Family-Based Therapy: Three Steps to Anorexia Recovery, Part 2

As we continue our exploration of the application of Family-Based Therapy for recovery from anorexia nervosa, it might be helpful if we first do a quick review.

In Part 1 of this series we discussed why parental involvement in a child or adolescent’s recovery process is so vital to recovery success. Children need their parents. Parents want and need to be involved. Beyond these simple relational facts, research results have proven that a parent’s active involvement in a child’s recovery process is often a major determinant of a successful outcome.

There are three main stages for implementing a Maudsley or Family-Based Therapy (FBT) approach. The first stage is weight restoration. This phase is nearly guaranteed to strike fear into the hearts of even the most stalwart parents. The basis of this fear and trepidation, accordingly to treating professionals and parents active in the FBT approach, is a simple misunderstanding. Maudsley Parents, another parent support and advocacy organization, explains that the confusion comes in when a parent sees food as different from medicine. FBT treating professionals are able to clear up much of the confusion and fear when they explain to the parents that food is medicine, and as such it is both medically-prescribed and absolutely necessary for the reversal of the anorexic adolescent’s malnourishment.

During the weight restoration phase, the treating team, which often and ideally includes a medical doctor, therapist, dietician, and psychiatrist, coaches the parents on the proper administration and dosages of “food as medicine.” With coaching and support, parents learn how to empathize with the pain, fear, and anger their adolescent may express, while continuing to insist that the child take in proper dosages of the necessary medicine. Family mealtimes and parental supervision of caloric and nutrient intake is a vital part of the success of this phase. Simultaneously, siblings are taught how to support the patient, and the treating team works to help the patient reintegrate with siblings and with the family unit. Parents who persist and learn the skills necessary to successfully navigate the weight restoration phase find that it is tremendously healing and nurturing for both the patient and for the family unit as a whole.

The next phase is one parents will look forward to during the entirety of phase one, because in phase two parents begin turning control of eating back over to the adolescent. The family unit’s ability to transition to this phase is dependent upon the patient’s continued weight gain, acquiescence to continual increases in food intake, and a positive change in the demeanor and dynamic of the family unit. Often at this phase, everyone from the patient to the parents to the siblings is feeling relief that the eating disorder symptoms are being effectively and consistently addressed, and this relief changes the family interactions for the better, reducing resistance and strengthening resolve. Parents can then begin to give the patient more control over food choice and eating. There is a trust bond that is mutually demonstrated and earned again with each meal as parents see that the adolescent is both willing and medically able to make their own sound and healthy food choices. The patient is also able to eat away from the parents to such an extent as they are able to demonstrate the same healthy choices with friends, peers, and other family members that they do in the home. While this phase can feel stop-and-start especially at first, the entire family is encouraged by the patient’s progress through dependence to interdependence to eventual independence in making healthy nutritional choices and practicing effective body care.

During phase three, the focus moves beyond the food to a re-establishment of a healthy adolescent identity. This is the most exciting phase when parents, siblings, and the patient begin to see the real fruits of persistence with the FBT approach. Here, the adolescent is able to maintain 95% of their ideal weight consistently. Signs of desire or intent to self-starve have abated. The patient has newfound ability to navigate mealtimes with relative ease whether in the home or while out with friends or family. Privileges around food come back into alignment with other privileges that signal a growth from child to adolescent into the teen and young adult years. Often there is a much increased closeness within the family unit and signs of the fear, anger, and resistance that characterized much of phase one and into phase two have vanished (also easing residual parent concerns that phase one and two supervision may somehow irreparably harm the parent-child relationship – research results show that for most families the exact opposite is the case). With weight restoration and stabilization and mealtime autonomy also comes a willingness and ability on the part of the patient to look at some of the underlying triggers and issues that may have contributed to the anorexia. In phase three, the patient can begin or resume work with a therapist and other treating professionals to further discuss healthy life coping skills, identity development, and pursuit of life dreams and goals.

Emergence from phase three shows a young, bright, promising future where the anorexia used to be. The entire family continues to exercise vigilance even amidst beaming smiles and a huge, long sigh of RELIEF.

At Southlake Counseling, we have more than twenty years’ experience with successfully treating eating disorders, disordered eating, body image, self esteem, recovery, health, and wellness concerns in children, adolescents, young and mature adults. Our caring, compassionate, professional and highly trained staff partner with you and your family to smoothly navigate all three phases of the Family-Based Therapy (FBT) process. Discover how rewarding and satisfying it can be to become an active participant in your child or adolescent’s health and wellness by contacting us at

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