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FAMILY BASED TREATMENT
What is Family Based Treatment?
Family Based Treatment (FBT) (sometimes referred to as the Maudsley method) is often recommended as a way to provide more intensive outpatient support to medically stable, eating disordered children and adolescents. It mainly applies to restrictive disorders and behaviors, however, we adapt the model to help teens stop engaging in other eating disorder behaviors, like binging or purging.
Family Based Treatment enables parents to play a central role in supporting health restoration in their teen, possibly preventing the need for higher level care. It’s also commonly used by families whose teens have recently discharged from a treatment center. At Dr. Daisy & Co., we take a modified FBT approach. This means we can help guide you on how, what, and when to feed your teen. We do not conduct therapist-supported family meals, but we are able to collaborate with your teen’s therapist, ensuring cohesive support.
Family Based Treatment is an evidenced-based approach. A plethora of research studies have shown that FBT is an effective outpatient treatment for teens with eating disorders.
How does FBT work?
There are three phases to FBT. This article will focus on Phase I, because each phase thereafter calls for slowly relaxing the rules and handing back some responsibility to your teen.
In Phase I of FBT, parents are given responsibility for deciding what their teen eats, how much is eaten, and when it is eaten, monitoring food intake and generally limiting physical activity -- much like a treatment team would do in an inpatient facility. Your dietitian will guide you through the what, how much and when for meals and snacks with a meal plan.
Family Based Treatment is a food first approach. Imagine your teen is being issued new Rules to their Universe - first the meal or snack and THEN they can continue doing what they plan on doing (eg, using their phone, Facetiming with friends, watching TV). Food becomes medicine, and getting enough of it is now the most important rule. This is because food can help weight restore, and replete the undernourished brain. It can also prevent eating disorders from becoming further entrenched.
There’s nuance to this approach and we encourage you to use your intuition at the table. If you think your teen could probably eat more, they should take a 2nd helping of food. If they are telling you they are uncomfortably full and you feel they have probably had enough food, you can permit them to stop eating before their meal is 100% complete. There is a little room for negotiation there. Not much, but a little…
Will FBT work in my family?
Upon hearing about Phase I, most parents worry they will be powerless or make mistakes implementing the new Rules of the Universe, or that their teen will grow to resent them. Let’s not forget you have years of experience feeding your children. You are capable of this.
Another thing - your teen is not their eating disorder. Right now, it’s their eating disorder that takes over when it comes to thoughts, feelings, and behaviors relating to food and body image. It’s true, their eating disorder may not like you and may grow very angry with you during Phase I. This is a sure sign that their ED is being challenged. Anger is okay, and it’s not your job in these moments to be liked. The only job you have is to make sure your teen is safe and healthy.
FBT is an effective intervention, and is often considered a treatment of choice for adolescents. Even if your teen does not respond to the model, you will be able to gather valuable information from the process and feel confident in your decision to seek higher level care.
Tips for success: find your leverage
The key to success here is figuring out what leverage you have, and using it. What does your teen really enjoy doing? Is it school? FaceTime? Shopping? Their cell phone? Exercise (note- we might need to limit this and as such, might not be a viable point of leverage)?
Here’s what using leverage might look like:
You can’t Facetime your friends unless your breakfast gets eaten.
If you eat your lunch, you can have your phone back.
I’m sorry, you didn’t eat dinner. You’re not well enough to do X,Y,Z.
We always recommend that parents are very matter-of-fact when they’re issuing rules and consequences. They’re not yelling, not emotional, not pleading or begging. All they’re doing is acting as messengers of the new Rules of the Universe.
Remember when your kids were toddlers? When they would cry and scream because they wanted to go to the playground but they didn’t want to put their shoes on? You had to remain calm and reiterate, “first shoes, then playground.” Now it’s first we have lunch, and then you go back to Facetiming. Feel free to use ingenuity and your years of parenting experience to make this process your own. We will help you every step of the way. Positive reinforcements are also on the table. It’s okay to allow your teen to enjoy a meal and a movie with you, or watch a favorite TV show together over lunch, etc.
How do we know when our teen is ready to progress to Phase II?
Once there is steady weight gain (or weight stability), the eating disorder has begun to recede, and your teen is eating without much resistance to parental involvement, we can move to Phase II, which involves gradually giving some responsibility back to them. We look forward to talking about Phase II with you and your teen!