What is Family Based Treatment?

Family Based Treatment (FBT)

Family Based Treatment (FBT) is currently the front-line treatment for adolescents and young adults with eating disorders in the outpatient setting. FBT, also known as the Maudsley Method, are terms used interchangeably as they support the same approach to recovery: families take a central approach to their loved one’s recovery with the support of trained clinicians.
FBT has three phases, with the initial phase focused on ‘refeeding’ efforts and helping your teen become medically safe. This may require weight restoration or it may just refer to stopping eating disorder behaviors. Weight restoration, if needed, and behavioral change are the first goals of treatment because an undernourished brain is often an anxious brain, and one that is usually less interested in making positive changes. We can’t expect psychological shifts to happen until the brain becomes nourished and essentially comes back ‘online’. This same is true for individuals who may not be underweight but struggle with eating disorder behaviors (eg. purging, binging, excessive exercise, etc.) or find it difficult to get a wide variety of nutrition in, as in the case of ARFID. FBT supports caregivers to take a highly structured approach to eating at home and to help their teen challenge eating disorder thoughts and urges until they are able to do this on their own.
Once your teen is medically stable and able to eat with regularity, you can begin to transition autonomy back over to your teen in phase two. Lastly, phase three focuses on supporting your teen with processing developmental and psychological issues (what are known as ‘maintaining factors’). This essentially refers to all of the things that, if left unaddressed, may cause relapse down the road. Maintaining factors may address family dynamics, such as shifting the whole family’s approach to eating, or may be more intrapersonal, as in identity formation. 

FBT PHASES 

Phase One: 

Caregivers hold the vital task of feeding their teen.Caregivers learn education and skills to intercept harmful behaviors, create structure and success to meal completion, and support weight restoration (if needed). Treatment may start with caregivers supervising all meals and snacks during a transitional period before having the teen become more involved with their food. This means planning, preparing, and supervising meals and snacks. Clinicians help to guide and empower parents throughout the recovery process. 

Phase Two: 

Once eating disorder behaviors are decreased and teens are medically stable, treatment focuses on the development of skills and independence. Caregivers gradually transition autonomy back over to the teen.Teens may begin to create meals side-by-side with caregivers, go to the grocery and choose the meals, and eventually eat meals without supervision. The rate of independence reintroduction is determined by the individuals’ ongoing clinical progress. 

Phase Three: 

By this stage, the teen has reached a successful state of recovery from eating disorder behaviors and has normalized eating. Treatment shifts in focus to helping the teen develop a healthy balanced life and catch up on other developmental issues.Treatment might focus on establishing new parental boundaries, supporting healthy development of identity and emotion processing, among other things. If there are co-occurring mental health conditions, these can be addressed at this time.
Because eating disorders have a high rate of relapse, relapse prevention is an essential focus during the last phase of treatment. 

FBT has 5 Core Principles 

Agnostic view of illness: Meaning we don’t want to get sidetracked trying to figure out why the eating disorder developed. Eating disorders are multifactorial and quite complex, so this can take us down a never-ending rabbit hole. We ultimately don’t need to know the ‘why’ to know how to treat eating disorders. 

Initial symptom focus: FBT prioritizes full nutrition and prevention of eating disorder behaviors as the first step. For anyone to recover from an eating disorder, their brain needs to be nourished and they need to learn healthier ways to manage emotions and stress. 

Family is responsible for refeeding efforts: Caregivers provide full nutrition by taking charge of meals for their loved one. 

Non-authoritarian stance: Caregivers are seen as the experts on their loved one. Clinicians actively collaborate with caregivers; they are essential members of their loved one’s treatment team. 

Externalization of illness: The illness is seen as an external force that has taken over the person and is attacking their health. Caregivers and providers join forces with the healthy part of the teen to fight off the eating disorder. 

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Cypress offers Family Based Treatment for teen eating disorder recovery, including psychotherapy and nutrition counseling.

Not ready to get started with FBT, but interested in more support, join one of our groups!
Cypress offers Caregiver Education and Support Groups, Teen Process and Skills-Building Groups, and Intuitive Eating groups.