Family Based Treatment for Teens and Young Adults

I offer Family Based Treatment (FBT) to Teens and Young Adults as a first line, evidence based treatment for individuals struggling with anorexia nervosa and bulimia nervosa. It differs significantly from individual therapy and instead focuses on empowering parents and/or caregivers to support their loved one in regaining their nutrition- and their lives- back.

Oftentimes when we expect teens to develop the motivation to fight an eating disorder on their own we underestimate how strong and insidious eating disorders actually are. Historically, individual therapy has relied on teens to develop this motivation while they are starving. FBT empowers parents and loved ones to hold the motivation for teens so that they don’t have to constantly fight the often critical, loud, and tenacious eating disorder voice.

Assumptions of FBT

• Agnostic view of the illness: we don’t need to know what caused the eating disorder in order to treat it.

• Focus on symptoms first: eating disorders are dangerous and deadly. FBT prioritizes nutrition rehabilitation, safety, and prevention of eating disorder behaviors.

• The family is responsible for refeeding and preventing ED behaviors: Parents know their children best. I trust parents to make choices for their children and am here to provide guidance.

• Non-authoritarian stance: As your therapist I will be acting as a consultant, not a prescriber or a director. Parents are full members of the treatment team.

• Externalization of the illness: the eating disorder is an illness that your loved one didn’t choose and is also something they can’t fight on their own. Parents and providers join forces with the healthy part of their loved one to fight “The Eating Disorder” or “ED.”

Parent/Caregiver Resources

F.E.A.S.T or Families Empowered and Supporting Treatment for Eating Disorders is a website dedicated to offering support, articles, resources, and ideas for families engaging in FBT.

When Your Teen Has an Eating Disorder by Dr. Lauren Muhlheim is an excellent practical book I recommend to all of my families engaging in FBT.

Sick Enough by Dr. Gaudiani gives a fantastic overview of how eating disorders affect the body so that you can advocate with your teen or loved one’s medical providers. Please see also the Academy of Eating Disorders Guide to Medical Care to take with you to your teen’s doctor’s appointments

What you can expect

FBT is conducted in three phases:
Phase 1: Parents/Caregivers are in full control of the refeeding process and prevention of eating disorder behaviors. In Phase 1, parents are encouraged to meal plan, shop, plate, and provide structure for eating for their loved one. If weight gain is needed, we set a goal of at least 1-2 lbs per week. In Phase 1, I will meet with the family weekly in order to provide support to parents and their loved one to progress in this refeeding process. Siblings and close family members are also invited to sessions.

Phase 2: Gradual control is returned to the adolescent/young adult. We usually begin this phase when eating is coming more easily, weight is restored at or close to the individual’s genetic growth curve, and eating disorder behaviors are mostly under control. We begin to experiment with giving age appropriate choices, changing settings with food (e.g., eating at restaurants) and increasing exposure to fear foods. In this phase I typically meet with families every other week.

Phase 3: Autonomy is reestablished and if needed, we discuss how the family returns to life post eating disorder. In this phase, if individual therapy is desired, we can begin that process.

Medical Concerns/Other Treatment Providers

Eating disorders have one of the highest mortality rates of all mental illnesses, second only behind opioid use disorder. In addition, they can have devastating medical consequences. Particularly in adolescence and young adulthood, severe and lifelong medical issues can occur. I almost always work with clients’ medical providers in order to evaluate and monitor health concerns.

I will likely request growth curve records from pediatricians. Growth curves give us wonderful information about an individual's unique growth pathway, and give us good clues about weight ranges we might need to achieve in order for eating disorder symptoms to recede.

I may recommend or refer clients to other services if needed. This may include support from a dietitian, for example.

Higher Level of Care (i.e, residential, inpatient, or partial hospitalization treatment) may be indicated or necessary in order to stabilize severe health concerns or eating disorder behaviors. If I believe a higher level of care is indicated, you will receive a clear explanation about my clinical recommendations and I will support you in finding the best fit.