While some older adolescents may benefit from individual cognitive behavioral therapy, for many adolescents with anorexia and bulimia, a better option is Family-Based Treatment (FBT or Maudsley Approach), one of the most successful and empirically validated treatments. Family-based treatment (FBT) usually consists of 20 treatment sessions over a course of 6 to 12 months.
Family-Based Treatment was developed at the Maudsley Hospital in London, England in the late 1970s and early 1980s by Drs. Christopher Dare, Ivan Eisler, Gerald Russell, and George Szmukler. Dr. Daniel le Grange and Dr. James Lock brought the treatment approach to the US and published the first treatment manual in 2002 (Lock, J., Le Grange, D., Agras, W.S., Dare, C. (2002). An updated manual was published in 2015 and a manual for bulimia nervosa was published in 2009.
In the FBT approach, no one is blamed for the development of the eating disorder. The symptoms are seen as outside of the child’s control and taking on a life of their own.
In contrast to traditional therapies, Family-Based Treatment enlists the support of the entire family as a resource in helping the adolescent battle the eating disorder. Treatment initially focuses on weight restoration and/or elimination of bingeing and purging behaviors, with the parents given the task of providing adequate nutrition for their adolescent during family meals. The therapist supports the parents in this difficult task and also models an uncritical stance that views the eating disorder as an external force that must be fought off by the entire family working together. Once progress has been made in weight gain and cessation of bingeing and purging, in the second phase of treatment the child is gradually returned more control over their own eating. In the final phase of treatment issues of adolescent identity are addressed within the family context.
FBT is a promising alternative model to costly inpatient or day hospital programs. Research out of the University of Chicago and Stanford University shows that at the end of a course of FBT, two-thirds of adolescents with anorexia nervosa are recovered and 75% to 90% are weight-recovered at five year follow-up. It has also been successfully employed with adolescents with bulimia nervosa and with college students with anorexia nervosa. It can also be adapted for young adults who have parents who can support them in recovery.
FBT is not appropriate for all families. It is rigorous and requires a strong commitment by the family members. However, we find that the partnerships with families who have this commitment to their child’s recovery are very rewarding. Families who have used this approach are generally enthusiastic and grateful to have been a part of the solution.
- Lock, J., Le Grange, D., Agras, W.S., Dare, C. (2002). Treatment Manual for Anorexia Nervosa: A Family-Based Approach. The Guilford Press: New York.