Family based treatment (FBT) is an evidence-based (i.e. research-founded) outpatient therapy for anorexia nervosa and bulimia nervosa. It was preceded by clinical developments in the treatment of anorexia nervosa in London at The Maudsley Hospital, then was further refined in the U.S. by psychologist Daniel Le Grange at the University of Chicago and psychiatrist James Lock at Stanford. Research currently reflects that this treatment model is modestly best as the first-line intervention for restricting eating disorders in adolescents. The model, with age-appropriate adaptations, has also been used with success in young adults 18-25 years.
The underlying assumption in FBT is that parents are an afflicted child's best resource for recovering from an eating disorder. Parents are guided toward joining their efforts against the eating disorder through the power of nurturance and healthy parental authority. Parents and teens are held equally blameless for the emergence of an eating disorder. Rather, the eating disorder is viewed as harming the individual and all of her personal relationships.
In FBT, parents assume the challenge of re-feeding their undernourished daughter or son. The FBT therapist is an expert consultant guiding the process and providing emotional support for each family member. A key difference in this model is that the therapist supports the parents in emotional support of their child/teen rather than such emotional support being provided from therapist to child/teen. One reason for this difference is that the influence of the enduring relationship between parent and child is strong medicine against an eating disorder. Anorexia nervosa has the highest mortality rate of any psychiatric condition and is resistant to treatment. People experiencing these disorders benefit greatly from family involvement and awareness of the harsh and seductive mindset that characterizes anorexia nervosa.
In FBT-TAY (Family Based Treatment for Transition Age Youth), the independence and autonomy of the older teen and young adult is acknowledged in a modified approach that includes more individual work and eating independence according to resources of the older teen and young adult combined with family engagement. Specific developmental issues are considered and addressed in the treatment while the focus on weight restoration remains a high priority.
As the ill child, adolescent or young adult recovers, factors that may have increased vulnerability to an eating disorder are explored so that recovery may be enduring.
