What is Family Based Therapy (FBT)?

by Tracy Narins Welchoff, Ph.D.

Family Based Therapy (FBT) is an approach to treating eating disorders that recognizes the powerful influence that families can have on their loved-one’s recovery.  Thankfully, the outdated notion that parents cause eating disorders no longer dominates the treatment community.  Rather, the family is appreciated as a tremendous support and agent of change.  Although FBT is typically used with children and adolescents, the principles of FBT can be adapted to benefit adults as well.  Family Based Therapy is based on the following principles:

• Families are not to blame for the eating disorder.
• Families can be a tremendous help in recovery.
• Although sometimes family problems contribute to the development of the eating disorder, more often, family dysfunction is an understandable consequence of having a serious illness in the family.
• Families need (and deserve) support, guidance, education, and compassion as much as the family member with the eating disorder. 
• FBT is both supportive of the family in distress and corrective of problems in the family (without assigning blame).

So… what specifically do parents/ caregivers need to do?

1. Take charge of the food.  This includes grocery shopping, meal planning, food preparation, and meal support.
2. Meal support involves sitting and eating with the family member, watching to make sure all food is eaten, keeping an eye out for eating disorder behaviors, keeping conversation light and cheerful, and providing pleasant distraction and supervision for an hour after meals. 
3. Requests from the family member with the eating disorder can be considered, but parents have final say in providing meals that meet the specifications of the individually determined meal plan.
4. Learn to recognize eating disorder behaviors.  The treatment team can help with this.
5. Learn to provide support and encouragement through the meal by remaining calm and compassionate while also reinforcing boundaries and rules.  Keep conversation calm and pleasant, no talking about issues or stressful topics, and no lecturing or threatening. 
6. Adopt a “staying sick is not an option” attitude with both words and actions. 
7. Recognize signs of emotional distress (anxiety, anger, withdrawal) without making accommodations to reduce or eliminate these feelings.  Communicate that you understand the feelings but that your job is to safeguard your loved one’s health even if it is upsetting. 
8. Support the exercise restrictions given by the team.  Although walking the dog or “just going to the corner for fresh air” may seem harmless, these activities can reinforce the idea that movement is not “exercise” and can be enough to prevent progress with medical recovery.
9. Practice self-compassion in your role of caregiver.  It is very challenging to remain calm, and not “fix” the emotions, threaten consequences, or give in to the demands of the eating disorder.  Criticizing yourself when you are doing your best never helps. 
10. Communicate with the treatment team.  Your observations and thoughts are very important in the recovery process.

Remember, no family is perfect and there is no need for perfection to be a strong support system.   Be prepared for ups and downs, good days and bad, tears and arguments, and lots of uncertainty.   Most importantly, keep in mind that even the most serious eating disorders get better with time, patience, and persistence as well as education, support of the team, and loads of compassion.  There will be difficult emotions, inconvenient appointments, and sleepless nights, but staying the course ultimately allows you the joy of reconnecting with your healthy, happy loved one.