Eating disorders are serious conditions with severe physical and emotional consequences. And these conditions are difficult for everyone involved, including a patient’s friends, family, and loved ones.
Still, some types of therapy have been developed to help someone struggling with an eating disorder and those closest to them get through these challenging situations together.
If your child is dealing with disordered eating behaviors, your family may benefit from family therapy or other family-based treatment approaches.
In any case, the right combination of therapies and interventions can help a child recover, and help pave the way for long-term healing and a return to a more normal way of life.
What Is Family Based Treatment?
Family-based treatment (FBT) is a form of therapy that involves the entire family, rather than just the individual with the eating disorder.
The therapy is premised on the idea that family dynamics can contribute to the development of eating disorder behaviors, and changing these dynamics can help aid in sustained recovery.
The thought then goes that involving all close family members in the treatment process will lead to better outcomes in the recovery process.
How Does Family Based Treatment Work?
Like many types of individual treatment, family-based treatment often follows a general structure. The process involves regular meetings with a professional who is versed in both adolescent eating disorders and other types of family interventions.
Meanwhile, your family will be given certain “assignments” to work on together, at home, between sessions. Typically, these assignments progress in three stages.
The therapist, along with your child’s treatment team, will help provide additional advice and tools to work through these three phases.
The Engagement Phase
Before a child can develop a healthy adolescent identity on their own, they’ll need additional help and guidance in their food choices. That’s why in this first phase of your child’s recovery, the primary focus is on building a therapeutic relationship between them and you, as a caregiver.
During the engagement phase, you, as parent or guardian, will have complete control over the child’s food intake. A meal plan will be developed for the child by a qualified nutritionist or eating disorder specialist, and you will be instructed to follow this eating plan. You may also be given additional tools and advice for this phase, and can bring up any issues in ongoing therapy sessions.
The Weight Restoration Phase
This phase is focused on weight gain and healthy weight maintenance. Your child will be given more free reign over their own eating choices at this point, but you will still be the ultimate authority on what gets eaten and when.
To help a child with anorexia nervosa, bulimia nervosa, or other eating disorders achieve this goal, your entire family will receive nutritional counseling and be given tips and tools to help with meal planning. Having a regular, healthy family meal together is generally encouraged.
You’ll also be advised the best ways to monitor your child’s weight and eating behavior. Though it’s important to follow up on these tasks with a mind to sensitivity. Monitoring weight can be very triggering for many people struggling with eating disorders.
The Behavioral Family Therapy Phase
Once potentially dangerous eating behaviors are back on track, your family can progress to the behavioral phase of therapy. At this point in family-based treatment, underlying psychological and emotional issues that contributed to the development of the eating disorder are addressed.
Families uncover these often complex underlying factors together in therapy. This can include:
- Addressing family dynamics
- Learning about co-occurring mental health issues
- Teaching the child and family coping skills to help prevent relapse.
At this point, the group also works together to create a plan for sustained recovery. Each family member will have a role to play in this plan.
Why is Family-Based Treatment Recommended?
Family-based therapy is an effective treatment, particularly when it comes to addressing adolescent eating disorders. The practice is especially recommended for cases involving adolescent anorexia nervosa. (1)
One key benefit of this form of therapy is that it helps a therapist get a bigger picture of what’s going on in a child’s life, and assess different ways that the family dynamics impacting a child’s daily life may contribute to the maintenance of their condition.
There’s also an element of group therapy that can be very helpful for people going through FBT. Going through the therapeutic process together can bring common goals to the fore, and encourage family members to support each other in healthier ways.
Family-based therapy also helps consolidate the family unit, and can work to build a stronger support system around the person with the disorder. As social isolation is a big driver of many eating disorders, a strong support system can be a particularly crucial aspect for sustained recovery.
When to Not Seek Family Based Treatment
Family-based therapy (FBT) is often considered a first-line approach for treating eating disorders in children and adolescents. (2) However, there may be instances where FBT may not be the most appropriate treatment option.
Co-Occurring Mental Health Disorders
In cases where a child has a co-occurring mental health disorder, such as severe depression or anxiety, therapists may first recommend other types of treatment. This can help stabilize the child’s mental health before proceeding.
Mood disorders, which nearly always accompany eating disorders, often require more intensive treatment to fully address, and in these cases, it may be more beneficial for your child to receive other therapies in addition to FBT.
History of Trauma or Abuse
If your child has experienced significant trauma or abuse, they may also not be recommended for family-based treatment.
Since family therapy primarily focuses on family dynamics, it may not be the most well-suited treatment to address these serious underlying issues. A child may also feel hesitant to open up about such a sensitive and damaging topic in a group setting.
Other more trauma-focused therapies will likely be recommended instead in these situations.
Severe Eating Disorder Symptoms
Additionally, FBT is not generally recommended in cases when a child’s eating disorder is considered severe. That’s mostly because, in extreme cases, there will be more pressing issues to deal with, concerning a child’s physical health.
Instead of therapy, hospitalization may be necessary for treatment in these cases. But once a child has made a substantial physical recovery, they may be able to enter other forms of therapy, including FBT.
Pros and Cons of Family Based Treatment
Every eating disorder case is unique, and the appropriate treatment plan depends entirely on the specifics of your child’s—and family’s—needs.
As such, there may be a number of pros and cons in pursuing family-based therapy.
Some pros include:
- Shorter illness period: Research has shown that FBT can shorten the illness duration of anorexia nervosa, reducing disruption to the child’s school and family life. (3)
- Emphasis on family involvement: FBT works to strengthen family dynamics, and teach the group, as a whole, healthier coping mechanisms and ways to interact with each other. This can help lead to a more sustainable recovery.
Still, not every technique is perfect. Some potential cons of FBT include:
- Requiring total participation: FBT can be difficult to implement if members of the family are unwilling or unable to participate. Even in cases where everyone is on board, it can be difficult to schedule times that work for everyone.
- Not suitable for everyone: If your child is exhibiting severe eating disorder behavior or showcasing other extraordinary concerns, they may not yet be ready for family-based treatment.
It’s important to remember that other options, including individual therapy, support groups, and medication, are also available. Before exploring your options for family-based treatment, you should speak with a qualified mental health specialist to determine the best treatment for your child and family.
Finding Help for an Eating Disorder
Eating disorders are notoriously difficult and complex conditions, but help—and recovery—is always possible.
If your child is struggling with this difficult condition, you may want to research some support groups for yourself. These are safe spaces where you can share your story and benefit from the knowledge and advice of others going through similar situations.
You should also reach out to your child’s primary care doctor or mental health therapist as soon as possible for the best next steps. With appropriate care, it’s possible for your child to get on the road to recovery and live a happier, healthier life.
- Couturier, J., Kimber, M., & Szatmari, P. (2013). Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. The International journal of eating disorders; 46(1):3–11.
- Rienecke R. D. (2017). Family-based treatment of eating disorders in adolescents: current insights. Adolescent health, medicine and therapeutics; 8:69–79.
- Wong, L., Goh, L. G., & Ramachandran, R. (2019). Family-based therapy for anorexia nervosa: results from a 7-year longitudinal Singapore study. Eating and weight disorders: EWD; 24(6):1215–1219.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on March 13, 2023
Published on EatingDisorderHope.com