Last updated on April 27th, 2021
Are you wondering if family therapy is suitable for your young adult with anorexia?
We're in a crazy situation where the minute someone turns 18, the gold-standard treatment for eating disorders gets ditched.
That's because the family-based treatment model has not yet been put to much research in adults.
So I pounced on one bit of research on a variant of family-based treamtent (FBT) applied to 'Transition Age Adults (TAY)', defined as 17 to 25 years old.
This makes sense to me. There are plenty of accounts of older adults benefiting from support from their parents. I hope that one day, the involvement of family members will become a standard treatment option: suitable for many, whatever their age.
Currently the eating disorder treatment available to individuals aged 18+ is almost exclusively via individual therapy, with parents or partners kept firmly at bay. For some eating disorders, there is also group therapy, but again, parents or partners are excluded.
Through weekly appointments, the person is expected to find motivation and insight, which, the theory goes, will eventually enable them to nourish themselves, gain weight if required, stop purging, stop over-exercising, stop bingeing. When individuals don't manage all this and deteriorate, hopefully they get access to a higher level of care ( hospital / residential / day-hospital treatment etc). Upon discharge, the person may not be able to continue the recovery work, and the cycle starts all over again.
In this model, parents or partners can only watch and suffer.
Far from being empowered to support the person with the eating disorder, they have been instructed not to get involved, to let the person 'take ownership of their recovery', to 'take responsibility' for themselves. If they try and help, they may get branded as enmeshed, over-controlling, co-dependent…. just like parents of teens, before research showed that youngsters with an eating disorder can really benefit from their parents' involvement.
I believe people, whatever their age, need skilled support from people who love them. Parents and partners must be empowered by therapists, because they are facing someone whose illness creates ambivalence about getting help. And they need coaching because it's an extremely skilled task.
If you think you can't possibly take charge of your son or daughter's eating because they are older and are used to a high level of autonomy, then FBT-TAY (family-based treatment for transition-age youth) may be the answer. It's an adaptation of FBT, where with a therapist's help, the young person takes on a little more ownership of their treatment. This works if they agree, at least in principle, to have their parents' help. When they waver, the therapist helps renew the agreement.
For more on this, head over to my article on mirror-mirror here.
It summarises findings in a chapter of this excellent book (which all clinicians should have). More research from Gina Dimitropoulos, Kristen Anderson, James Lock and Daniel Le Grange is due to be published. Sign up for emails from me for news.
For more on supporting an adult with an eating disorder using a family-based approach
Head over to Tabitha Farrar's excellent resources for adults (podcast, YouTubes, blog, books).
Read Modified Family-Based Treatment for the Young Adult by therapist Sarah Wells
Read a fantastic first-hand account by 40-year old Helen, who got her parents to help her recover.
Check out @recovering_nomad on Instagram
For a review of the research on treatment for adults, see Glenn Waller (2016), ‘Recent advances in psychological therapies for eating disorders’
I say a little more on the treatment of adults or 18+ here