Family Based Treatment for Eating Disorders: A Parent Guide
Written by Caroline Loher, LCMHCA
At a glance
This article will cover:
What is Family Based Treatment for eating disorders
Phases of FBT
Components of the FBT treatment team
What is it?- Family Based Treatment for Eating Disorders
Family-Based Therapy (FBT) for eating disorders is a type of treatment tailored for children and adolescents. FBT is most often used in cases where a child or teen has an eating disorder which may not yet require residential treatment but needs more intensive care than typical weekly psychotherapy with only a therapist. This treatment has five central components: 1) The therapist works to treat the eating disorder without putting emphasis on what caused it; 2) The therapist defaults to the parents/guardians as the expert on their children, therefore taking a "non-authoritarian" stance; 3) Parents/Guardians are encouraged and empowered by the rest of the treatment team to bring about the change for their children; 4) The eating disorder is "externalized" in treatment, meaning it is viewed as a separate entity from the child as opposed to the child themselves; and 5) The focus of FBT is a practical one—aiming for complete nutrition and the prevention of continued disordered behaviors.
Treatment using FBT consists of three phases, initially removing all autonomy around food decisions and then progressively giving the adolescent more freedom and independence. These three phases are outlined in more depth here:
Phases of Family Based Treatment for Eating Disorders
Phase 1: Caregivers Take Full Control of Food
In this phase, the child's parents/guardians are completely in charge of the child's food intake and supervision. The main goals of this phase are establishing a regular eating routine, helping the child gain weight if necessary, and reducing disordered behaviors such as purging or over-exercising. This includes supervising your child for the entire duration of their meal/snack time and thereafter if they engage in the disordered behaviors mentioned previously. This phase is often the most difficult emotionally, as the child is losing their autonomy, the eating disorder becomes "louder" or harder to resist for the child, the caregivers typically feel an upheaval in their everyday routines, and the treatment team (including the caregivers) must be extremely diligent and rigid in their boundaries and treatment structure.
Phase 2: Autonomy of the Child is Slowly Regained
After the child has regained the appropriate weight, established a regular feeding routine, and has a reduction in disordered behaviors, flexibility in the child's access to food increases. This might mean the child has snacks independently from the parents or has more freedom during mealtimes with proper supervision. Another aspect of this phase is introducing "fear foods," or foods that the child previously refused to eat as a result of the eating disorder. It is not uncommon for the child to fall back into disordered behaviors or thinking during this phase—the rigid boundaries will come back until the child is ready again.
Phase 3: Autonomy of the Child is Fully Re-Established
Once it is clear the child/adolescent has established age-appropriate independence around food, the treatment team assists them in developing a balanced lifestyle and addressing developmental concerns and other mental health issues. Relapse prevention skills are addressed and plans in case of relapse are established.
FBT treatment can take anywhere from 6 months to a year or more. As it is highly individualized, treatment length will depend on the severity of the eating disorder, the rate of weight gain (if applicable), the ability for the child to manage freedom and independence, and more. In any case, the treatment team will be there for support and guidance every step of the way.
The Treatment Team: Family Based Treatment for Eating Disorders
The treatment team is a crucial aspect of FBT and can be seen as a "united front" against the eating disorder. The medical doctor, therapist, and nutritionist along with the parents/guardians work collaboratively to overcome the disorder together. This is most effective because the child will be monitored on all sides—medically, emotionally, and nutritionally. As a therapist myself, I can provide the family with skills to manage distress and conflict that will inevitably arise and extend compassion and understanding through the experience. I can also aid the parents/guardians in keeping the structure necessary for FBT's success and work with the child to establish trust and rapport in the process. Checking a child's vitals or informing you of your child's unique nutritional needs, however, is not within my scope of practice despite being just as important. This is why a multi-professional approach is necessary.
The treatment team as a whole also serves as a support system for the caregivers. This process is not easy on anyone, and it's important for the caregivers to feel supported and encouraged even when the treatment is difficult. We often liken the experience of FBT to treatment you would provide a child if they were diagnosed with another severe illness such as cancer. As a parent/guardian, you would likely take your child to the appropriate treatments even if it were difficult. An eating disorder is no different. Another important note that I will often remind caregivers is, it may often feel like you are fighting your child through this treatment. However, what you are really fighting is the eating disorder. So, just as you would work with an oncologist and treatment team to develop a strategy to tackle a malignant tumor, we do the same with eating disorders.
Why Choose Family Based Treatment for Eating Disorders
While there are many treatment approaches to eating disorders, such as Cognitive Behavioral Therapy or Dialectical Behavioral Therapy, FBT is unique in that it puts the parents/guardians of the child in the driver's seat of the treatment. The treatment team directs, coaches, and aids in the execution of the treatment, but the caregivers are what makes FBT possible.
Compared to therapy focused on the adolescent and their behaviors alone, children with FBT-treated eating disorders consistently had higher rates of remission 6- and 12-months following treatment*. This means, while many different therapeutic methods are effective in the short term, FBT seems to establish structure that maintains that efficacy long-term.
Our resources page is chalk full of information about eating disorder treatment.
Sources:
*Gorrell S, Loeb KL, Le Grange D. Family-based Treatment of Eating Disorders: A Narrative Review. Psychiatr Clin North Am. 2019 Jun;42(2):193-204. doi: 10.1016
Sheldon-Dean, H. (2024, December 9). Family-based treatment for eating disorders. Child Mind Institute. https://childmind.org/article/family-based-treatment-for-eating-disorders/