The Role of Family-Based Treatment In Recovery

Family Based-Treatment (FBT) is the leading evidence-based treatment model for eating disorders in children and adolescents in the outpatient setting. Randomized clinical trials have shown that FBT leads to faster weight restoration, decreased hospitalization rates, fewer admissions, shorter stays, higher recovery rates, and excellent treatment retention rates in both the short and long-term. But what does FBT actually involve? And is it for everyone?

Fact #1: FBT externalizes the ED

Many parents struggle to understand what their child is experiencing during the recovery process. When they see their teen struggling to complete meals, being secretive, and experiencing mood swings, oftentimes parents become angry and accusatory.

“Why are they giving me such a hard time?”

“Why are they so irritable today?”

“They have been so disrespectful to me recently.”

FBT helps parents understand that their child is separate from their mental illness. The upsetting behaviors and words that they are seeing are not the kid they have always loved and known - it is the eating disorder taking over. It’s sometimes helpful for parents to name the ED in order to differentiate ED behaviors from their teen. Rather than becoming angry when the child doesn’t eat, FBT encourages caregivers to compassionately validate what their child is going through due to their ED - which makes recovery feel supportive.

“I know how hard it is for you to eat right now because the ED is so powerful. I am right here with you. You can do this. We will keep going step by step together.”

Fact #2: FBT encourages an agnostic, act-now view of the ED

Many families spend so much of their time at the start of the recovery process focusing on how, why, and who caused the ED to develop rather than treating the ED itself. Mental illnesses are widely misunderstood and the detrimental effects of EDs are underestimated. It’s easy for caregivers to see how harmful and serious a broken bone is or any other sickness that affects the body. Whereas with the flu or a broken wrist treatment is prioritized quickly. Time isn’t spent determining where the flu could have been contracted or how the fall occurred. The priority is receiving medical care and resting the body. Eating disorders need to be treated with just as much seriousness and urgency. EDs can cause a multitude of physiological consequences and research shows that the longer a person engages in eating disorder behaviors and remains weight suppressed, the less likely treatment will be successful. As for any other illness, the longer you have the illness the more difficult it is to resolve. FBT emphasizes how imperative it is to intervene and get help for long-term recovery success. It encourages caregivers to stop wasting time on who is to blame, and to start focusing on what we can do to best support our loved one. 

Fact #3: Non-authoritarian stance

Every teen is different and every family dynamic is different. FBT views therapists and dietitians as experts in mental health counseling and medical nutrition therapy in regards to eating disorder recovery. It also views parents and caregivers as experts in their child. Rather than demanding family members follow certain treatment protocols, the treatment team offers helpful and individualized solutions to combat eating disorder behaviors and symptoms while acknowledging that family members truly know their child best. What makes FBT so special is that the treatment team works together with the caregivers to harness their combined expertise as a united front against the ED. 

Fact #4: Parental empowerment

ED thoughts and behaviors are incredibly powerful, making it extremely difficult for adolescents to make rational food-related decisions. As long as the ED is present, the mind is occupied with unhealthy, shaming thoughts about food, bodies, and exercise. That’s why FBT gives parents and caregivers the responsibility of meals and snacks. Caregivers explain to their teen that they see how difficult, exhausting, and draining it is for them to make healthy decisions around food. For the time being parents will take that burden off of their kiddo and take on the job of worrying about planning meals and snacks. Parents become the primary agents of change in helping their child take control back from the ED. Kiddos are reassured that they will slowly and gradually regain food-related decisions once the treatment team determines they are stable enough to do so. Taking away food-related decisions is not a punishment, rather a supportive measure for individuals at the beginning of the recovery journey.

Fact #5: FBT is not for everyone

While Family-Based Treatment can be incredibly powerful in helping children and adolescents overcome their ED, it is not suitable for every family. Barriers to utilizing FBT include family dynamics, an inability for caregivers to take time away from work for treatment and supervision, etc. It’s important for clinicians to recognize when FBT is not the most feasible treatment option for a family in order to best support them. Eating disorder recovery is most impactful when families work with qualified treatment providers who truly understand that each person’s healing journey is different and requires an individualized, multidisciplinary approach.  

Sources:

Agras, W. S., Lock, J., Brandt, H., Bryson, S. W., Dodge, E., Halmi, K. A., Jo, B., Johnson, C., Kaye, W., Wilfley, D., & Woodside, B. (2014). Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA psychiatry, 71(11), 1279–1286. https://doi.org/10.1001/jamapsychiatry.2014.1025