An alternative to FBT for treating teens with Eating Disorders.

Written By Edie Stark

By Natalia Michaelson and Edie Stark

So Your Teen has Eating Disorder.

And you are searching the internet for what to do. You're either lost on what to do next, overwhelmed by all of the inconsistent and non-existent information out there, or exhausted from fighting their eating disorder. 

You may have come across FBT, or Family Based Therapy.

FBT is a treatment approach that involves the entire family system and can be summarized into 5 basic beliefs.

1. The treatment team won't know and don't need to know the cause of the eating disorder to treat it.

2. The therapist is the expert on the eating disorder and treatment and caregivers are the expert on their family and teen. 

3. Caregivers will need to take more control with confidence to support the teen's recovery, so the eating disorder doesn't take advantage of the situation.

4. The eating disorder is viewed as a separate entity from the individual who has the eating disorder.

5. A change in the current behavioral symptoms must be addressed first/prioritized instead of addressing symptoms perceived as secondary like anxiety, depression, etc.

The Three Phases of Family Based Treatment

FBT has 3 phases, which begin with parents taking on the responsibility to prepare meals and help their teen begin consistent weight restoration by reducing the teen's autonomy related to eating. In phase 2, the slowly teen gains more control over their eating and food preparation. Lastly, phase 3 consists of reviewing any challenges the teen may face and brainstorming as a family on how these challenges may be addressed in lieu of returning to the eating disorder.

Reasons FBT might not be the right fit for you:

While Family Based Treatment can be an effective treatment tool for teens with eating disorders, it is not the only approach available. Like any treatment modality, there can be barriers in place. Let’s explore what those might be.

Eight Common Issues Found with FBT:

  1. Intensive Family Involvement: FBT requires significant involvement from the family, which can be challenging for families with various dynamics or logistical constraints. Not all families may be able to commit to the level of time involvement required.

  2. Parental Stress and Burden: FBT places a substantial burden on parents or caregivers, who must take on the sole responsibility of refeeding their child, monitoring meals, and managing behaviors. This can lead to increased stress and strain on parents, especially if they already have other responsibilities or personal struggles.

  3. Resistance from the Adolescent: Some adolescents may resist the idea of their parents taking control of their eating habits and may struggle with the loss of autonomy. This resistance can hinder the effectiveness of the treatment and may lead to conflict within the family. This resistance is a normal developmental process especially for older teens.

  4. Limited Effectiveness for Some Cases: While FBT has shown effectiveness for many adolescents with anorexia nervosa, it may not be suitable for all cases or all types of eating disorders. Some individuals may require additional or alternative forms of treatment.

  5. Relapse and Long-Term Outcomes: While FBT can lead to initial improvements in weight restoration and eating behaviors, long-term outcomes vary, and relapse can occur. Sustaining the gains made during treatment and preventing relapse can be challenging, requiring ongoing support and monitoring. This can be especially challenging for teens attempting to returning to high school, college or jobs.

  6. Lack of Individual Therapy: FBT primarily focuses on family dynamics and restoring the adolescent's weight. While family involvement is crucial in teens recovery process, We argue that FBT neglects individual therapy for the adolescent which leads to not addressing underlying psychological issues contributing to the eating disorder, and taking away the teens autonomy.

  7. Access and Affordability: Access to qualified FBT therapists may be limited in some regions, and the cost of treatment can be prohibitive for some families. Since the involvement for families is so intensive it often requires one or both of the parents to take time off of work, which can further impacts the financial wellbeing of the family system.

  8. Cultural Considerations: The focus on family dynamics in FBT may not align with cultural beliefs or practices in some communities. Cultural sensitivity and adaptation may be necessary to ensure that the therapy is effective and acceptable within diverse cultural contexts

An Alternative Approach for Treating Teens with Eating Disorder

Sometimes it might feel like you just can't get through to your teen and maybe your teen also feels like they just can't get through to you. 

Maybe your relationship with your teen has felt like oil and water. Oil and water don't mix, BUT we can still put both together and mix them to make cake. It's just the recipe and/or approach that matters.

At Stark Therapy Group, our approach involves finding a balance between honoring the teen's autonomy and supporting caregivers and the family unit collectively.

We intentionally have  mutliple amazing eating disorder therapists on our team, so your entire family can feel supported during this process. We have a therapist for your teen, you and/or all caregivers involved, and for the family as a whole! 

We offer a three-tiered support system to the families of teens with eating disorders. We’ll connect you with a full support team to help you navigate their eating disorder recovery.

Our 3-tiered umbrella care support for teens with eating disorders can help caregivers get back to doing what they do best: being a loving parent.

Why Choose Stark Therapy Group?

  1. You will have individual, parental and family support!

  2. When we're able to provide therapy for the teen, caregivers, and family all within our practice, we have the ability to collaborate to understand dynamics, strengths, and barriers from different angles in order to best support you all. We honor different cultures, family structures and work with you to create the treatment program that works for YOUR family.

  3. We believe it's important to look at all parts of the family system to deepen yours and our understanding of how to facilitate change. With your dedicated Family Therapist, you and your family system will work on safe communication, reducing conflict and bringing joyfulness back into the home.

  4. We want to provide a safe space for the caregivers to be able to process, grief, and learn that free from judgement. Through Parental Counseling, we will work through all the emotions, and trauma that can arise having a sick child in a confidential and compassion space. You will also learn skills and tools to help work with your child to reduce anxiety and create better connection.

  5. We want to include you in your teen's treatment while honoring your teen's autonomy and utilizing your support in meaningful ways to increase understanding and connection.

  6. Your family’s, Teen therapist, Parent therapist and Family Therapist with hold Weekly Treatment meetings to ensure a continuum of care, and a true collaborative approach.

  7. There are so many benefits to having a whole team dedicated to supporting your family!

We would feel honored to support you. Reach out today and let us help your teen and family heal.

Edie Stark
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