What is Family Based Therapy (FBT) and Why Does My Child Need It?
By the time a family has arrived on our doorstep for help with a teenager who is struggling with their eating, exercise or weight, everyone is normally pretty stressed.
The most common scenario is this:
1. The parents/carers have been worried about things for some time – they’ve been watching things change but have been unsure how to intervene.
2. The parents/carers have finally managed to negotiate getting the adolescent to attend a GP appointment. This process has taken several weeks, because wait times suck and because teenagers generally don’t like being told what to do.
3. Once there, the GP suggests a referral to see a psychologist, to help “get things back on track.”
4. The teenager, true to form, is very anxious/annoyed about this referral because a) they didn’t want to go to the GP in the first-place b) don’t want to talk to another stranger about their eating and c) don’t need to see a psychologist because that would mean “somethings wrong,” and actually they’re fine thank you very much.
5. Despite this, the parents/carers trust their instinct, follow the GPs advice, reach out to us and make the appointment.
6. D-day arrives; the family turn up for the appointment with the teenager reluctantly in tow. At this session, we inform the family that the gold-standard treatment for adolescent’s struggling with disordered eating is Family-Based Therapy. Meaning, both parents/carers will need to be involved in sessions to help get things back on track.
7. Crickets. Blank stares. What? Immediately the teenager hates this idea, and the parents feel anxious about it – Does this mean you think we’re the problem? Are we doing something wrong?
Nobody expects this twist because it goes against our common understanding of seeing a psychologist. But our research* shows us that a 1:1 therapy style is not the most effective approach for teenagers with eating disorders. This is because young people with eating disorders do not believe they need help. They are convinced that they are in control of their eating/exercise and that losing weight is necessary. In short, left to their own devices, things are likely to get worse, not better.
Enter family-based therapy (FBT).
FBT is a treatment approach to adolescent eating disorders. It works from the premise that most young people with eating disorders cannot make the changes required for weight gain without help from their parents. This approach acknowledges that parents/carers are the most powerful people in a teenager’s life, and thus are the biggest resources for change. For this reason, parents/carers are involved in every session from the beginning.
Alongside this, FBT also understands that adolescent eating disorders are very serious conditions. Left unchecked, things can quickly spiral.To combat this, the first goal of treatment is weight gain and/or the restoration of normal eating patterns and treatment is intensive (read:weekly). Renourishing a starved body/brain or curving malnutrition must take precedent over any cognitive therapy. And because of this need, distress becomes an expected part of treatment. Refeeding or gaining weight will upset the young person because they are fearful of food/eating, but exposure to the process of normal eating is essential to recovery and parents are key in containing this distress.
Understandably, FBT is a difficult process. It requires an intensive focus on recovery, which often requires the structure of family life to change for a period. Parents/carers are often pushed to their limits and young people quickly dislike attending care. It’s scary and it’s tough – but it’s also necessary.
For more information on this treatment model, see our eating disorder resources section.
Until next time.
Courtney
*Lock, J. (2015). An update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and Adolescents, Journal of Clinical Child & Adolescent Psychology, DOI:10.1080/15374416.2014.971458
