Family-Based Treatment: The Child’s Perspective

Edited by: Maya Dalack, BS, Michelle Laub, LCSW, and Brooke Lundy, LCSW

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 strength of the family unit and structure to create an at-home hospitalization, in which 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.

We recently wrote about two parents’ perspectives on FBT at the Columbia Center for Eating Disorders. Here we present the perspectives of 3 teens who received FBT as part of our longitudinal study of adolescents with anorexia nervosa. Answers have been shortened and edited for clarity, but not content, and approved by the contributors.

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

• Respondent 1: When I was on the inpatient unit at Columbia, my family and therapists were talking about possible options for me to continue treatment after my discharge. Multiple doctors of mine suggested FBT because my family generally gets along quite well. We settled on it because of its high success rate and my parents wanted to be involved in my path to get better.
• Respondent 2: We were recommended by the inpatient program treatment providers. My family felt it was a good fit for us after meeting with a team that explained the process to us.
• Respondent 3: thought FBT was the best because it would not only help me, but it would help educate the whole family on the issue. 

What advice would you give to other children who are worried or reluctant to try FBT?

• Respondent 1: If I could talk to other children who are resistant to beginning FBT, I would say that yes, it is difficult, but it is most likely the right choice. What is meant to be is not always comfortable. If you are comfortable with your treatment, something is most likely wrong. I faced some of the biggest challenges I will probably ever face in my life, but I can now confidently say that every challenge I faced only made me stronger. Lastly, I would say that it is okay to not feel okay all the time. However, it is not okay to not have at least a little faith in yourself. Instead of “I feel horrible and I will never get better,” tell yourself, “I may not feel good right now, but I will eventually feel good in the future.”
• Respondent 2: If you want to get better, then you will. You are going to go through highs and lows but the whole point of FBT is that no matter what you are supported. 
• Respondent 3: I would say that it is really worth it because although it seems scary at first, it not only helps you a lot, but it helps your whole family too. 

Did you find this treatment helpful? What strategies did your family use to help you eat when it was really challenging?

• Respondent 1: While this treatment was extremely hard for me, I did find it very helpful. I did not like how involved my parents were in my eating, but looking back on that discomfort, it was mostly my eating disorder that didn’t like them butting in. They were telling me something entirely different than what my eating disorder was telling me. It’s hard to hand control over to others, especially when they’re going to tell you all things that you do not want to hear. But I think that that’s what it takes to get better – you need to let go and hand the steering wheel into the hands of someone else. As close as my family is, we fought day and night when it came to food. Crying, yelling, more crying, and more yelling constantly. It was exhausting, but communication is always the best thing to do. As much as you want to, don’t hide how you’re feeling. And to the parents, do not get angry when your kid fights back! Mending an eating disorder takes much more than just food. It takes understanding and comforting. Your child is trying to control an internal monster – help them through the fight.
• Respondent 2: Yes, I found this treatment very helpful. My family was extremely loving and was willing to sit with me no matter how long it took without any judgment. They understood the difference between me and the illness.
• Respondent 3: I definitely found this treatment helpful. If I had trouble eating, then my family reminded me of my goals. 

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

• Respondent 1: My family has always been extremely close, but I do believe that FBT made us even stronger. We were constantly negotiating, and they did a great job at always being there for me. I really learned that communication is extremely necessary for a healthy relationship.
• Respondent 2: FBT completely helped my family grow. It helped us to understand our dynamic much more and work out a lot of issues we have had amongst each other in the past because of all the time we spent together. 
• Respondent 3: I learned that my family is really supportive and that they will help me through anything. 

Were there any surprises about the treatment?

• Respondent 1: I think everything was sort of a surprise about this treatment. I think it surprised me how challenging it was and how strict the eating part of it was. In the end, though, most treatments are like this, so I think it is less of being surprised by it but instead, it is being introduced to this new type of therapy that is truly unlike any other.
• Respondent 2: I didn’t expect to grow so much as a person. What shocked me was the change in my attitude towards life. I discovered my passions and the relationship between my happiness and my weight. 
• Respondent 3: I was surprised about how effective this treatment was because I didn’t think it would help as much as it did. 

Would you recommend this treatment to others? Why or why not?

• Respondent 1: I would definitely recommend this treatment to others. As I’ve said multiple times, it is really difficult! But, as long as you go into it expecting it to be hard and prepared to face the challenges, you will succeed. Success doesn’t mean perfection throughout your entire journey. You will most likely face minor relapses or steps backward, but as long as you have even the slightest bit of courage, you will get past each and every hurdle. I think this treatment is especially beneficial because it makes sure that your parents are involved in your journey. This is important because it helps to provide the patient with a support system that will always be available in the future. I do wish FBT had involved a bit more of therapy, like some CBT, etc. But FBT is extremely successful no matter how uncomfortable it may be.
• Respondent 2: Yes! I think this is an amazing treatment for people who want to get better but struggle to do so on their own. I wouldn’t recommend this treatment for someone who is deeply rooted in their disorder. This is for people who know that the disorder is ruling their life. Though maybe it could help someone realize how much it is impacting them.
• Respondent 3: I would recommend this treatment to others because without it I wouldn’t be where I am today, and I don’t think my family would have understood my eating disorder as much. 

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

Websites

• Maudsley Parents
• Families Empowered and Supporting Treatment of Eating Disorders (FEAST)
• National Eating Disorders Association

Books

• Help Your Teenager Beat an Eating Disorder by James Lock & Daniel le Grange
• When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating by Lauren Muhlheim, PsyD

Documentary

• Parents to Parents

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