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What is Family-Based Treatment?
Family-Based Treatment (sometimes referred to as the Maudsley Method or Maudsley Approach) is an evidence-based approach for supporting individuals with eating disorders.
It’s most commonly used with adolescents who are recovering from anorexia, but more recent research is showing its effectiveness for other eating disorders as well.
In this blog, I’m going to speak a little bit about what Family-Based Treatment (FBT) is and whether or not it might be a good treatment fit for you or a loved one.
At the end of this blog are some tips for caregivers if they are working within an FBT framework. I want to avoid getting too technical, but I think some education about the Family-Based approach can be useful.
Family-Based Treatment is run by the primary therapist and a dietitian is involved if the family needs more coaching on nutrition.
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The primary therapist counsels the client’s loved ones and the client is fairly uninvolved until they are more properly nourished.
I get a lot of questions from referral sources and from families about whether or not I can take a Family-Based Treatment approach with my clients. I like to call our work either FBT-informed or FBT-modified because it’s not a true FBT approach.
In my opinion, it’s important to have a dietitian involved. Nutrition rehabilitation can be so complicated and confusing for families and clients. Typically, the body’s needs are higher at initial stages, so having guidance from someone who is trained in nutrition is crucial.
Family-Based Treatment occurs in 3 phases:
Phase 1: Weight Restoration
In this phase, the family and the therapist are working to assure the client is fueling enough. The family (or loved ones) actually have full control over what the client is going to eat, so the client’s only job is to eat. Often times distractions during meals are helpful. The family will also get coached on how to support the client through a meal.
Phase 2: Returning Control
The client can now begin to start choosing some of their own food choices. The family might also notice a change in their loved one’s mood, which can be attributed to the body and brain finally getting the fuel it needs to function properly.
Phase 3: Establishing a Healthy Identity
Now, the client can finally do some work in finding out who they are without the eating disorder voice. In therapy, there might be discussions about core values and finding autonomy within the family system.
FBT Tips for Caregivers
Family-Based Treatment can be helpful for many families who have a loved one struggling with an eating disorder. I’ve modified the FBT approach for my clients and I’ve heard feedback from many that it can be comforting when someone else makes the food decisions. However, FBT does put a lot of pressure on the caregiver.
Here are some tips and reminders for caregivers and loved ones of those who are struggling with an eating disorder:
Ask what you can do to help. Sometimes the answer will be, “nothing.” And that’s okay. You can tell your loved one you’re there if they do want support
Validate. Validate that what your loved one is doing through is really, really hard. There are some resources about validation on this website.
It’s not your loved one, it’s their eating disorder. The eating disorder can be and manipulative. And that’s not your loved one. Your loved one is kind and generous.
Every day won’t be “perfect.” I’m sure you’re doing your best to follow the recommendations set by your dietitian or therapist. Some days this will go really well. And other days you may struggle through it.
Colluding with the eating disorder isn’t helpful. Your loved one’s eating disorder may try to bargain with you. Talk to your loved one’s therapist or dietitian on how to navigate this.
Asking for help is important. Supporting a loved one is emotionally and physically exhausting. You may need to seek out your own therapy and make time for your own self-care.
A higher level of care is often needed. The idea of sending a loved one to treatment can be terrifying. Often times, this is exactly what someone in recovery needs. Going to a higher level of care isn’t a “failure.” It’s a safe space to do the hard work necessary for recovery.
A lovely resource to check out is https://www.feast-ed.org. They have an amazing assortment of resources on family-based treatment and eating disorders for caregivers, especially parents, of those who are struggling with an eating disorder.
Have a question for Alex Raymond about eating disorders or recovery? Submit it to our Ask An Expert column!
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