Being part of a group practice is an important part of my work at the Leggett Group because it provides me with a team of people who are there to support me and my work. This resounding idea that we often need the support of others to get through difficult times is one that continually appears in therapeutic frameworks, and a sentiment that is used over and over in the treatment of an eating disorder. Receiving the news that your child has an eating disorder is a terrifying realization, and often leaves caregivers feeling powerless and unsure of what the next steps may be. One answer that continues to gain more and more acclaim since it came to the United States from England in 1994 is Family-Based Treatment (FBT), also known as the Maudsley Method. FBT is a clinical framework used to treat eating disorders in children and adolescents that involves the whole family, and any other important adults in the adolescent’s life, as part of a plan to disrupt the eating disorder and return the child to their lives. The intervention can be thought of as a reset button in many ways, as the main characteristic involves the caregivers taking over all meal prep and presentation, and learning skills to help the child tolerate their distress and overcome their fears through exposure to food again. FBT is made up of three treatment phases that generally last over the period of a year; weight restoration, returning responsibility of food preparation and slowly moving towards increased autonomy, and the adolescent returning to establishing a healthy adolescent identity as is developmentally appropriate during this stage of their life.
During phase one, often caregivers feel as though they are caring for their adolescent as if they were a small child again because of the need to supervise them so closely and take back responsibility around food, which can feel developmentally inappropriate. Most caregivers are working to promote increased autonomy and self-reliance in their developing adolescent, so it can be difficult for both the adults and the adolescent. In some ways, because the eating disorder is controlling their behavior, the adolescent has regressed to behaving like a young child; the eating disorder is preventing them from safely caring for themselves and giving their body what it needs to survive. A helpful reminder is that this phase is temporary, and as the child begins to improve and challenge the eating disorder more regularly, they are ready to take on more responsibilities around food again.
Evidence-based studies show that FBT has a very high efficacy rate and the hard work and struggles are worth the effort when it means a family can return to their pre-eating disorder lives. When a caregiver feels ambivalent towards the treatment modality it can decrease the effectiveness of FBT, and the eating disorder may take advantage of any wavering on limits the caregiver has set. It can be extremely difficult for a caregiver to put all their trust in the FBT approach when it is new and they are feeling vulnerable and out of control, so it is important to communicate those concerns to the clinician the family is working with. If the caregiver can come to a decision on what limits they are comfortable enforcing, then the treatment can still be effective. Lastly, another important aspect of FBT is working to remove blame within the family and focusing on how to move forward; the emphasis is less on what may have contributed to the development of the disorder and more on how to effectively cope and ultimately be in recovery. As a clinician who works with families going through such a tumultuous and frightening time, it is my role to be part of the team and to provide support, education, and ongoing feedback to help everyone involved learn to tolerate the distress of the experience in order to move forward towards recovery. If you or a loved one is struggling with an eating disorder, or you have concerns that they may be having symptoms related to disordered eating, please feel free to reach out for a consultation, or with any questions you may have about FBT!
Written by: Nathalie Paquette, LICSW