Family-Based Treatment (FBT) has emerged as a highly effective approach for addressing eating disorders in children and adolescents. This comprehensive treatment method prioritizes the well-being of the patient by focusing on restoring full nutrition and preventing ED behaviors, while actively involving and empowering family members throughout the process.

Principles of FBT

Agnostic view of illness:

Parents will often want to know why their child is suffering from an ED and will want the counselor to figure out why the ED developed, but with FBT the most important piece is to get the child eating again and not engaging in ED behaviors. There is no time to waste on analyzing the why because of the severity of the illness. There is also a component of acknowledging that EDs occur for a variety of reasons and are typically not one specific event or situation.

Initial symptom focus:

FBT prioritizes full nutrition and prevention of ED behaviors.

FBT focuses on achieving recovery by treating the symptoms directly, rather than focusing on the root cause.

The first phase of treatment is more geared towards restoring weight, so the counselor will work with the parents in supporting them to create a plan around meals for their child and giving them tools to be loving but firm in getting their child eating a regular and sufficient amount of food again. A child suffering from an ED cannot be talked into eating; they are not making the choice to not eat, resulting in the need for parents to assume control and become more hands-on, and an expectation to eat no matter what needs to be set by parents.

This can be very challenging for parents who are dealing with a child or adolescent who has developed extreme anxiety towards food and weight gain when they are being made to eat again. This is why support for parents is essential as they care for their loved one.

Family is responsible for refeeding/addressing behaviors:

Parents take charge of the meals for their child and ensure their child's nutritional needs are being met. Typically, therapists will leave the actual meal planning up to the family. A therapist will be there to support them in the process but acknowledges that each family has engaged in meal times in a certain way and can draw on meals that they feel comfortable cooking, etc. The therapist will encourage parents to remember how their child ate prior to the ED and empower them to plan meals with that in mind.

Externalizing the illness:

Encouraging the client and their family to externalize the illness is important in FBT (THE ED vs. MY ED). Taking on a stance that the ED is attacking the client's health, and that as a team, we are working together to fight it off. The ED is not the client, and separating the two also leaves space for the client to differentiate their wise mind from the ED thoughts/voices.

Therapist taking on a non-authoritarian stance:

The therapist is in full collaboration with the client's caregivers and acknowledges that they are the experts on their child. The therapist walks alongside parents to empower them and support them with tools on how to navigate ED treatment.

How it works

The Family-Based Treatment (FBT) consists of three phases:

Phase 1:

Full parental control: Parents take full charge of their child's meals, helping them to establish regular eating patterns and interrupting eating disorder (ED) behaviors. In this phase, parents reintroduce foods that the child has been avoiding due to fear of weight gain.

Phase 2: Gradual return of control to the child. This phase occurs when the child is weight-restored and regularly eating. The child is slowly given more independence over snacks and meals, learning how to build flexibility in their eating. Parents should be prepared to reclaim control if ED behaviors return.

Phase 3: Establishing autonomy once the child is not exhibiting any ED behaviors. Treatment can shift to address other mental health problems or developmental challenges. The focus is on establishing a balanced life for the child and looking at relapse prevention tools.

Collaborative team approach to treatment:

Treatment should be collaborative, with adults and children involved. If someone suspects they or their loved one is experiencing an ED, they should contact their doctor first. From there, they can get connected to local resources and access group therapy and a dietician. The therapist is part of the client's treatment team.

Support and self-care for caregivers:

Support for parents is essential. Making sure that caregivers in the home are on the same page is also important. Loved ones should remember that EDs are not a choice. Compassion and self-care while supporting their recovery are crucial. Self-care for loved ones walking alongside includes joining a support group, seeing a therapist, taking time for rest, and doing things that bring joy. Learn more about how to support yourself as a caregiver/parent of a loved one struggling with an ED here.

Overcome Eating Disorders with FBT

FBT prioritizes the well-being of the patient, focuses on full nutrition and prevention of ED behaviors, and involves family members in the treatment process. The three-phase structure of FBT helps families navigate through the challenges of restoring healthy eating habits and supports the patient in regaining autonomy over their lives. A collaborative team approach, coupled with support and self-care for caregivers, ensures lasting recovery and healing for those affected by EDs. By understanding FBT's potential, families can effectively deal with EDs and promote a healthier and more balanced life for their loved ones.

When you are ready to take that first step, we are here for you. Schedule your free consultation with our Eating Disorders Specialist Counsellor, Sofia Daulat or contact us at info@restingtree.ca to find out more.