Clinicians' Corner / Helpful Hints

Family-Based Treatment: The Parents’ Perspective

Edited by: Maya Dalack, BS, Lauren Davis, BS and Michelle Laub, LCSW

At the Columbia Center for Eating Disorders, we understand that looking for treatment can be a confusing and, at times, daunting process.

Family-Based Treatment (also known as The Maudsley Method or FBT) is an evidence-based outpatient treatment for adolescents with anorexia nervosa.  The treatment uses the family structure to create an at-home hospitalization where the parents are empowered to re-nourish their child. FBT has also been adapted for use with other eating disorders (such as bulimia nervosa and ARFID), and slightly older individuals who are living at home with their families.

While in-depth explanations of FBT are readily available (please see the end of this post for some resources), we recognize that personal accounts may provide a unique insight into how the treatment actually works.  We’ve asked one set of parents who received FBT with us while participating in our ongoing Teen Study to answer some commonly asked questions and they generously agreed to do so. Answers have been shortened and edited for clarity, but not content, and approved by the contributors.

How did you decide that FBT was the right treatment for your family?

Our daughter was in an inpatient program and we were researching treatment options for her after discharge. We decided on FBT for several reasons:

  • The recovery rate for FBT is much better than the other options
  • FBT provided the structure and support needed to closely monitor her meals until she was ready for more independence.

Any words of advice for parents whose child is resisting FBT?

Supporting our child during FBT feels very similar to parenting her when she was much younger-with similar challenges and words of advice.  We tried hard to separate the eating disorder from our daughter. When she was being resistant/difficult, it was the eating disorder–not her–that was putting up the fight.

Some meals/days were harder than others. I was always afraid that would mean the next meal/s would be hard too. But they never were. The next day/meal was always better. I learned that nothing is permanent. The bad spells pass and there are better days right around the corner. (Even if there are more bad spells around the corner too.)

Don’t negotiate. Sometimes our daughter would make what seemed at first to be reasonable requests for an alternative to what was being served for a meal. But more often than not, one request would lead to another and then another. In those cases, it was the eating disorder talking and we’d end up in a losing battle of finding the “right” thing to eat. If we just said no–our daughter would move on with the meal (and, I think, was often relieved that the conversation was over).

We commonly hear families express concerns about making time to supervise and prepare all meals and helping a child through the re-nourishment process. What challenges did you face? What strategies did you find helpful?

Challenge #1: Managing mealtime difficulties

When our kids were babies and not sleeping through the night, we took turns getting up with them, so the other parent could get some sleep. We do the same thing with difficult meals. Distractions during meal times are good. We played board games during hard meals and sometimes watched a movie. During some rough patches, we avoided meals with friends/families—because it was too hard on all of us to have to visit/make conversation during a stressful meal.

Challenge #2:  Finding support

We leaned on our FBT therapist a lot. For all of us, it was very helpful to be able to talk to a professional–and to get a perspective from outside our family. Our daughter was often more receptive to hearing things from her than from us.

Challenge #3: Establishing identity outside of the eating disorder

Knowing when to give our daughter more independence is hard and scary. Sometimes I think we rushed into independence before we should have–just because we didn’t want her to miss out on something (like a school trip). Other times, we were maybe too cautious. I think it’s all about balance though. One bad meal or day can be made up the next day and learning how to navigate bad meals or days is part of the recovery process.

We try–not always successfully–to not talk about the eating disorder with our daughter all the time. My natural instinct is to talk ALL the time about it, but our conversations were much more productive and manageable at pre-determined times, such as a quick check-in in the morning or a longer conversation a couple of times a week. It is also very important to her that we recognize parts of her that have nothing to do with the eating disorder. For example, if she is having a bad day, my instinct is to wonder if she’s gotten enough to eat. But sometimes, I had to accept that she was just having a bad day–and talk to her about her day without bringing up the eating disorder.

What did you learn about your family, did you find that FBT helped you grow as a family? 

My husband and I have really had to learn to work together. We’ve been married for 20 years and thought we knew how to do that. But the eating disorder really tested us. We’ve gotten better, but it’s a work in progress. For instance, my husband and I set aside time to talk about our daughter and how she (and we) are doing and what’s needed at a given time.

Our whole family has also talked a LOT through this process. I think we are getting pretty good at talking about the hard stuff in a constructive way and then moving on.

Our daughter is a teenager and wants independence, but she also wants our help and support. There are SO many times that she’s pushed us away during her illness and recovery. But that was the eating disorder. And there were always glimmers of the real her underneath. The morning after the worst meal we had as a family during her recovery, she was sad/mad and wouldn’t really talk to me. But she reached out and took my hand. That showed me that she still wanted us to help, even if it was really hard for her to admit it.

Were there any surprises about the treatment?

The numbers don’t lie. Whenever our daughter hits a rough patch that lasts more than a couple of days, it turns out that her weight has dropped out of the healthy range–even by a little. We understand why now, but it’s almost like clockwork–and that surprised me. 

Food really is medicine 

It takes a long time. At the beginning, I thought there would be a time when she was “better” –maybe 6 months or a year from the time she started treatment. But, for us, it hasn’t been that clear cut. There have been times when she’s made a bunch of progress and then for some reason goes “backwards” and needs more support again. I don’t think I realized the recovery wouldn’t be a straight line forward.

Would you recommend this treatment to others? How come/ Why not?

Yes.  Adolescents eventually come home from treatment and will be eating meals without professional support. Through FBT we learned and developed the tools to support our daughter ourselves. If it’s at all possible to structure your schedule to make this treatment work, it is worth it. I often hear eating disorders compared to other illnesses, like cancer, and that perspective is helpful. If you would rearrange your job to support a child with cancer, you should do the same to support a child with an eating disorder.

For additional perspectives on FBT, check out the following resources:

Websites

Books

Documentary

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