What Parents Need To Know About Family Based Treatment For Eating Disorder Recovery
Erin was terrified when her 13-year-old daughter was diagnosed with anorexia. She spent a few months just trying to get her feet under her as she navigated the care system and tried to figure out what she was supposed to do to help her daughter get better.
I felt like I was running through quicksand, she says. It was awful. Professional advice ranged from wait and see to residential treatment, and neither option felt like the right one for us.
Eventually, she was relieved when she was referred to a practice providing family-based treatment for anorexia. When I found FBT I just knew that was what we needed, she says. Our therapist helped us get our arms around the disorder and treat our child with respect and firmness. It made a world of difference, and she started to get better faster than I thought was possible.
Erins experience with FBT is what every parent who has a child with an eating disorder wishes for: efficient recovery at home. And while FBT isnt a fit for every child who has an eating disorder, it has been very effective for many families facing anorexia.
Understanding Family Based Treatment A Short Guide For Family
Your child has been selected to begin Family Based Treatment , what does this mean?
Recommendation: It is really useful to get a copy of Help Your Teenager Beat an Eating Disorder by James Lock and Daniel Le Grange. 2nd edition. This is the parents companion to the therapists manual.
Systemic family therapy is the most recommended treatment for adolescents with anorexia nervosa, and FBT is the most researched version of this. This approach has a significant body of evidence supporting its effectiveness with young people, and it is considered the leading evidence based approach for treating young people with anorexia nervosa.
This approach requires the parents / family coming together and working together to achieve the goal of restoring normal weight and eating patterns, as a way of banishing the eating disorder from the person. Through empowering parents to regain control of their childs eating, parents are given the responsibility for weight restoration.
In other words, parents take back control from the eating disorder.
The treatment team has chosen to treat your child in this way because
- international evidence supports its effectiveness in treating eating disorders in young people
- the treatment team believe that this will give your child the optimal chance of recovering in a timely period which is crucial for this age group
- The treatment team has the experience, knowledge and expertise in this treatment approach to offer the best opportunity for change to happen
Eating Disorders Treated By The Maudsley Approach
The maudsley approach was specifically designed as a therapy method of treatment for anorexia nervosa. However, it has since been adapted to treat other eating disorders. I highly recommend this treatment option for anorexia nervosa, but may recommend other treatment methods for other eating disorders.
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Discussion On South America Eating Disorder Treatment:
Research from the Ministry of Health, also referred to as Minsal, notes that rates of anorexia nervosa and bulimia nervosa in Chile rose by 97 percent from 2005 to 2007. Rates of these eating disorders in adolescents ages 10 to 19 increased by as much as 115 percent during the same period.
To what do you attribute this recent rise in eating disorders in Chile and throughout South America? How can we spread eating disorder awareness and promote body positivity throughout this region? Contact Us with your thoughts.
Is Fbt Right For Your Family
Family-based treatment can be more effective than other treatments for anorexia, especially in cases where its caught early. However, if its not a good fit for you and your child is not gaining weight, you should know within four weeks. If that is the case, you may want to try other treatment options. Its not a failure on your part, it just means FBT is not the right treatment for your family. FBT is great when it works, but its not the only path to recovery. There are alternatives, and you should not feel ashamed if FBT is not the right fit for you.
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Three: Creating A Healthy Adolescent Identity
Adolescence is a time when people start becoming way more independent from their parents. This can be complicated during eating disorder recovery because the normal need for independence must be balanced with support from family in order to reach recovery. Step three helps teens and their parents work through this process.
Eating Disorder Causes Are Complex And Not As Important As Getting The Right Treatment
Eating disorders are complex brain disorders with strong genetic, neurobiological and psychological underpinnings. No single person, experience, or issue causes an eating disorder. They often co-occur with and can be hidden by anxiety disorders, depression, OCD, PTSD, and substance use disorder. The good news is that we don’t need to know the exact cause of your child’s eating disorder to treat it effectively.
Researchers are still learning what triggers or “turns on” eating disorders in the brain. For many, it seems to come from a negative energy balance caused from more calories out than in which can be triggered by a diet, over-exercise, stomach bug, or surgery. Once that imbalance occurs, a switch flips in the brain, turning the eating disorder on and tyrannizing the brain.
Many people use disordered eating behaviors, such as bingeing, purging, excessive exercise, and restricting, to help regulate or soothe their emotions similar to the use of alcohol or self-harm to escape difficult feelings. When these behaviors are used frequently to manage emotions, it goes from ‘disordered eating’ to being an ‘eating disorder.’
Societal and cultural factors such as the pandemic, diet culture, and social media can trigger an eating disorder for those with a genetic predisposition and/or can trigger big emotions that people try to combat with disordered behaviors.
I feel like I can exhale for the first time since this nightmare started and I am very grateful.
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What Is Family Based Therapy
Family based therapy, or Maudsley Approach, can be summed up as an intensive outpatient treatment where the parents or guardians of the child play an active role in their childs recovery.
Traditional treatment of Anorexia Nervosa and other eating disorders suggests that care should be individually based. Traditional views suggest that parents involvement in recovery range from unnecessary to interfering with recovery. Parents are often seen as part of the cause or reason their child suffers from an eating disorder. The Maudsley Approach opposes this idea that parents should be blamed for development. Instead, parents are considered a resource and essential part of successful treatment.
Benefits And Limitations Of Family Therapy For Eating Disorders
Another benefit is that FBT doesnt require a teen to go to residential or inpatient treatment. Family can stay with their loved one during the treatment process.
One limitation of this approach is that its not easily used in situations where someone needs a higher level-of-care, such as hospitalization or residential treatment. The next section will go over other challenges of this approach.
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What Is Family Therapy
Family based therapy for eating disorders involves the therapist treating the family system instead of a single client. There are many effective family therapy techniques that help treat relationship distress within a family. Most of these therapies are rooted in systems theories which examine how individuals within larger groups interact with each other and rely on specific roles and communication patterns to function. The process of family therapy begins with the therapist getting to know each member and the family as a whole, thereby developing an understanding of the familys needs and their goals for change and healing.
The therapists role is not to say how family members should interact with each other. Instead, their job is to help the family find their own ways of relating that are in alignment with the needs, preferences, traditions, and culture of the family. Many families enter therapy due to one member being unwell, and they often anticipate that only that member will be asked to change. Instead, true family therapy involves addressing the family dynamics that contribute to the feelings and behaviors of the ill member and finding small ways that each family member can change to create healthier functioning for everyone.
Types Of Eating Disorders
There are many types of eating disorders, but family-based therapy is usually focused on only a few. Anorexia nervosa is an eating disorder characterised by restrictive eating patterns, often accompanied by low body weight and an intense fear of gaining weight. Teenagers and young people diagnosed with anorexia will often use various methods and extreme restrictions to control their food and water intake to keep their weight low. In pre-teens, anorexia may delay the onset of puberty and prevent normal growth, and in older teens, menstruation may cease. Teens and young people will often be in denial about the severity of their low body weight and symptoms.
Bulimia nervosa is an eating disorder defined by uncontrolled periods of binge eating, where the child or teen will eat much more than they intended to. This binge is followed by compensatory behaviours that fall into three types:
- Mixed behaviour
Young people who purge may use self-induced vomiting, misuse laxatives, diuretics or enemas to rid themselves of food. Teens who are non-purging may use excessive exercise, fasting or go without food for long periods. Those with mixed behaviour may alternate between purging and non-purging behaviours.
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When And How Can Fbt Be Used As A Treatment Approach
FBT can only be used when:
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The patient is medically stable
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There is no risk of self-harm or suicide
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None of the primary caregivers also suffer from an eating disorder
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No one in the household has inflicted trauma on the adolescent
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The family is able and willing to fully commit to FBT
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A professional is able to guide the family in this outpatient process
The Maudsley Approach Versus The New Maudsley Approach
Before I say more about FBT, I’ll make a detour to talk about ‘The New Maudsley Approach‘. The name leads to confusion because people in the United States often refer to FBT as “The Maudsley approach”, as its roots are in the Child and Adolescent Eating Disorders Service of the Maudsley hospital, London. When you hear ‘New Maudsley’ you could assume that this is some kind of improvement of FBT/Maudsley. Actually it’s a different proposition and the ‘New Maudsley’ book makes no reference to FBT/Maudsley at all.
New Maudsley is not a treatment in itself. It teaches communication skills for carers. The way I see it, it makes sens for carers whose loved one is in individual treatment or who is currently not engaging with any treatment. New Maudsley could help you if your child is being treated with CBT or AFT, and if you’ve been told to only support what’s been agreed in therapy. New Maudsley provides you with communication tools if your child is being made responsible for their own recovery.
New Maudsley was initially developed for adult patients who have been ill for a very long time . Also, the Maudsley hospital tends to treat adult anorexia patients with a method called ‘MANTRA’, and family members get New Maudsley training in order to support the process.. with the person’s agreement.
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How To Provide Family
Many parents will cobble together an FBT-like treatment for their child with an eating disorder. However, true FBT is a detailed program based on a manual. Therefore, it contains specific elements in an outpatient setting and requires sessions with a trained therapist. Studies have evaluated short-term FBT and long-term FBT . FBT is delivered in 3 stages with decreasing levels of parental control over feeding.
The second session of treatment includes a family meal. During this meal the therapist can observe the childs eating patterns and family behaviors. At each session, the therapist will weigh the person who has an eating disorder. Following that, they meet with the family to discuss progress, including a review of weight gain. These meetings begin on a weekly schedule and decrease over time.
The central premise of FBT is that families can be central to eating disorder recovery. And while it is not a fit for every family, many find it very helpful.
Stage 1 of FBT is designed to replace inpatient treatment for an eating disorder. Eating and weight gain are the priority, similar to how they form the foundation of inpatient treatment. Typically the person with the eating disorder is able to continue attending school and participating in activities as long as they are eating and gaining weight.
Phase I: Weight Restoration
In Phase I , therapy focuses on the consequences of anorexia-associated malnutrition, e.g., changes in growth hormone levels, cardiac dysfunction, and behavioral disturbances. The therapist assesses the family’s typical interaction pattern and eating habits and assists the family in re-feeding their child. This may involve reestablishing the patient’s relationships with their siblings and peers. Typically, the therapist will attend a family meal during this phase. Conducting a family meal serves at least two functions: it allows the therapist to observe the family’s typical interaction patterns around eating, and it provides the therapist with an opportunity to assist the family in encouraging their adolescent to eat a restorative amount of food.
Throughout this phase, the therapist must anticipate and prevent parental criticism of the adolescent. In part, this is accomplished by modeling to the parents an uncritical stance toward the adolescent. This is a tenet of the Maudsley Approach: the adolescent is not to blame for their eating disorder behaviors, as these behaviors are symptoms largely outside the adolescent’s control.
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Emotion Focused Family Therapy
Emotion Focused Family Therapy serves as a comprehensive treatment modality to help manage both behaviors and emotions. This therapy is helpful for child/adolescent and adult patients.
The beauty of EFFT is that it creates an opportunity to address emotions in family therapy, which FBT doesnt discuss. Some have hypothesized that FBT can increase caregiver emotionality. EFFT helps teach caregivers how to manage these emotions with the goal being to work towards repairing and strengthening the relationship between a caregiver and their loved one.
What Is Fbt And Is It Different From Maudsley
In the US, James Lock and Daniel Le Grange conducted further trials on the family therapy approach originating from London’s Maudsley child and adolescent services. To do so they needed to outline with more precision the method they were testing: this resulted in a manual for what they named Family-Based Treatment . And confusion, confusion Americans may refer to it as ‘The Maudsley method even though it’s now a bit different from what is done at the Maudsley service.
Watch Daniel Le Grange explaining how his and James Lock’s work on FBT evolved from his work at the Maudsley.
You can read the FBT manual and there’s also a book for parents . Therapists can go for certification, which offers you, the parent, some confidence that they have gone through a lot of training and supervision. There are also good FBT therapists who don’t have the certification . My own family got top-notch support from a therapist who was shadowing another therapist who was going through FBT certification.
You will find FBT dotted around the world, in particular in the US, Canada, Australia, New Zealand and Scotland. For a list of certified FBT therapists who are open to working by video call anywhere in the world, see my list here.
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How Do You Know If Family
If a child or young adult is in a life-threatening medical or psychiatric situation, then hospitalization is necessary. In most other cases of anorexia and bulimia including those where the young person is very underweight but otherwise medically stable experts recommend FBT.
Dr. Le Grange emphasizes while FBT might sound daunting, most parents do have the capacity to manage it. All parents come to us with strengths and weaknesses, he says. FBT involves coping with each familys unique challenges and building on their strengths. And the major strength is that families love their kids, Dr. Le Grange adds. There are other eating disorder treatments available if FBT doesnt work or isnt feasible, but they generally dont help kids regain weight as fast as FBT does.
Accordingly, Dr. Le Grange urges parents not to rule out FBT, even if their circumstances are challenging. We have to be creative as clinicians, he says. That might mean helping parents juggle work responsibilities or financial difficulties, bringing in extended family for support, or helping parents navigate disagreements with each other. Some situations are much tougher than others, without a doubt, says Dr. Le Grange. But that just means that we as clinicians have to work harder and be more supportive.
Heres How The Process Works
With family-based therapy, at least one meal is eaten in the therapists office at first, so the therapist can see what kind of dynamics happen and how they can help change behaviors. Typically, a family starts with weekly sessions with a therapist, and over time sessions decrease. Adolescents may not necessarily want to participate initially, but the treatment is centered around the family.
There are three phases of treatment:
1. Full control by the parents or loved ones. In this phase, the parents decide what to do based on nutritional needs. It eases the responsibilities and stress for the child, Dr. Srivathsal said. They dont have to worry about what they are going to eat. The parents or caregivers are going to take care of it.
This stage is crucial, because when the brain is nutritionally deprived, people cant think clearly. They cant understand that something bad is going on. It could be like a delusion, Dr. Srivathsal said. They may look in the mirror and feel like they are fat when thats not the case. But they cannot understand or believe it.
Parents need to supervise all meals and may need to supervise their child after meals if theres a risk of purging or overexercising. The level of supervision is similar to inpatient treatment, but outside of meals, the child can participate in everyday activities as much as possible.
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