In our series focused on family-based treatment (FBT) for children and adolescents, we started with a comprehensive description of the treatment model, highlighting the stages of treatment, the role of parents, and the approach to feeding. In this blog, we’d like to address some common myths or misconceptions about FBT.
Research has demonstrated that FBT is more effective for treating anorexia nervosa (AN) than any other intervention for patients under 18 years old, but still, some families and clinicians alike are opposed or resistant to utilizing FBT. Too often, we find that the rationale for bypassing FBT is based on misinformation.
Let’s take a look at some of the most common myths about FBT.
Myth 1: “Teenagers need be working towards independence. I don’t want to stifle age-appropriate separation with FBT.”
Adolescence is a time when teens need to separate, spread their wings and develop independent living skills. Some vocalize the fear that a treatment that focuses on taking overfeeding might inhibit this growth process.
Of course, separation is essential, however, it can only happen if an adolescent is healthy and stable enough to be able to feed him/herself adequately. If the teen can’t take care of this most basic need, it means that independence in the area of feeding would be inappropriate – and actually quite dangerous. The task of FBT is to take control of feeding temporarily with the goal of transferring control back to the teen as soon as it can be managed. Ideally, the teen can participate normally in all other aspects of life while in treatment. It’s just the food that needs to be managed until the teen is ready to take over.
Myth 2: “Anorexia is about control, so controlling my child’s food could make it worse.”
I often ask parents to consider how they would intervene if their teenager was drunk and about to get into a car to drive away. Of course, the response is that they would grab the keys away and escort the child to safety. Anorexia is intoxicating. It takes over the mind and renders the sufferer completely at the mercy of the disease. Ultimately, the sufferer is driven by the disorder and while the restrictive behaviors can feel calming or reassuring at the moment, they can drive the individual quite literally to death. When parents relieve their child of the responsibility of food – they take control temporarily, until the patient can responsibly get back in the driver’s seat on the road to health.
Myth 3: “Parents can’t participate in FBT if they have their own food struggles.”
There is no reason why a family can’t feed their child adequately even if one or both parents struggle with food/weight themselves. FBT is not about treating or changing parental eating. The treatment is about empowering parents to be able to feed their child adequately and to provide the emotional support necessary for the child to recover. We provide plenty of nutrition education and guidance around feeding, always with the focus on the child and his/her unique needs as a young, developing individual in recovery.
Myth 4: “I don’t want to bring the whole family into the treatment plan.”
While it is helpful to educate the entire family unit on FBT, this treatment is intended to reduce the stress in the home, not exacerbate it. We integrate family members (like siblings) only if we believe it will be helpful to the process. Siblings are involved if together we agree that they would benefit from more understanding about their family member’s illness. FBT should not be rigid or oppressive. It is a responsive treatment that navigates the family life in order to support full and lasting recovery.
Myth 5: “My child is too sick. We need to consider a hospital.”
As long as the patient is medically stable, there is rarely a reason to send a child to a program or inpatient facility. FBT is an alternative to these more restrictive settings. Essentially, we create a “hospital at home.” FBT is incredibly efficient and cost-effective (once weekly meetings). We see excellent results using FBT at our center and have seen dozens of young patients avoid hospitalization as a result of successful FBT.
Myth 6: “My child is headstrong and just won’t eat no matter what we do.”
We’ve heard this many times before… and still find that we get there. After working with literally hundreds of families, we have the experience and tools to problem solve any scenario. Of course, on occasion, we’ll meet a child whose anorexia is just too advanced to manage at home, but at least 95% of the time, we find that we absolutely can do it. We may advise implementing a behavior plan with both rewards and consequences to shape the desired behavior (which is 100% meal completion). Even if your child refuses to participate in sessions, we can still be successful by working with parent[s] alone. Your child doesn’t need to appear willing or “on board”. Parents are guided in taking a strong, unwavering stance against anorexia and asserting their position of control as necessary to help their child recover.
Please reach out to our Clinical Director and Certified Family-Based Treatment Therapist, Melissa Gerson, LCSW, directly to discuss whether FBT is right for your family.