Family Based Therapy (“Maudsley”) for Anorexia Nervosa
What is Family Based Therapy? Family Based Therapy (FBT) is a short term treatment that focuses on family efforts to help your child overcome Anorexia Nervosa (AN) or Eating Disorder Not Otherwise Specified (ED NOS) where there is weight loss or dietary restriction. Therapy typically consists of 10-20 sessions of therapy, in an outpatient setting.
1. Preliminary evidence has found FBT to be the most effective and efficient model for reaching recovery in AN
2. FBT is the model best supported by the treatment literature (“empirically supported treatments”).
There are 3 phases to FBT:
Phase 1 focuses on renourishment and helps parents take charge to restore their child’s weight and eating behaviors to a healthy range. This involves placing parents in the role of helping to manage food intake, reduce or eliminate exercise and stop behaviors that keep AN going. For many parents this is a change from what they are used to: we want you to talk about food and eating, not so much with your child but with the adults who are involved in providing food for your child. Until your child is at a healthy weight, he/she cannot “think” clearly about food, health and this disease – sometimes refered to as “driving under the influence of AN.” Many parents are shocked by how difficult it is for their child to eat, when they have done so with relatively little struggle for their entire lives. But logic and asking doesn’t help: if your child could eat without struggle he/she would not have this disease! We need parents to set up an environment where eating is not only encouraged, but expected. This often means monitoring meals, providing longer times for meals to be completed, parents providing and watching meals to make certain a healthy amount and type of food is taken in. Gaining weight and regaining health is very challenging and your child may have to eat much more, or differently, than he/she has been. The focus is on increasing the number of times your child eats (often 6 or more times per day), the portion sizes (larger than they may have eaten before they became ill) and caloric density (foods that provide healthy fats and high calories to help with weight restoration). Parents often require support during this phase and we meet once per week.
Phase 2 focuses on a return to independent eating. This is often a slow process of learning how to eat socially, eat in restaurants and eat with flexibility. In addition it also means parents handing back responsibility to their child of choosing and eating meals, in order for your child to eat as he/she was before the illness. This means decreasing monitoring and may also involve a change in the frequency, size or caloric density of foods over the course of treatment. Problem-solving around difficult areas of eating and helping your child get back to a more typical adolescent life are key goals in this phase of treatment. Because your child is gaining health and moving into wellness, frequency of treatment will likely decrease to once every other week. This gives you and your child more time to explore healthy coping behaviors, such as spending time with friends, engaging in sports activities or other hobbies.
Phase 3 focuses on a return to healthy living. Recovery does not just mean gaining weight, it means gaining health. The focus in this phase is on identifying ways to help with continued adjustment, helping focus on what your child needs to have a value centered and balanced life. During this phase we meet once per month.
FBT is a family treatment: it is strongly encouraged that all family members who live with your child to be present, including siblings. This is important as each person is a vital part of your child’s support, and each person has a slightly different role. In FBT, parents are in charge of renourishment (more on that later). Siblings are there to help support your child in his/her struggle by providing support, nurturance and a sense of normalcy in an otherwise trying time.
FBT is an intensive treatment: Facing AN/ED NOS is a tremendous challenge. Indeed, this is one of the reasons families are involved: your child cannot manage this disorder on his/her own! Families are busy, have many responsibilities and may be scared of making the wrong decisions or creating conflict in their relationship with their child. However, parents are in a unique position: their love and protection of their child knows no bounds and parents are experts in their children and know best what can be accomplished. The job of an FBT therapist is to guide you toward what is important, help you gain knowledge about AN/ED NOS to help you in your fight, to provide support and suggestions where necessary and to help you restore your child to health.
Finally, FBT requires a team: You, your therapist and your medical providers all work together to provide a network of support for your child. Communication between team members is vital and helps keep the focus on making sure you and your child are informed and you are empowered to help your child back to wellness.
What is Family Based Therapy? Family Based Therapy (FBT) is a short term treatment that focuses on family efforts to help your child overcome Anorexia Nervosa (AN) or Eating Disorder Not Otherwise Specified (ED NOS) where there is weight loss or dietary restriction. Therapy typically consists of 10-20 sessions of therapy, in an outpatient setting.
1. Preliminary evidence has found FBT to be the most effective and efficient model for reaching recovery in AN
2. FBT is the model best supported by the treatment literature (“empirically supported treatments”).
There are 3 phases to FBT:
Phase 1 focuses on renourishment and helps parents take charge to restore their child’s weight and eating behaviors to a healthy range. This involves placing parents in the role of helping to manage food intake, reduce or eliminate exercise and stop behaviors that keep AN going. For many parents this is a change from what they are used to: we want you to talk about food and eating, not so much with your child but with the adults who are involved in providing food for your child. Until your child is at a healthy weight, he/she cannot “think” clearly about food, health and this disease – sometimes refered to as “driving under the influence of AN.” Many parents are shocked by how difficult it is for their child to eat, when they have done so with relatively little struggle for their entire lives. But logic and asking doesn’t help: if your child could eat without struggle he/she would not have this disease! We need parents to set up an environment where eating is not only encouraged, but expected. This often means monitoring meals, providing longer times for meals to be completed, parents providing and watching meals to make certain a healthy amount and type of food is taken in. Gaining weight and regaining health is very challenging and your child may have to eat much more, or differently, than he/she has been. The focus is on increasing the number of times your child eats (often 6 or more times per day), the portion sizes (larger than they may have eaten before they became ill) and caloric density (foods that provide healthy fats and high calories to help with weight restoration). Parents often require support during this phase and we meet once per week.
Phase 2 focuses on a return to independent eating. This is often a slow process of learning how to eat socially, eat in restaurants and eat with flexibility. In addition it also means parents handing back responsibility to their child of choosing and eating meals, in order for your child to eat as he/she was before the illness. This means decreasing monitoring and may also involve a change in the frequency, size or caloric density of foods over the course of treatment. Problem-solving around difficult areas of eating and helping your child get back to a more typical adolescent life are key goals in this phase of treatment. Because your child is gaining health and moving into wellness, frequency of treatment will likely decrease to once every other week. This gives you and your child more time to explore healthy coping behaviors, such as spending time with friends, engaging in sports activities or other hobbies.
Phase 3 focuses on a return to healthy living. Recovery does not just mean gaining weight, it means gaining health. The focus in this phase is on identifying ways to help with continued adjustment, helping focus on what your child needs to have a value centered and balanced life. During this phase we meet once per month.
FBT is a family treatment: it is strongly encouraged that all family members who live with your child to be present, including siblings. This is important as each person is a vital part of your child’s support, and each person has a slightly different role. In FBT, parents are in charge of renourishment (more on that later). Siblings are there to help support your child in his/her struggle by providing support, nurturance and a sense of normalcy in an otherwise trying time.
FBT is an intensive treatment: Facing AN/ED NOS is a tremendous challenge. Indeed, this is one of the reasons families are involved: your child cannot manage this disorder on his/her own! Families are busy, have many responsibilities and may be scared of making the wrong decisions or creating conflict in their relationship with their child. However, parents are in a unique position: their love and protection of their child knows no bounds and parents are experts in their children and know best what can be accomplished. The job of an FBT therapist is to guide you toward what is important, help you gain knowledge about AN/ED NOS to help you in your fight, to provide support and suggestions where necessary and to help you restore your child to health.
Finally, FBT requires a team: You, your therapist and your medical providers all work together to provide a network of support for your child. Communication between team members is vital and helps keep the focus on making sure you and your child are informed and you are empowered to help your child back to wellness.