Family Based Treatment

What is Family Based
Treatment (FBT)?

FBT is a treatment approach for children and adolescents with eating disorders. FBT places parents at the center of the young person’s recovery by charging them with the task of nourishing their body. The family is supported by their outpatient team which may include: therapist, nutritionist, and/or medical provider.

The Evidence for
FBT

After collecting evidence for 30 years, researchers have found that FBT(sometimes known as the “Maudsley Method”) is the most effective treatment for adolescents with eating disorders, where the focus is on nourishment and the impact of eating disorders on the family.

Couturier, J., Kimber, M., Barwick, M., Woodford, T., Mcvey, G., Findlay, S., Webb, C., Niccols, A., & Lock, J. (2019). Family-based treatment for children and adolescents with eating disorders: a mixed-methods evaluation of a blended evidence-based implementation approach. Translational Behavioral Medicine. https://doi.org/10.1093/tbm/ibz160

The Phases of Treatment

FBT HAS 3 PHASES WHICH ARE DELIVERED OVER A 12 MONTH PERIOD.

Phase 1

Focuses on empowering parents to work together to nourish the young person. Due to

the physical impact of starvation on the brain, the young person is not able to make healthy and appropriate decisions regarding their eating at this time.

All meals are prepared and supervised by a parent and physical exercise is limited. This is

necessary because the eating disorder will make it difficult for a young person to willingly eat.

Parents foster a supervised, compassionate, persistent and firm expectation that the adolescent eat a sufficient (often large) amount of food to reverse the state of starvation.

The treatment team works with the family to discuss the impact of the illness, to provide

education about eating disorders, and to understand and manage the young person’s fear and distress during meal times.

Siblings provide a crucial role in supporting the young person – this can be as simple as offering a hug or watching TV together. Sibling relationships have often been disrupted by the illness and require some repair.

Phase 1 is typically the most challenging phase of treatment for the family.

Phase 2

Once the young person is eating adequately with minimal parental prompting and has regained sufficient weight, parents gradually return the responsibility for eating back to the young person.

Phase 3

When the young person is maintaining a stable, healthy weight and eating normally,

the focus of treatment shifts to other issues that have been disrupted by the eating disorder.

Phase 3 aims to ensure the young person is ‘back on track’ developmentally, and engaging in normal, adolescent activities. Relapse prevention and completing treatment are also discussed.

What FBT is not

FBT does not focus on why the eating disorder developed.

FBT does not blame anyone for the development of an eating disorder. Eating disorders are

seen as separate from the young person, and guilt and blame within the family are explicitly

addressed.

FBT is not about being unnecessarily harsh or restrictive. The clinician works with parents to

manage the distress of the young person and hand back responsibility for eating as soon as

possible.

FBT does not damage family relationships

FBT is not harmful to the young person’s stage of development in the long-term. Parental

responsibility for nourishment is temporary and young people often reflect in retrospect that they feel grateful their parents were able to fight the illness for them so they can return to a full life.