Free Workbook for Parents and Caregivers: Supporting Teens with an Eating Disorder

Posted on May 21, 2025June 3, 2025 by Crowncreatives

In March I wrote a blog post about validation and how it can be used to support your teen in their recovery from their eating disorder.

Validation stuff is tricky. Take it from me. I am a parent and a trained therapist and sometimes I still get it wrong.

And it is still worth pursuing.

Validation is not something that you learned from a typical parenting book.

In fact it is something that therapists spend endless hours learning about in grad school and practicing with clients.

Because it is so tricky I wanted to provide a resource for caregivers to help learn more and hone their skills in validation–that’s why I created this free validation workbook. This workbook is geared towards parents supporting a teen with anorexia, bulimia or binge eating (not ARFID-that is a whole other workbook-stay tuned!) I hope you find the workbook helpful!

Quick recap why validation is important:

It fosters trust
Helps regulate your teens nervous system be feeling seen and heard
A regulated nervous system allows your teen to engage in problem solving
And as a parent you may notice that it helps you feel calm!

Grab the Free Workbook for Parents and Caregivers Supporting Teens with an Eating Disorder here!

Schedule your free 20 minute consultation here.

The Power of Validation: Supporting Your Child Through Eating Disorder Recovery

Posted on March 5, 2025June 3, 2025 by Alison Pelz, LD, RD, CDE, LCSW

Is your teen struggling with an eating disorder?

As a parent, witnessing that struggle and feeling like nothing you say helps or wondering if you’re helping or are making things worse, can be one of the most difficult obstacles to navigate as a parent. And if you’ve felt this way, know that you are not alone. These aren’t experiences most of us know how to prepare for–there are no tools for caring for a loved one with an eating disorder in general parenting books. Unlike clinicians who go to school and receive on-going training to help people in recovery, parents have no such roadmap.

Witnessing your child struggling with an eating disorder can feel overwhelming, confusing, and deeply painful. As a parent, you naturally want to help, but knowing how to respond in the most effective way is not always intuitive. One key tool you can use to support your child’s recovery is validation–understanding what it is, why it matters, and how to practice it can make a world of difference for both your child and your family.

What Is Validation (And what it is not)?

Validation is the act of recognizing, understanding, and accepting someone’s feelings or experiences as real and meaningful.

Caregivers often worry that their validation will give their child permission to restrict food or purge–but that’s not the effect that validation has. Validating your child’s emotional experience doesn’t mean endorsing or encouraging damaging behaviors. What it does mean is that you are able to acknowledge their emotional reality without judgment. This practice lets your teen know that you are someone safe to turn to, because you will listen without assigning “right” or “wrong” to what they are feeling, and are instead there to try and understand their experience so you can better support them. Practicing validation can also be helpful for parents or caregivers in the moment because it often diffuses intense reactions you may be experiencing, and give you a moment to listen rather than react.

What validation is:

Actively listening and showing empathy.
Communicating that their feelings make sense, given their perspective.
Offering a safe space for them to share their struggles without fear of criticism.

What validation is not:

Agreeing with unhealthy behaviors or distorted beliefs about food, body, or worth.
Dismissing your own boundaries or enabling harmful actions.
Fixing their problems or trying to reason them out of their feelings.

Why Validation Is Crucial in Healing

Validation is a cornerstone of emotional healing because it helps your child feel heard, understood, and less alone. Eating disorders often thrive in silence and shame, and by validating the emotional experience your child is having, you help dismantle the isolation that fuels their struggle.

When your child feels validated, their nervous system can move out of a heightened state of stress or fear (often referred to as “fight, flight, or freeze”) into a calmer, more regulated state. This shift is essential because a regulated nervous system allows your child to:

Think more clearly and process emotions more effectively.
Develop healthy coping mechanisms.
Engage more fully in therapy and other forms of treatment.

Fears Parents May Have About Validation

Parents often worry that validation might:

Encourage unhealthy behaviors: It’s important to remember that validating your child’s feelings is not the same as endorsing their actions. For example, “I can imagine that it is very hard for you to complete your meal right now because it makes you anxious” is letting them know that you understand what they are struggling against, without encouraging them to restrict themselves.
Undermine parental authority: Validation doesn’t mean you have to compromise your boundaries or expectations. In other words, because you understand how hard it is for them to eat, that doesn’t mean you let them go unnourished.
Reinforce disordered thoughts: Validation focuses on emotions, not necessarily agreeing with the thoughts driving them. For example, saying, “It makes sense that you feel overwhelmed right now” doesn’t mean you agree with their belief that they “must” restrict food to feel in control.

Barriers to Validating Your Child

It’s not always easy to validate your child’s emotions, especially when:

Their feelings seem irrational or extreme. For example, your child may be fearful that they will gain a bunch of weight if they eat a piece of bread or that if they get a B in a class they won’t get a good job.
You’re feeling triggered, stressed, or unsure of how to respond.
You’re worried about saying the “wrong” thing and making things worse. The important thing is that you are trying and your teen will see that you are trying to understand them and what they are experiencing.
Your own emotions—such as frustration, fear, or sadness—are taking over in the moment. If this is the case, you may need to take a step back and come back later to your teen and validate them later. It is never too late.

Validation often doesn’t come naturally to us (I know when in my personal relationships I often find it challenging, and I am a therapist!). The good news is that validation is a skill that you can learn and practice.

Examples of How to Validate

Here are some ways to practice validation in everyday conversations:

Listen Without Interrupting: Show you’re fully present by maintaining eye contact, nodding, and responding with short affirmations like “I’m listening” or “Tell me more.”
Reflect Their Emotions: Paraphrase what they’ve shared to make sure you understand what they are saying. For example, “It sounds like you’re feeling really anxious about eating today, am I understanding that correctly?”
Normalize Their Feelings: Help them see their emotions as a natural response. For instance, “I can understand why you’d feel overwhelmed; this is a big change for you.”
Acknowledge Their Struggle: Recognize the difficulty of their experience. For example, “I can see how hard this is for you, and I’m here to support you.”

Ways to Practice Validation

Validation is a skill that can be developed with practice. Here are some tips:

Pause Before Responding: Take a deep breath to ground yourself if you’re feeling reactive. This both gives you a moment to decide how to respond, and helps to regulate your emotions so you are more able to respond intentionally.
Practice Empathy: Try to see the situation from your child’s perspective. Ask yourself, “How might this feel for them?” If you don’t know how they are feeling, ask.
Use “I” Statements: For example, “I’m here for you” or “I want to understand how you’re feeling” or “I can see why this feels overwhelming” rather than focusing on what they “should” do can help show your teen that you want to be an active support for them, and don’t want to blame them for what they are struggling with.
Role-Play Scenarios: If you’re working with a therapist or support group, practice validating responses to common situations.

A Path to Healing

Validation is not a magic cure, but it lays a critical foundation for healing. By helping your child feel seen and understood, you create a space where they can face their struggles without fear of judgment. Over time, this fosters the emotional resilience and trust they need to move toward recovery.

As a parent, you don’t have to be perfect—and there will be times when you stumble.

But each effort you make to validate your child’s emotions is a step toward connection and healing. Remember, you are not alone in this journey. Reach out for support, whether from therapists, support groups, or other parents who understand the challenges of eating disorder recovery. Together, you can help your child find their way to health and hope.

As a therapist who is also a dietitian, I can help you understand what is going on from both angles. If you are in Texas and interested in working with me, click here to fill out a contact form. I would love to support you and your child on your journey to health.

Supporting Your Child Through an Eating Disorder: A Guide for Parents

Posted on February 5, 2025June 3, 2025 by Alison Pelz, LD, RD, CDE, LCSW

Feeling overwhelmed, frightened, and unsure of how to help when your teen is struggling with an eating disorder is a common and natural experience for parents. And while eating disorders are complex and often misunderstood, with the right resources and support, recovery is possible for your teen. And as a parent, you play a crucial role in your teen’s healing journey.

Below you can find compassionate guidance as well as therapist recommended resources to help you support your teen through their eating disorder recovery effectively.

Start With Understanding:

Eating disorders are complex, but that doesn’t mean they are unknowable. Education is one of the most powerful tools you have at your disposal, not only to help you find effective methods of support, but also to help expand your understanding of what causes and may impact eating disorders, so you can give informed care to your teen–rather than having to rely on guess work and risk causing harm. Understanding the nature of eating disorders and their impact on both physical and mental health can demystify the illness and empower you to provide informed support to your teen.

Here are some highly recommended resources to deepen your knowledge and help you in supporting your child:

When Your Teen Has an Eating Disorder by Lauren Muhlheim:

This book provides practical advice for parents navigating their child’s eating disorder, offering evidence-based strategies rooted in Family-Based Treatment (FBT) in a non-clinical manner so they’re accessible to the non-clinical reader. Muhlheim is the founder of Eating Disorder Therapy LA, an outpatient treatment center, has trained many clinicians and is a frequent speaker at eating disorder trainings and conferences. You can read my full review of this book, and why I consider it a must read here.

Sick Enough: A Guide to the Medical Complications of Eating Disorders by Jennifer Gaudiani:

Dr. Gaudiani’s offers a compassionate exploration of the medical side of eating disorders throughout Sick Enough, helping parents understand the seriousness of eating disorders and how to advocate for their child’s car by breaking down the impact of dietary restriction on your children’s bodies and brains, providing descriptions of common medical problems associated with eating disorders, as well as common co-occurring medical issues that complicate diagnosis and treatment.

Dr. Gaudiani is a board certified-internal medicine doctor who specializes in the treatment of eating disorders, as well as the founder of the Gaudiani Clinic: an outpatient medical practice specializing in the treatment of eating disorders, and a highly respected physician in the eating disorder community.

How to Nourish Your Child Through an Eating Disorder by Casey Crosbie and Wendy Sterling.

Authors Crosbie and Sterling are registered dietitians who specialize in the treatment of eating disorders. How to Nourish Your Child focuses on the Plate-by-Plate approach, a resource which gives parents actionable steps to help their child restore nutrition-without counting calories or macros.This book helps parents answer the question, “what and how much should I be feeding my child,” especially for parents of teens with eating disorders.

Anorexia and Other Eating Disorders: How to Help Your Child Eat Well and Be Well By Eva Musby.

Eva Musby’s lived experience as parent supporting a teen daughter through in an eating disorder makes her book a wonderful resource. She provides invaluable tools for parents, including guidance on communicating with compassion, handling mealtime challenges, and navigating the emotional toll of supporting a child with an eating disorder. You can visit her website for free resources and updates.

Lean on Community

Try to remember that you are not alone in this journey. Many parents have walked this path and found solace, guidance, and strength in connecting with community and many who have found healing in connecting with others who understand your struggles. Some places to start:

FEAST-ED.org:

F.E.A.S.T-ED (Families Empowered and Supporting Treatment of Eating Disorders) is an organization that offers resources specifically for parents and caregivers of children with eating disorders. Their community of parents provides support and shared experiences, and resources like forums, educational materials, and a library of researched back information

The Alliance for Eating Disorders Awareness:

This organization offers support groups, treatment referrals, and education for families. Their resources can help you find professionals and programs tailored to your child’s needs.

Practical Tips for Supporting Your Child Effectively:

Practice Patience and Empathy: Recovery is a marathon, not a sprint. Validate your child’s feelings, even when you don’t fully understand them. If you want to learn more about why validation is important (and how to do it) in your child’s recovery I highly recommend this video on emotional coaching.
Focus on Nourishment, Not Blame: Approach meals and food with a goal of healing and restoration, rather than criticism or punishment.
Prioritize Your Own Well-Being: Supporting a child through an eating disorder is emotionally taxing. Seek support for yourself, whether through therapy, parent groups, or trusted friends.
Communicate Openly With Your Child: Foster an environment where your child feels safe to share their thoughts and feelings without fear of judgment.

A Final Word

As daunting as this journey may seem, remember that recovery is possible. By equipping yourself with knowledge, support, and compassion, you can help your child reclaim their health and happiness. Keep taking it one step at a time, and don’t hesitate to reach out for help when you need it. You are not alone in this fight—and neither is your child.

Do you have a teen who is struggling with an eating disorder? Working with a therapist who is experienced in Family-Based Treatment can help. If you are in Texas and interested in working with me, click here to fill out a contact form.

Levels of Care in Eating Disorder Treatment: How to Choose the Right Option

Posted on October 1, 2024June 3, 2025 by Alison Pelz, LD, RD, CDE, LCSW

Treatment for eating disorder recovery isn’t a one-size-fits-all approach.

Every person is unique, and not everyone recovers in the exact same way. This is why eating disorder treatment is categorized into different levels of care, depending on what the person in recovery needs.

This post will provide a brief overview of the different levels of care available during eating disorder treatment.

What are levels of care?

Levels of care refer to how much support is needed to reduce eating disorder behaviors during treatment. Several levels of care may be utilized throughout treatment for an eating disorder, based on what is necessary for the person in recovery.

Treatment choices can be overwhelming if you or your teen are newly diagnosed with an eating disorder. Residential, day treatment, or outpatient care – what does this all mean?

Levels of care in eating disorder treatment are selected based on many factors including:

Medical: This often is the driving factor in selecting the level of care. If you or your teen are medically compromised more care may be needed.
Severity of malnutrition: Different levels of care offer varied amounts of support for nutrition rehabilitation.
Co-occurring conditions: Often those with eating disorders have other medical or psychological conditions that also need to be treated.
Social support: Social support improves mental and physical health. The different levels of care offer varying levels of social support.
“Motivation”: Most of us want to feel better and be healthy. However, change can feel scary, overwhelming and downright impossible at times. Those who feel more stuck in their eating disorder may need more support to feel like change is possible.
Access to care: Proximity to treatment, insurance, and specialty care are all considerations. Virtual treatment by clinicians and treatment programs are being utilized to increase access to care.

What are the different levels of care in eating disorder treatment?

In-patient hospital care

In-patient hospital care is used when a person with an eating disorder needs round-the-clock medical care. Since eating disorders have significant medical consequences due to malnutrition and/or purging, medical stabilization may be needed during treatment.

Residential care

In this level of care, round-the-clock care is provided in a therapeutic environment. This allows for intensive psychological treatment and nutrition rehabilitation, while also monitoring medical status. The residential care environment is highly structured and allows for the reduction of eating disorder behaviors.

Partial hospitalization

In a partial hospitalization program, the person attends several hours per day most of the week. Partial hospitalization provides psychological treatment (individual therapy, group therapy, and family therapy) and nutritional therapy, including therapeutic meal support. This level of care is very similar to residential care, just without spending the night. In this level of care, you or your teen may go in several days a week, and each day have a meal or snack at home.

Intensive out-patient (IOP)

This level of care is when you or your teen spend the majority of time at home and engaged in usual activities such as work or school. The person in eating disorder treatment usually has a therapist, dietitian, and doctor and attends several groups per week.

Outpatient

Outpatient care is considered the lowest level of care in eating disorder treatment. In this level of care, you or your teen are spending 2-3 hours a week in treatment with an outpatient treatment team. Oftentimes, outpatient services are utilized first because it allows the person in treatment to stay active in daily activities such as work or school. Outpatient care can be easiest to access because most areas, particularly with telehealth options available, have qualified eating disorder outpatient providers.

Family-based treatment (FBT) is an outpatient treatment for teens. It is particularly effective for teens with anorexia nervosa. FBT can be an option in place of residential care or partial hospitalization, if the person in treatment is medically stable.

How do I know which level of care is right for me?

First, consider your medical needs with your doctor. The more medically compromised the person with the eating disorder is, the higher level care they may need.

If residential treatment is recommended, that doesn’t mean the eating disorder is worse than others. It just means that you need this level of support to get back to health.

If you or your teen are utilizing outpatient care, your treatment team will work with you to help determine the level of support needed.

Many treatment centers provide multiple levels of care residential, partial-hospitalization, and IOP. The treatment center will help determine the level of care needed via an assessment, which is usually free and done over the phone.

It is not unusual to utilize multiple levels of care during the course of recovery.

For example, someone in treatment may start out as an outpatient. If the person in treatment and their treatment team determine that their eating disorder symptoms are not getting better, they may benefit from a more supportive level of care (which is also referred to as a “higher level of care”).

Eating disorders usually don’t go away on their own. They can progressively get worse over time. My hope is that if you, or someone you care about, is suffering with an eating disorder that you make the initial call to get help.

Hi! I’m Alison Pelz, a psychotherapist and registered dietitian in Austin, TX with over 16 years of experience in eating disorder treatment. If you or someone you care about is struggling with an eating disorder, don’t hesitate to reach out for help. To learn more about eating disorder treatment and levels of care, schedule a consultation with me today.

Are you a clinician? Sign up for my mailing list and get a coupon for 10% off of one of my CE courses!

Book Review: When Your Teen Has an Eating Disorder is a Must-Read

Posted on September 10, 2024June 3, 2025 by Alison Pelz, LD, RD, CDE, LCSW

The book When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating, author Dr. Lauren Muhlheim discusses eating disorders and their treatment in great depth.

If you think your child or teen has an eating disorder, this is a must-read.

Eating disorders can perplex many parents and clinicians alike. Your teen may not be acting like their usual self. It’s hard to know if this is just normal teenage angst or something more serious. If your teen has an eating disorder, they may have changed greatly right before your eyes. Including food refusal, increased anxiety around eating, or changes in mood and energy.

You may have talked with them about the importance of eating and tried to reassure them that they are not gaining weight. (In fact, they are likely losing weight.) But your child’s struggles seem to be getting worse, not better.

If your teen has not seen a doctor yet about their eating disorder, this is the first step to make sure they are medically stable.

This book can help guide you and your family in treatment while establishing an eating disorder treatment team consisting, at minimum, of a doctor and therapist.

About the Book

When Your Teen Has an Eating Disorder discusses the complicated concepts surrounding eating disorders in teens in a non-clinical manner. The book provides an overview of various treatment options. It goes into depth about a unique and well-studied treatment called Family-Based Treatment (FBT).

The author of the book, Dr. Lauren Mulheim, owns a counseling and training center in southern California. She uses Family-Based Treatment in her clinic and has been instrumental in training many of the eating disorder therapists in the Los Angeles area and beyond. And she is currently serving on the advisory panel of FEAST (an organization for parents). She is a regular speaker at national eating disorder conferences.

If you are a parent worried about your child and unsure how to help them overcome their eating disorder, this book is a must-read. As an eating disorder therapist myself, I recommend this book to all of the families that I work with. It is a great resource and provides a glimmer of hope to you on your journey.

What is discussed in When Your Teen Has an Eating Disorder?

When Your Teen Has an Eating Disorder outlines the complexities of eating disorders and the impact that they can have on your teen (and your family’s) life.

Learn the warning signs:

Changes in eating and/or exercise habits
Frequent trips to the bathroom
Changes in body weight
Loss of menstrual cycle
Complaining of feeling cold all of the time
Lack of growth
Obsessive thoughts about food, body image
Changes in overall mood
Poorer concentration

Muhlheim highlights the importance of early detection and intervention with trained clinicians, so that the eating disorder can be addressed before it escalates or becomes chronic.

She provides the reader with an excellent explanation of how malnourishment impacts your teen’s ability to understand how the eating disorder is impacting their mind and body. Parents often feel perplexed when their bright, loving child begins to act irrationally around food. You will also learn how to separate your child from their illness, one of the basic assumptions of family-based treatment.

The majority of the book really gets to the heart of the matter: What parents really want to know when their child has an eating disorder. You might be asking yourself questions like “What do we do?”. Or, “How do we improve our child or teen’s health and get them feeling better again?”

This book can help you answer those questions. In it, Mulheim:

Outlines the path to help your child or teen heal from their eating disorder using family-based treatment (FBT).
Discusses the three stages of recovery-nutrition rehabilitation, eating independence, and relapse prevention in depth.
Provides parents rationale behind each step so parents can feel empowered to help their child.

Discover Practical and Helpful Tools to Help Your Teen in Eating Disorder Recovery

This book is a practical guide that provides effective, concrete strategies for eating disorder treatment, and examples of how to use them.

Family-based treatment helps parents become empowered agents of change amid their child’s eating disorder. The book provides general guidelines about what to feed your child and how to structure meal times. Additionally, highlights how to effectively interact with your child at each stage of treatment. Including how to be empathetic with them when they are struggling.

In addition to concrete strategies and practical steps, it also covers the challenges that parents might face during treatment. The book details what to do when your child refuses to eat. It also explains how the parents can get support throughout the difficult journey of helping their child get better. You know about The hard aspects of treatment athat they are prepared.

Muhlheim provides all of this information while also sharing real-life examples throughout the book. The stories within this book help parents feel less alone about what is going on with their child. It also provides them with a realistic picture of what they are facing. These examples make parents feel more confident about applying the practical tools needed for recovery.

It is normal for parents to worry about how treatment will affect their relationship with their teen. When Your Teen Has an Eating Disorder emphasizes the importance of your relationship with your teen in the treatment of their eating disorder. A family culture of unconditional acceptance, respect, trust, and empathy supports your child in their recovery. Furthermore, it provides strategies of how to talk to your teen about food and body image during the recovery process.

When Your Teen Has an Eating Disorder is a Great Resource For Parents

Whether your teen is struggling with anorexia, bulimia, or binge eating disorder, this book is helpful for parents. This book will help you if your child is newly diagnosed with an eating disorder, in early stages of treatment, or if your teen has been through several rounds of treatment already.

This book will empower you to support your child’s recovery. If you are seeking treatment for your child, it will give you enough information to decide whether or not Family-Based Treatment is right for your family. If you decide that FBT is the best treatment option, this book walks you through how to create a treatment team that will be the best fit for your child and family.

As a therapist and parent, I appreciate how this book (and FBT in general), takes a very non-blaming stance on eating disorders. Parents aren’t faulted for the disorder and the child isn’t isolated from their family. This book recognizes the family-based treatment approach and belief that parents are the experts on their child. It emphasizes how treatment for eating disorders needs to include the family for best results and also the importance of meal support and nutritional rehabilitation for recovery. I highly recommend reading this book!

If you think your teen has an eating disorder please consult their doctor for assessment and medical care as eating disorders can be life threatening. If you are a parent and are interested in family-based treatment for your child in Texas, you can schedule a consultation with me here.

If you are a clinician looking for a book that can help you understand eating disorders and family-based treatment, you can get CEU’s for reading this book by clicking here.

*Please note this book is not a substitute for professional help from a doctor and eating disorder treatment professionals.

Can Family-Based Treatment Help My Child Recover from an Eating Disorder?

Posted on June 3, 2024June 3, 2025 by Alison Pelz, LD, RD, CDE, LCSW

If you are a parent or caregiver desperate to help your child who is struggling with an eating disorder, family-based treatment may be the solution.

Often, families come into my office worried sick about their child.

Your child may have lost weight or become more rigid around food. Perhaps your child has been over-exercising, using laxatives, or throwing up after eating.

Or, your child only eats a small number of foods, or eats a lot of food at once.

You may feel terrified because the doctors mention treatment centers or hospitalization.

No matter what your child’s symptoms are, you may feel frantic, frustrated, and powerless. You have tried to make things different, but don’t know what to do.

If you find yourself in a similar boat today, you’re not alone. I have worked with countless families who walk into my office feeling this way.

Many parents have been seeking help for a while. Unfortunately, they have found no real results. They often receive criticism, but no real guidance on how to help their child get better, or well-meaning doctors say they will grow out of it, and that it’s just a phase.

I’m here to give you hope.

After years as a therapist and registered dietitian, I’ve seen the positive results that come from family-based treatment. When parents are properly equipped and supported to be part of the solution, their child’s needs to get better.

Why Choose Family-Based Treatment?

Family-based treatment (FBT) for eating disorders is an evidence-based treatment for anorexia and bulimia nervosa.

Unlike many other treatments that put the responsibility on the identified patient or the person with the eating disorder, FBT includes the parents. Instead of seeing the parents as part of the cause of the eating disorder, they are seen as part of the solution.

We use your expert knowledge of your child to help your child get better.

This method of treatment makes sense to parents. If your child had cancer or some other serious medical condition, you, as the parents, would be highly involved in treatment. Such as attending appointments, physical therapy, and all the steps to recovery.

It shouldn’t be any different for treating eating disorders.

Eating disorders are an epidemic in our country. According to the NIH, for teens between the ages of 13 and 18, the lifetime occurrence of anorexia, bulimia, and binge eating disorder is 2.7%. These disorders are twice as common among girls as boys. They also tend to be more common the older the teen gets.

How Effective is Family-Based Treatment?

Family-based treatment has been used in the United Kingdom for many years. It has proven to be more effective than other forms of eating disorder treatment.

With a 75% success rate, teens receiving FBT also recover faster than with other treatments. The research also shows that teens are doing better after engaging in FBT than in other treatments.

How Does Family-Based Treatment Work?

In family-based treatment, a clinician guides the parents in empathizing with the child while also holding boundaries around eating and food. Parents help interrupt other eating disorder behaviors like binge eating and laxative use.

The therapist coaches the parent on how to teach their child to eat again. The goal is for the child to eventually have age-appropriate responsibility for food intake and eating habits.

Family-based treatment usually lasts around 20 sessions and happens in three stages.

During the first stage, the parents are responsible for preparing and serving food. Helping their child eat as much as their body needs to nourish them back to health. Parents do the job that a nurse would do during an inpatient stay at a hospital. There is no room for negotiation around food or other eating disorder behaviors like purging, misusing exercise, or laxatives.

The second and third phases include slowly giving responsibility for food and exercise back to the child.

During the second phase, the child may return to more normal activities while being supervised by their parents for any signs of relapse.

During the third stage, the child begins to transition back on track with their developmental stage of eating.

What Makes FBT Different?

Family-based treatment is quite different from the standard eating disorder treatment.

First of all, at its core, FBT does not blame the child’s parents (or the child) for the eating disorder. One of the core beliefs of family-based treatment is that no one in the family is to blame. Really, the focus is on getting the child well instead of placing blame.

In other treatments, the person with the eating disorder receives the bulk of the treatment outside of the family system. But, with FBT, the parents, child, and sometimes even the siblings, are involved in treatment.

The parents’ care and motivation to help their child are used to make some major changes in the family’s life, especially around food. Their unique expertise on their child is used to help them get better, and parents are taught how to interact with their child around food, and other eating disorder behaviors.

This allows the family to overcome the eating disorder together.

Another difference with FBT is the focus on food, nutrition, and eating disorder behavior rehabilitation. FBT believes that a lot of the symptoms of the eating disorder will disappear when the child is better nourished and no longer using other eating disorder behaviors. So they first focus on nutrition, feeding, and decreasing other eating disorder behaviors.

Often, parents think that their child has to be “motivated” for treatment to be effective. One of the differences with FBT is that the child does not need to be motivated to change to get better. The motivation to make change happen starts with the parents.

What are the Benefits of Family-Based Treatment?

Family-based treatment has benefits for both the family as a whole and the child, including:

The child or teen usually gets better faster than any other treatment, making it one of the quickest ways to help your child and family heal.
Parents are involved in the child’s treatment, allowing them to be the child’s primary support instead of feeling powerless and at fault.
This is a good replacement for inpatient treatment or partial hospitalization, allowing your child to stay home.
FBT is an evidence-based approach, so you know you are doing the best you can for your child.

Now that you know how FBT can help, let’s look at who it can help.

Who is FBT for?

FBT has been shown to be effective for kids, teens, and young adults showing signs of eating disorders.

It has been used to help kids and teens who are struggling with anorexia, bulimia, binge eating disorder, and in some cases ARFID.

In the cases of binge eating disorder and bulimia, the family is taught to help feed their child adequately and supportively interrupt binge eating, purging, laxative use, and misuse of exercise.

FBT works both for teens who have been to inpatient multiple times and still struggle to let go of the symptoms, and for teens who have just started to engage in eating disorder behaviors, and for any child in between.

FBT is not just for teens, however. It can also be used with children and young adults still living at home. FBT can be used in all different types of families or caregiving situations (like grandparent caregivers and single-parent households).

Who Should Not Do FBT?

FBT should not be used for children and teens who are medically unstable. Always consult a doctor if you think your child has an eating disorder.

FBT is often used instead of higher levels of care, such as residential or day treatment. If the child is underweight and cleared by their doctor to stay outpatient, FBT can be a great option rather than high levels of care.

In the same way, if the child needs to be supervised for other psychiatric illnesses, then this is also a situation where FBT is not going to help until the child is stable psychologically. Family-based treatment may also not be a good option if the child has experienced certain types of trauma.

What Happens During Family-Based Treatment?

Family-based treatment may last around 20 sessions. At each session, you can expect your child or teen to check in with the therapist for mental health support.

After this, the therapist will meet with the parents and child for coaching around nutrition and other eating disorder behaviors. The coaching isn’t just about what to eat but also about how to talk to your child about eating and other eating disorder behaviors, including how to express empathy without giving in.

Unlike other eating disorder treatments, where the therapist just meets with the child, most of the time, the FBT therapist meets with the caregivers and the child.

Family-Based Treatment is Worth the Hard Work

Family-based treatment can be very intense for the whole family. In the beginning, you will be very involved in your child’s day-to-day life, as well as your child’s nutritional rehab, but the hard work will be worth it when your child learns to eat and regains their health again.

Not only does family-based treatment help your child stay home, as hospitalizations can last weeks or months, but it also helps to heal your whole family from the disruption that the eating disorder has caused.

While it can be hard to find family-based treatment, don’t give up! Finding someone who is trained to do family-based treatment can make the difference for your child.

At a minimum, when you are seeking FBT you will need to at least start with a medical doctor and a therapist. If your team includes a dietitian, initially, they will only meet with the parents and not the child.

As a therapist who is also a dietitian, I can help you understand what is going on from both angles. If you are in Texas and interested in working with me, click here to fill out a contact form. I would love to support you and your child on your journey to health.