin to talk about “having [their] child back.” I hear families talk about their child’s increased energy, sense of humor returning, interest in friendships again, and reestablishment in the family. I hear the satisfaction when parents talk about receiving feedback from others who approach them just to say that they have recognized a positive change in their child. Over time, I hear families talk about feeling confident that they helped their child recover. They share that they can once again trust their child to make healthy food choices, and they feel a sense of relief that they no longer have to live with the constant presence of the illness. I hear families tell me that the “fight” with the eating disorder gets easier and less demanding, and eventually they don’t need to engage in the battle at all.
If you think your family member, or someone you know may benefit from family-based treatment, I would recommend starting by talking to a professional about this option, either your current treatment provider or, if you are not currently in treatment, finding a family therapist who is trained specifically in FBT. The Center for Eating Disorders has several FBT therapists in our outpatient department, and we are happy to answer any questions you may have about this treatment modality. You can email us at EatingDisorderInfo@sheppardpratt.org or call (410) 938-5252. Additionally, we encourage all of the families we work with to utilize the book, Help Your Teenager Beat an Eating Disorder (Lock & Le Grange, 2005) as an educational and supportive resource throughout the FBT process. You can also access an extensive selection of journal articles regarding clinical research on FBT courtesy of Maudsley Parents organization.
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Written by Laura Sproch, PhD
Individual and Family Therapist
The Center for Eating Disorders at Sheppard Pratt
You may also be interested in:
- New Collaborative Care Programs for parents, caregivers and loved ones
- The Role of the Family in Eating Disorders
- Brave Girl Eating: 3-Part Q&A series with Harriet Brown
- What Causes an Eating Disorder?
- Family Therapy Services at The Center for Eating Disorders
- Upcoming Events at The Center for Eating Disorders…