Family-Based Treatment (FBT) is a structured therapy approach with specific components aimed for optimal success for the treatment of adolescents struggling with an eating disorder. Parental involvement is vital and the family is an asset for defeating the eating disorder. There are three phases to FBT, Weight Restoration, Transitioning Control of Eating Back to the Adolescent, and Adolescent Issues. FBT is also known as “The Maudsley Approach” and has been researched at Maudsley Hospital in London (www.maudsleyparents.org), Stanford University, University of Chicago, and Lucile Salter Packard Children’s Hospital. Several studies regarding FBT effectiveness resulted in the following outcomes: two-thirds of adolescent anorexic patients recover by the end of treatment, 75–90% are fully weight recovered five years later, the average treatment duration is no more than 20 sessions over the course of 6–12 months and 80% of patients are weight restored with menses by the end of treatment. FBT takes a team approach recognizing treatment works best when the therapist, dietician and pediatrician or primary care physician communicates and works together.

FBT works best when the family works together and parents are aligned in their approach. It can be modified for single-parent families or blended families. Siblings play an integral role in supporting the adolescent. FBT is used mostly in outpatient settings, which allows for the adolescent and family to maintain normal day-to-day activities. Inpatient and partial-hospitalizations are successful with weight restoration, but this alone is not sufficient for long term recovery and relapse is common. An outpatient FBT approach will work to address adolescent issues that contribute to the eating disorder. The FBT approach sees eating disorders as a complex diagnosis and does not blame the patient, parents, siblings or the family. No one is responsible for the disease, but everyone plays a part in helping defeat the disease. In this way the illness is seen as separate from the patient, which requires drastic action against the illness, not the patient. As such it is important not to be critical of the adolescent because we know from research that criticism is associated with early dropout of treatment and exacerbation of symptoms. Think of the eating disorder as a malignant tumor that has taken over your adolescent’s behavior and thinking. While treatment requires drastic and concerted efforts to eradicate the tumor, you would not be critical of cancer patient for their symptoms.

FBT is used for adolescents and young adults living at home with their families because it assumes that families eat together and have routine access to one another. Involving all family members, who may or may not be blood relatives, may require some sacrifice by the entire family. Parents are a major resource for recovery, and they take on the task of weight restoration. They must be aligned for success in this process. FBT believes that parents know their child best and are most invested in the well-being of their adolescent. Most importantly, the adolescent needs their parents, especially at such a vulnerable time as struggling with an eating disorder. The role of siblings can be very useful in Family-based treatment. Siblings can support the adolescent outside of mealtimes, provide uncritical support, sympathy, and distraction, can listen, and be comforting. It is important that siblings do not interfere with parents’ efforts to feed their child.

There are three phases in FBT. The first phase is Weight Restoration. This phase focuses on collecting information, weighing the patient at the start of each session, eating a meal as a family in session, addressing food, eating and weight behaviors, working on the parental dyad’s efforts at weight restoration, helping the family to evaluate siblings’ impact, modifying any family criticisms and reviewing progress with the family. The goals in the first session are to engage everyone in the family in therapy, understand the history of how the disorder has affected the family, and obtain info about how the family functions. The goals in the second session, which is the meal session, are to assess the family process during eating, provide parents success in helping their child to eat normally, and continue assessment of the family structure. Overall, the goals of the entire phase is to keep the family focused on the eating disorder, help parents take charge of the child’s eating, and mobilize siblings for support.

The second phase is Helping the Adolescent Eat on Their Own. We will know you are ready to move to phase two when weight is 90% restored, there are no significant struggles with getting the patient to eat, parents feel empowered, and the illness feels more manageable. The goals of phase two are to maintain parental management of eating disorder symptoms until the patient can show proof of their ability to eat well and gain weight independently; returning food and weight control to adolescent, and explore the relationship between adolescent developmental issues and the eating disorder. This requires the parents to learn how to relinquish control. Some of the ways to relinquish control over food and eating are 1) patient starts to serve herself while parents supervise, 2) allowing more food choices as long as they are nutritious and portions are adequate, and 3) monitoring main meal while allowing patient to control other meals. This process involves family collaboration for problem solving.

The third phase is Adolescent Issues. You are ready to move to phase three when the patient has achieved near normal weight, control over eating and exercise has been successfully returned to adolescent without relapse, and when the relationship between parent and child is no longer focused on the eating disorder. Phase three goals are to establish that the parent-adolescent relationship is no longer dominated by the symptoms of an eating disorder, address adolescent issues with the family, and eventually terminate treatment. In essence the goal is to return the adolescent to the natural course of adolescent development, since the eating disorder stops this process. Some of the topics discussed in phase three are to review the adolescent’s issues, exploring adolescent themes, checking on parents as a couple, and planning for future issues. There are several ways to help parents through phase three by 1) developing activities, interests, and skills that constitute a life of parenting, 2) developing an identity as a couple, 3) discovering ways in which parental roles, work, interests and studies can be integrated with those of the developing adults in the household, 4) accepting the distinctive physical and emotional aspects of the sexual development, orientation, and interests of growing adolescents, 5) giving up the skills, attitudes, and activities that were appropriate to their children’s earlier developmental stages, and 6) evolving personal capacities that increase adolescents’ ability to see and accept parents as developing individuals.