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.