Family Based Treatment (FBT) is an evidence-based treatment for eating disorders in children and adolescents. It keeps your loved one at home and puts parents and caregivers at the center of treatment, with an FBT therapist as an expert consultant.
Contributed by
Abby Sarrett-Cooper, LPC, CEDS
FBT places parents and caregivers at the center of treatment. The FBT therapist is an expert consultant to parents, bringing them into a treatment team that includes a physician and sometimes a psychiatrist.
The FBT therapist is not the individual therapist to the young person with the eating disorder, and the team is not waiting for or working toward "buy in" from that young person. Instead, FBT brings the effective interventions used in higher levels of care into the home, where parents use their love, care and knowledge of their own child to shape those interventions for their family.
The result is an individualized, effective treatment that eliminates the added trauma of separating a child from their family while focusing on refeeding, nutritional restoration, behavioral management, and a return to typical child and youth development and family functioning.
FBT is an outpatient intervention, in line with guidelines that recommend treating children and adolescents in the least restrictive environment possible. Rather than separating the child from the family, FBT empowers parents to become the primary agents of recovery within the home. Treatment moves through three distinct phases that guide the family from crisis and full parental control toward age-appropriate independence and recovery.
The FBT therapist helps you separate the illness from your loved one, while calling attention to the dire circumstances the family is facing. In FBT there is no "anorexic" or "bulimic." There is a young person with a life-threatening illness who urgently needs to be renourished, and that task begins in Phase 1.
It starts with a family meal, where you provide a meal designed to renourish your loved one. The therapist observes, asks questions, gives feedback on what is effective, and offers options for increasing your effectiveness. You are supported in trusting yourself and your knowledge of your loved one.
During Phase 1, parents are fully responsible for all decisions around nutrition and activity, including:
Phase 1 continues with weekly meetings where your loved one is weighed to assess progress and gives feedback if willing, and the family details successes and challenges in managing these tasks.
"Parents use the love, care and knowledge of their unique child to shape these interventions for their family."— Abby Sarrett-Cooper, LPC, CEDS
Much of Phase 1 happens at your table. F.E.A.S.T. has help for exactly that:
Phase 2 is a gradual transition from total parental responsibility for nutrition and activity to co-managing those tasks with your loved one, in a way that suits their age and development. That will, of course, look very different for a 10-year-old than for a 17-year-old.
The FBT therapist will ask you to assess what you think your loved one is ready to make decisions about, maybe picking a snack from a few options or plating their own dinner. For some families the process happens organically, based on observations at home, meal to meal. Sometimes it requires more didactic learning, where you instruct and model.
Weights continue to be taken at each session, and sessions are reduced to every other week.
Phase 3 focuses on reestablishing the relationship between you and your loved one so that it is based on increased autonomy for the young person and for the adults, with food and illness no longer at the center of the family.
This is a time to reflect on progress and highlight the strengths that brought the family together to effectively combat the eating disorder. Sessions are optimistic, while also encouraging vigilance against the return of any eating disorder related behaviors. They may be spaced at monthly intervals and are designed to create an opening for dialogues that will continue after treatment ends.
Where the three phases lead. The treatment is designed to guide the family from a state of crisis and full parental control toward age-appropriate independence and recovery.
F.E.A.S.T. is run by parents and caregivers who have been where you are.
FEAST 30 Days is our email series for caregivers who are new to this. The Caregiver Skills Series goes deeper, including mealtime support.
Enroll in FEAST 30 Days Caregiver Skills SeriesThe Around the Dinner Table forum and our online support groups connect you with other caregivers.
Visit the forum Support groupsOur Caregiver Skills Toolkit offers great guidance for mealtimes (among other things)!