Systemic family therapy is the most recommended treatment for adolescents with anorexia nervosa, and FBT is the most researched version of this. This approach has a significant body of evidence supporting its effectiveness with young people, and it is considered the leading evidence based approach for treating young people with anorexia nervosa.

In this treatment, weight restoration precedes psychological change. Should there be further underlying emotional issues which have, or are continuing, to contribute to the eating disorder, or causing the person distress, these are dealt with after FBT has achieved its aim.

For this approach to be effective, you have to commit to the process and work with the team in helping your child to recover. You are being asked to work collaboratively with the clinician to bring your child through the phases of the treatment. This commitment means that you, your child, and sometimes siblings are asked to come to approximately 20 sessions of treatment, often weekly to begin with.

Phase 1 Session : Re-feeding your child. Helpful strategies will be employed to bolster your confidence to taking on the task of refeeding at home. Phase 2 sessions : Negotiations for a new pattern of relationships.

Think of the analogy of learning to drive. At first the person drives under supervision, and as they learn and become more capable, they begin to drive independently. During phase 2, there will be a continued effort to modify family criticism of the patient by externalising the disorder from them.

Note: Psychological recovery lags behind approximately 12 months behind physical recovery. Phase 3 Session : Adolescent issues and ending treatment. Call our National Helpline on or email alex bodywhys. Menu About Eating Disorders Close What Causes an Eating Disorder?

Treatment Pathways Understanding Family Based Treatment. A Short Guide for Family. Understanding Family Based Treatment. Overview of Family Based Treatment:. Intervention style of FBT. The clinician will make no judgement or decision about what the cause of the eating disorder is, and most importantly, the clinician knows that parents are not to blame.

The clinician takes a Non-authoritarian stance TIPS! Keep Notes! You know how to feed your child! You have fed and nourished your child since birth. Do not get caught up in wondering about nutrition and calories, etc. Remember to trust your gut! Parents often feel incapable of feeding their child, or they have lost confidence in how to parent.

Remember how it feels to set rules and boundaries like you would with a toddler. Nobody wins in a power struggle, only the eating disorder!

The clinician and team are there to support you to do the work of the treatment. Use them for support. Understanding each stage in more detail. The idea behind family-based treatment is that getting the child nourished is the most important thing. Once they start eating more, they can get perspective on their eating disorder and start to behave in a healthier way.

As long as your child does not need emergency medical or psychiatric treatment, recovering from an eating disorder at home is usually the best option.

A clinician can help you manage the changes in routine and find ways to balance your other responsibilities. Traditional approaches to treating eating disorders in children and young adults often involve removing kids from their homes — and their parents — for in-patient psychiatric treatment.

In cases where a young person with an eating disorder needs immediate medical or psychiatric care, in-patient treatment is still recommended. But the treatment experts prefer for most kids with anorexia or bulimia lets kids remain at home, with parents taking the lead in helping them recover.

The core of family-based treatment is the assumption that parents are capable of helping a child recover from an eating disorder. In FBT they take back that role. Le Grange says.

In FBT, a clinician guides parents or caregivers in replicating the two major components of in-patient eating disorder treatment: empathy for the child and, in Dr. A child with an eating disorder will almost certainly fight eating food that will enable them to gain weight.

Le Grange explains. Repeating that process without any exceptions is the core of the initial phase of FBT. In single-parent families, it may be necessary to enlist help from extended family or trusted friends.

Le Grange. Because the treatment can be so disruptive, he emphasizes to parents that eating disorders are an urgent medical threat.

Ideally, siblings are involved in FBT as well. Because the treatment can be stressful and upsetting for the child with the eating disorder, siblings can give the child space to relax and be a kid, away from the structures that the parents impose at mealtimes. Depending on the family circumstances, it may not be plausible to involve siblings without creating more stress, but when possible, they can be an important support system.

FBT has been shown to be efficacious for underweight kids with anorexia nervosa and kids with binge eating and purging behavior bulimia nervosa. FBT has also been used for kids with other eating disorders such as atypical anorexia or ARFID, but the evidence is not quite as robust as it is for anorexia and bulimia.

The thinking behind FBT is that focusing on improving nutrition is more helpful than analyzing the underlying causes of the disorder. The child is behaving this way mainly because the brain is starved. FBT generally involves roughly 20 weekly sessions, divided into three phases.

Throughout all three phases, the clinician works primarily with the parents or caregivers, while being supportive of the adolescent who is in distress. At the start of each session, the child has a short check-in with the FBT clinician to check their weight and get basic mental health support.

Then, parents or caregivers, along with the child and sometimes their siblings, meet with the clinician for coaching and support around their work to nourish their child.

The child usually does not attend school for the first week or two, in part because they need to conserve energy while they gain weight. Then, if the treatment is going well, the parents might supervise the child a bit less as phase one goes on. And if they keep gaining weight, then maybe by week five the child eats lunch at school, but with a parent or school counselor there to supervise.

In phase two, which lasts for five or six sessions, the child begins to make some limited decisions about their eating again, and to participate in age-appropriate activities outside of the home. Le Grange notes. Phase three, the final three or four sessions of FBT, focuses on launching the child back into their normal daily life.

It also helps parents learn how to interact with their child again now that their relationship is much less focused on the eating disorder. If a child or young adult is in a life-threatening medical or psychiatric situation, then hospitalization is necessary.

In most other cases of anorexia and bulimia — including those where the young person is very underweight but otherwise medically stable — experts recommend FBT. Le Grange emphasizes while FBT might sound daunting, most parents do have the capacity to manage it.

Le Grange adds. Accordingly, Dr. Le Grange urges parents not to rule out FBT, even if their circumstances are challenging.

Patient satisfaction at the end of treatment. Chen EY, le Grange D, Doyle AC, Zaitsoff S, Doyle P, Roehrig JP, et al. A case series of family-based therapy for weight restoration in young adults with anorexia nervosa. J Contemp Psychother. le Grange D, Gelman T. S Afr J Psychol. Murray SB, Quintana DS, Loeb K, Griffiths S, Le Grange D.

Treatment outcomes for anorexia nervosa: a systematic review and meta-analysis of randomized controlled trials. Conti JE, Joyce C, Hay P, Meade T. BMC Psychol. Espindola CR, Blay SL. Anorexia nervosa treatment from the patient perspective: a metasynthesis of qualitative studies.

Ann Clin Psychiatry. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. Edley N. Analysing masculinity: interpretative repertoires, ideological dilemmas and subject positions. In: Wetherell M, Taylor S, Yates SJ, editors. Discourse as data: a guide for analysis.

London: Sage; Wufong E, Rhodes P, Conti JE. When adolescent distress persists after the Maudsley and family-based therapies for anorexia nervosa: parent experiences. Aradas J, Sales D, Rhodes P, Conti JE. Potter J, Wetherell M. Discourse and social psychology: beyond attitudes and behaviour.

Wetherell M. Positioning and interpretative repertoires: conversation analysis and post-structuralism in dialogue. Discourse Soc. Burr V. Social constructionism. New York: Routledge; Geller J, Srikameswaran S. Treatment non-negotiables: why we need them and how to make them work. Tan JOA, Stewart A, Fitzpatrick R, Hope T.

Competence to make treatment decisions in anorexia nervosa: thinking and processes and values. Philos Psychiatry Psychol. Karver MC, De Nadai AS, Monahan M, Shirk SR. Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy.

Swift JK, Mullins RH, Penix EA, Roth KL, Trusty WT. The importance of listening to patient preferences when making mental health care decisions. World Psychiatry. Obstacles and facilitators of therapeutic alliance among adolescents with anorexia nervosa, their parents and their psychiatrists: a qualitative study.

Touyz SW, Hay P. Severe and enduring anorexia nervosa SE-AN : in search of a new paradigm. White M. Narrative practice: continuing the conversations.

New York: W. Norton; Trainor C, Gorrell S, Hughes EK, Sawyer SM, Burton C, Le Grange D. Family-based treatment for adolescent anorexia nervosa: What happens to rates of comorbid diagnoses? Asen E. Multiple family therapy: an overview. Dare C, Eisler I. A multi-family group day treatment programme for adolescent eating disorder.

Rhodes P, Baillee A, Brown J, Madden S. Can parent-to-parent consultation improve the effectiveness of the Maudsley model of family-based treatment for anorexia nervosa?

A randomized control trial. Eisler I, Simic M, Russell GFM, Dare C. A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. J Child Psychol Psychiatry. Hurst K, Read S, Wallis A.

Anorexia nervosa in adolescence and Maudsley family-based treatment. J Couns Dev. A pilot study of Maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders.

J Clin Psychol. Binford Hopf RB, Le Grange D, Moessner M, Bauer S. Internet-based chat support groups for parents in family-based treatment for adolescent eating disorders: a pilot study. Richards I, Subar A, Touyz S, Rhodes P.

Augmentative approaches in family-based treatment for adolescents with restrictive eating disorders: a systematic review. Norcross JC. Psychotherapy relationships that work: Evidence-based responsiveness.

New York: Oxford University Press; Download references. The authors would like to acknowledge the collaborative work of the following researchers who contributed to the paper by Conti et al. JC is a Senior Lecturer in Clinical Psychology at Western Sydney University, CJ is a Lecturer in the School of Medicine at Western Sydney University , SN is a Clinical Psychologist working in private practice, KS is a Clinical Psychologist working in the NHS, UK, and PH is a Professor of Medicine at Western Sydney University.

School of Psychology and Translational Research Institute, Western Sydney University, Locked Bag , Penrith, , Australia.

School of Psychology, Western Sydney University, Penrith, Australia. Chair of Mental Health, School of Medicine, Translational Health Research Institute, Western Sydney University, Penrith, Australia.

You can also search for this author in PubMed Google Scholar. Each of the authors have made substantive contributions to this paper. JC conceived this research, interviewed participants, analysed the data, co-wrote and edited the manuscript. CJ analysed the data and contributed to the discussion, SN and KS analysed the data and contributed some of the sections of the paper, PH contributed to all sections of the paper including final editing.

All authors read and approved the final manuscript. Correspondence to Janet Conti. All transcript data has been de-identified through pseudonyms and participants were invited to remove any further identifying data and to review the analysis for consistency and resonance with their experiences.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This study is interested in hearing the voices of those who have experienced Family-based therapy for anorexia nervosa and decided for whatever reason to not continue in this treatment.

We are interested in hearing what it was like for you and your family to experience Family-Based Therapy for anorexia nervosa as we believe that your experiences are important to consider when developing new ways of treating anorexia. Identity e. When did anorexia start to have an impact on your life?

What was this like for you as a person? And as a child in your family? How did this have you seeing yourself as a person? Was this helpful or not? Can you tell me a bit about your relationship with anorexia now? How does this affect your life?

If so, how? If not, why? Overall, what stands out for you if you reflect on what impacts FBT had on you? How has participating in the FBT affected how you see yourself as a person?

Is this helpful or not? Then ask questions from C OR D. What has your relationship with anorexia been like since you completed FBT? How has this been for you as a person and as a family since discontinuing FBT?

What has your relationship with anorexia been like since then? E Questions to all participants regardless of whether completed or discontinued FBT. What would you like more of in future treatments for anorexia?

What would you like less of in future treatments for anorexia nervosa? What does this say to you about what you value as a person? Janet Conti : I am a Clinical Psychologist, Dietitian and academic in Clinical Psychology.

My research and clinical work seeks to prioritise the voice of the experiencing person to inform the development of a greater number of effective treatment inteventions for AN that are tailored to the needs and preferences of the experiencing person and their family.

This research is one arm of a larger research project that is aimed to give voice to adolescents, parents and the clinicians who treat them about their experience of FBT as the first line of treatment for adolescent AN in Australia.

Caroline Joyce : I am an academic in medicine with a background in Health Psychology. My research explores the impact of psychosocial factors on people adjusting to illness and chronic diseases.

I am particularly interested in how psychological distress impacts treatment adherence and recovery from illness to better understand more effective treatments.

Simone Natoli : I am a Clinical Psychologist currently working in private practice with a number of clients diagnosed with eating disorders. I have an interest in understanding the best treatments available and how to maximise treatment outcomes.

Understanding the factors contributing to poor treatment outcomes is an important part of this approach. Kelsey Skeoch : I am a Clinical Psychologist currently working in a Child and Adolescent Mental Health Service for the National Health Service NHS in the United Kingdom.

I have a keen interest in the mental health of children and young people, and in particular how the systems in which young people live and access, can both promote and hinder treatmemt outcomes. Phillipa Hay : I am an academic Psychiatrist with long-standing clincial and research experience in the treatment of people with anorexia nervosa.

I am very interested to explore and understand better how to improve treatments, reduce distress during treatment, and in particular to better understand why some people have poor outcomes. Lydia: I have read over the paper and am happy with the way my testimony has been used.

Thank you for keeping it authentic. I eagerly await publication of the final paper. I feel it will prove instructive for my parents, going forward. For me it was harder than what it should have been because FBT unmasked other psychological issues which the anorexia had been used to deal with.

Charlotte: I am happy with the paper and would be most grateful to receive a copy of the paper if published. Thank you very much for including me in the study. Open Access This article is licensed under a Creative Commons Attribution 4.

The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Reprints and permissions. Conti, J. et al. J Eat Disord 9 , Download citation. Received : 01 June Accepted : 14 October Published : 12 November Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF.

Download ePub. Abstract Background Family-based treatment FBT is the current treatment of choice for adolescent AN based on positive outcomes that include weight restoration in around two-thirds of adolescents.

Method Fourteen participants from Australia, New Zealand and the United Kingdom were interviewed about their experiences of FBT. Results The participants identified working as a family unit as key to their recovery, highlighting the importance of family therapy interventions for adolescent AN.

Plain English summary Family-Based Treatment FBT is a well-established, intensive approach to the treatment of adolescent anorexia nervosa AN. The current study The current study utilised a qualitative framework to give voice to the person with a lived adolescent AN experience with a focus on participant: 1 Experiences of Family-Based Treatment for adolescent AN in those who were interested in participating in research to improve the intervention; and 2 Identity negotiations in the context of this treatment intervention.

Methods Design This study was an inductive thematic analysis [ 43 ] with the understanding of themes as constructed within an interpersonal context. Participants A purposive sampling technique was utilised to invite participants to talk about their experiences of FBT and generate a context through which they could voice aspects of the treatment that was both helpful and their ideas of ways the intervention could be improved.

Table 1 Demographic and treatment details Full size table. Table 2 Additional treatments for Eating Disorder ED and other psychological problems Full size table. Full size image.

This concern has been echoed by Greg Dring [ 23 ]: […] if the therapist spends the first sixteen sessions of the work discouraging the discussion of feelings, relationship issues and developmental difficulties in a personal way, then it may be very difficult to revive such discussion at a later stage when, in any case, the work is about to be concluded p.

Concluding remarks This current study highlights the complexity that is involved in the treatment of adolescent AN and consideration of systemic family issues, adolescent psychological distress and identity formation in family-based treatments. Abbreviations AN: Anorexia Nervosa ED: Eating Disorder DBT: Dialectical Behavior Therapy FBT: Family-Based Treatment OCD: Obessive Compulsive Disorder.

References American Psychiatric Association. Book Google Scholar Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, et al.

PubMed Google Scholar Arcelus J, Mitchell AJ, Wales J, Nielsen S. Google Scholar Crow S, Peterson CB, Swanson S, Raymond N, Specker S, Eckert ED, et al.

PubMed Google Scholar Keel PK, Klump K, Miller K, McGue M, Iacono WG. PubMed Google Scholar Steinhausen HC. PubMed Google Scholar Gregertsen EC, Mandy W, Serpell L. Google Scholar Fassino S, Pierò A, Tomba E, Abbate-Daga G. PubMed PubMed Central Google Scholar Lock J, Le Grange D.

Google Scholar Zeeck A, Herpertz-Dahlmann B, Friederich H, Brockmeyer T, Resmark G, Hagenah U, et al. Google Scholar Murray SB, Thornton C, Wallis A.

PubMed Google Scholar Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. PubMed PubMed Central Google Scholar Agras W, Lock J, Brandt H, Bryson S, Dodge E, Halmi K, et al. Google Scholar Le Grange D, Hughes EK, Court A, Yeo M, Crosby R, Sawyer SM.

PubMed Google Scholar Allan E, Le Grange D, Sawyer SM, McLean LA, Hughes EK. PubMed Google Scholar Hughes EK, Sawyer SM, Accurso E, Singh S, Le Grange D. PubMed Google Scholar Tichenor V, Hill CE. Google Scholar Forsberg S, Lo Tempio E, Bryson S, Fitzpatrick KK, Le Grange D, Lock J.

PubMed Google Scholar Lo Tempio E, Forsberg S, Bryson S, Fitzpatrick KK, Le Grange D, Lock J. Google Scholar Pereira T, Lock J, Oggins J. PubMed Google Scholar Scarborough J. Google Scholar Smith A, Cook-Cottone C. PubMed Google Scholar Dring G.

Google Scholar Conti JE, Calder J, Cibralic S, Meade T, Hewson D. Google Scholar Wallis A, Miskovic-Wheatley J, Madden S, Alford C, Rhodes P, Touyz S.

PubMed Google Scholar Fisher CA, Skocic S, Rutherford KA, Hetrick SE. Google Scholar DeJong H, Broadbent H, Schmidt U.

PubMed Google Scholar Lock J, Couturier J, Agras WS. PubMed Google Scholar Le Grange D, Lock J, Agras WS, Moye A, Bryson SW, Jo B, et al. PubMed Google Scholar Lock J, Agras WS, Bryson S, Kraemer HC.

PubMed Google Scholar Franko DL, Tabri N, Keshaviah A, Murray HB, Herzog DB, Thomas JJ, et al. PubMed Google Scholar Dalle Grave R, Calugi S, Doll H, Fairburn CG.

PubMed PubMed Central Google Scholar Dalle Grave R, Sartirana M, Calugi S. PubMed Google Scholar Le Grange D, Eckhardt SG, Dalle Grave R, Crosby RD, Peterson CB, Keery H, et al. Google Scholar Krautter T, Lock J.

Google Scholar Chen EY, le Grange D, Doyle AC, Zaitsoff S, Doyle P, Roehrig JP, et al. PubMed PubMed Central Google Scholar le Grange D, Gelman T. Google Scholar Murray SB, Quintana DS, Loeb K, Griffiths S, Le Grange D.

PubMed Google Scholar Conti JE, Joyce C, Hay P, Meade T. PubMed PubMed Central Google Scholar Espindola CR, Blay SL. PubMed Google Scholar Braun V, Clarke V. Google Scholar Edley N. Google Scholar Wufong E, Rhodes P, Conti JE. Google Scholar Aradas J, Sales D, Rhodes P, Conti JE.

Google Scholar Potter J, Wetherell M. Google Scholar Wetherell M. Google Scholar Burr V. Google Scholar Geller J, Srikameswaran S. Google Scholar Tan JOA, Stewart A, Fitzpatrick R, Hope T.

Google Scholar Karver MC, De Nadai AS, Monahan M, Shirk SR. PubMed Google Scholar Swift JK, Mullins RH, Penix EA, Roth KL, Trusty WT. PubMed Google Scholar Touyz SW, Hay P. Google Scholar White M.

Google Scholar Trainor C, Gorrell S, Hughes EK, Sawyer SM, Burton C, Le Grange D. PubMed PubMed Central Google Scholar Asen E. Google Scholar Dare C, Eisler I. Google Scholar Rhodes P, Baillee A, Brown J, Madden S. Google Scholar Eisler I, Simic M, Russell GFM, Dare C.

PubMed Google Scholar Hurst K, Read S, Wallis A. PubMed Google Scholar Binford Hopf RB, Le Grange D, Moessner M, Bauer S. PubMed Google Scholar Richards I, Subar A, Touyz S, Rhodes P. PubMed Google Scholar Norcross JC. Google Scholar Download references. Acknowledgements The authors would like to acknowledge the collaborative work of the following researchers who contributed to the paper by Conti et al.

Authors' information JC is a Senior Lecturer in Clinical Psychology at Western Sydney University, CJ is a Lecturer in the School of Medicine at Western Sydney University , SN is a Clinical Psychologist working in private practice, KS is a Clinical Psychologist working in the NHS, UK, and PH is a Professor of Medicine at Western Sydney University.

View author publications. Ethics declarations Ethics approval and consent to participate This research was approved by the Western Sydney University Ethics Committee H Consent for publication All transcript data has been de-identified through pseudonyms and participants were invited to remove any further identifying data and to review the analysis for consistency and resonance with their experiences.

Competing interests The authors declares that they have no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices Appendix A Research study advertisement This study is interested in hearing the voices of those who have experienced Family-based therapy for anorexia nervosa and decided for whatever reason to not continue in this treatment. Appendix B Interview schedule A selection of questions will be used with each participant and questions will scaffold between.

Experience e. Can you tell me about …? Meaning What does … mean to you? is this OK for you or not? Can you tell me your story of anorexia? What does having experienced anorexia mean to you as a person? B Experiences of Family-Based treatment 1.

How did you come to be involved in Family-Based treatment FBT? Can you tell me about your experiences of FBT? What was most helpful about FBT?

What was least helpful about FBT? Did you complete FBT? Why or why not? Did FBT assist you to shift your relationship with anorexia? When did you finish FBT? At what phase of FBT did you discontinue treatment? Looking back how do you make sense of why you chose not to continue with FBT?

Are you settled with the decision or not? What were you hoping for as you made the decision to cease FBT? E Questions to all participants regardless of whether completed or discontinued FBT 1.

What do you want to not forget about yourself from the FBT? What advice might you give to a person or family who is about to start FBT? Has our conversation today been helpful or unhelpful or both? What has stood out for you from our conversation today?

What might be important for us not to forget as we analyse the data from this interview? Appendix C Researcher positioning statements Janet Conti : I am a Clinical Psychologist, Dietitian and academic in Clinical Psychology. Appendix D Participant member check feedback participant pseudonyms Lydia: I have read over the paper and am happy with the way my testimony has been used.

Amy: lt looks great though, very interesting report. Note: Some participants were unable to be contacted. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.

Service Statuses and Closures Contact. PRIMARY CARE AND FAMILY MEDICINE Accessing Primary Health Care Need a Family Practice Registry Virtual Care NS Community Pharmacy Primary Clinics Urgent Treatment Centres Mobile Primary Care Clinics Home and Community Care Long-Term Care Respite and Caregiver Support Health Equipment Protecting Vulnerable Adults Covid Symptoms Testing I Tested Positive COVID Vaccines Living with COVID In-Home Blood Collection Specimen Testing Water Testing CT Scan MRI X-ray Ultrasound Bereavement Support NSH Ethics Support Family Presence Hospice In-home Respite Medical Assistance in Dying Music Therapy Palliative Care Pride Health Protecting Vulnerable Adults Respite and Caregiver Support