Family-Based Treatment (FBT)
What is FBT?
Family-Based Treatment is a therapeutic approach that involves the whole family to heal a child’s eating disorder. Parents are not blamed for the eating disorder; rather, they are seen as the best chance at saving their child’s life from the devastating effects of the eating disorder. Parents are empowered to take on the primary role for re-feeding their child with the help and support of a therapist trained in FBT.
FBT is done on an outpatient basis with relatively few treatment providers compared to other forms of treating eating disorders. Typically, it includes a therapist and medical provider. Sometimes a dietitian meets with the parents to provide extra support in nourishing their child.
FBT consists of three phases. In the first phase, weekly therapy sessions with the whole family are focused primarily on nourishing the child and gaining necessary weight. Parents are in charge of planning, preparing, and ensuring that meals are eaten. Eating becomes the primary focus of the child’s life, and the parents are essentially providing a structure akin to a residential treatment center.
Early in treatment, the therapist will observe one family meal in the therapist’s office and provide guidance about ways parents can help their child eat. The parents can then implement these strategies at home.
Because the focus of Phase 1 is empowering parents to nourish their child, little time is spent on the child’s mental health. Until the child is renourished, it is hard to determine which symptoms are a result of malnourishment and which symptoms are long-standing mental health concerns.
Phase 2 begins when the child has regained most or all the weight and eating is going smoothly. The eating disorder has quieted down. At this point, the parents can begin to give feeding tasks back to the child. The child will also begin to add more flexibility to their eating and practice eating in different settings. There will likely be ups and downs during this phase, but practicing food independence is essential in the healing process.
Once the child is back to eating normally for their stage in development, the focus turns to other issues that may be present. This is the final phase of treatment. Often the eating disorder has taken away some important pieces of adolescent development, and the child will need to get caught up. The therapist will likely spend more time with the child and help the family navigate developmental issues and manage mental health concerns. Sessions become less frequent, relapse prevention is addressed, and then the family is prepared for discharge.
Does FBT work?
FBT is an evidence-based treatment for teens who have been struggling with the eating disorder for less than 3 years. It is effective in treating Anorexia Nervosa, Bulimia Nervosa, and OSFED (Other Specified Feeding and Eating Disorder). In fact, it is the most successful treatment for children and teens diagnosed with an eating disorder. It is even successful for children and teens diagnosed with ARFID (Avoidant/restrictive food intake disorder) and sometimes young adults.
However, sometimes FBT isn’t a good fit for some families. That is a decision that we can make together.
Why might your teen hate FBT?
FBT requires that parents take 100% control over food and eating. This isn’t a normal part of adolescence, and it’s developmentally appropriate for teens to want their independence. However, eating disorders aren’t normal. Eating disorders can kill and will certainly rob your child of their full potential if left untreated. Teens who are struggling with eating disorders don’t have the power to conquer the eating disorder or they would have done it already. The eating disorder won’t want anyone else taking control and will fight any attempt at healing.
The good news is that your teen doesn’t need to agree to FBT in order for it to be successful. This is one of those decisions that requires a caring adult to make, regardless of how resistant your child might be. If your child had cancer and required chemotherapy, what would you choose? Would you skip this life-saving treatment because your teen didn’t want to go through with it? Would you skip the treatment because it would be painful? This way of thinking can be applied to treatment of the eating disorder. Despite your teen’s protests, it could still be the right course of treatment for such a dire situation.
Some teens may feel like their relationship with their parents is suffering because FBT requires parents to be strong and unrelenting when battling the eating disorder. The truth is that parents who successfully help their child heal from the eating disorder will have time to rebuild their relationship (if rebuilding is even necessary). If the eating disorder continues to run the show, your child will never be totally capable of forming positive relationships, and your relationship with them will continue to be poor.
Oftentimes, and certainly in the case of FBT, providing structure is a demonstration of love. FBT will require parents to do hard things, and you’re not alone. Many parents have been down this road before, and you can do this even if your teen is unhappy with you in the short-term.