Family therapy for eating disorders: what is FBT / Maudsley and what else is recommended?

What is family therapy for eating disorders?

Family Therapy for eating disorders means you, the parents, are supported to treat your child at home. The evidence is this is the best treatment for anorexia, and to some extent, for bulimia, in teenagers.

With family therapy, the treatment parents give is

  • mealtime support, or mealtime management: refeeding your child if underweight, and supporting him or her to eat
  • supporting your son or daughter to return to normal behaviours
  • helping everyone return to normal life

The best treatment for teenagers with anorexia

The research on adolescents with anorexia is especially strong. With bulimia, it’s a toss-up between FBT and a specialised form of cognitive-behavioural therapy. If your child suffers from binge-eating disorder, there is no research to give you strong guidance, so you might want an adaptation of FBT.

Treating adults with anorexia

There are moves to adapt the family-based approach to adults, especially young adults (university age). In general, people suffering from an eating disorder need support from their family, whatever their age.

Careful – not all family therapies are suitable for eating disorders

Family Therapy for eating disorders is different from general family therapy. General family therapy may assume that family dynamics drive the eating disorder and/or impair recovery. It examines how problems affecting a child could be solved by having the parents and the rest of the family interact differently. This isn’t relevant to eating disorders and when it’s done badly, the assumptions are dangerous because:

  • there could be an assumption you are pathological parents, and therefore your child will be steered away from you and lose their most important resource towards recovery
  • the focus could be on your interactions, rather than on the urgent job of supporting you to feed your adolescent and keep him or her safe

The family therapy that  is indicated by research does the very opposite. In spite of this, many treatment centres for eating disorders offer general family therapy, not the specialised kind, so you’ll need to read between the lines or ask questions.

What kind of family therapy is the best for anorexia or bulimia?

Check that what’s on offer is “family therapy specialised for eating disorders” or “family-based treatment (FBT)” or “Maudsley”. In the UK, experts are about to release an update to the NICE guidelines, after examining all the possible evidence. They advocate “anorexia-nervosa-focused family therapy for young people”, which is a way of saying, it could be what is taught by Maudsley’s Eisler/Mimic’s team in London, or it could be the FBT from Stanford, or it could be variants — just don’t make it general family therapy.

Confusingly, “systemic family therapy” may refer to general family therapy or to the specialised form that is recommended for eating disorders.

Another confusion is the term “Maudsley”. People in the United States often refer to FBT as “The Maudsley approach”, because its roots are in the  Child and Adolescent Eating Disorders Service of the Maudsley hospital, London. Don’t confuse this with an adult-orientated approach later developed by the adult eating disorder services in the Maudsley hospital, headed by Janet Treasure, which, rather confusingly, is called ‘The new Maudsley Approach’.

Which strand of family therapy for eating disorders is best?

The first trials for the treatment of anorexia nervosa were done in the Child and Adolescent part of Maudsley, where the approach continues to evolve under Ivan Eisler and Mima Simic. Nowadays they place quite an emphasis on multifamily therapy. The team are training therapists worldwide but mostly in England and Wales. There is no certification and no obligatory supervision or mentoring, so there is no easy way to know how specialised a therapist will be.

Meanwhile In the US, Maudsley’s family therapy got set down in a manual and subjected to further trials. The name given to this manualised approach is Family-Based Treatment (FBT) (and some call it ‘The Maudsley method’). You can read the manual and there’s also a book for parents (there’s a list of these books and more here). Therapists can go for certification, which offers you, the parent, some confidence that they have gone through a lot of training and supervision. There are also good FBT therapists who don’t have the certification, though. My own family got top-notch support from a therapist who was shadowing another therapist who was going through FBT certification.

Research on variants of the original FBT continues, and clinicians deviate more or less from the manual, sometimes with careful testing and monitoring, sometimes not.

You will find FBT dotted around the world, in particular in the US, Canada, Australia, New Zealand and Scotland. For a list of FBT therapists who are open to Skyping anywhere in the world, see here.

Hospitals that do family based treatment

Your son or daughter is far more likely to recover with you at home than with nurses and therapists in some artificial environment. Even if your child needs to go to hospital, at some stage they will need your support to get into normal life. So there is always a role for treatment involving the family.

If your child or adolescent is medically unstable, if you just can’t get him or her to eat, or if they are a danger to themselves (self-harm, suicide) then hospitalisation or day programmes may be indicated. We need these and at times they provide essential relief to the family.

The approach within a hospital should be to get you, the parents, on board as quickly as possible. That way as soon as you are able to look after your child at home, you can do so. In Stanford, the home of FBT, the average hospital stay is just 8 days. In the UK, the trend is to only admit children and adolescents into hospitals for medical stabilisation, for no more than a couple of weeks. During that time, the community eating disorder specialists visit the young person along with the parents, to support both parents and nursing staff to get the young person to eat. This prepares parents and child for a successful return home as soon as possible.

How my book will guide you through family therapy for eating disorders

Here are the principles which I’m concentrating on in my book.

  • The best results are obtained when parents are central to the treatment.
  • Food is medicine, and children are brought back to a healthy weight.
  • Parents are best placed to support meals, while also preventing over-exercising, bingeing and purging.
  • All this is done within a loving, uncritical, supportive family environment.
  • Psychotherapy, insight, self-esteem or motivation are not needed, and many of the mental issues of the illness will be resolve with nutrition and weight-restoration.

This book isn’t pure FBT, though my experience is of being supported by a team who was committed to FBT. My book complements the Lock/Le Grange books nicely as it gives you more of the “How”, as well as a sense of having a companion who can guide you along the way.

For more on this subject, jump to: Treatment and support for your child and for you  

For more on how to help your child manage meals, jump to: How do you get your anorexic child to eat?



2 thoughts on “Family therapy for eating disorders: what is FBT / Maudsley and what else is recommended?

  1. Nicola said:

    Hi Eva, I plan to attend the FBT training in Aberdeen next week so very interested in your summary. On another issue, I am trying to find an illustrator to help me design a treatment manual for my doctorate – could you share who does your videos please?

    • Hi Nicola, sounds good! Who’s doing the training? Hope you get lots out of it. I’ll email you about my videos.

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