What If FBT Isn't Right For Your Family? Learning When To Pivot
As a parent navigating the complexities of your child's eating disorder, you've likely heard about Family Based Treatment (FBT) as a primary approach to managing this challenging condition.
FBT has shown significant effectiveness in treating eating disorders, particularly in adolescents.
However, what if you find that FBT isn't the right fit for your family? How do you navigate this delicate situation?
First, it's crucial to acknowledge that every family is unique, and what works for one may not necessarily work for another. While FBT has helped countless families in their journey towards recovery, it's essential to recognize when it might not be the most suitable option for your situation.
Here are some signs that FBT may not be the right fit for your family:
Resistance and Strain: If you and your child are experiencing significant resistance or strain during FBT sessions without improvement over time, it may indicate that the approach isn't resonating with your family dynamics. While resistance is common during FBT, especially in the beginning phases, excessive resistance may hinder progress and indicate the need for a different approach. Sometimes it’s helpful to address the family dynamics and improve communication, and then return to the FBT approach. Other times, taking a different approach altogether can yield better results.
Lack of Progress: Despite consistent effort and adherence to the FBT protocol, if you notice a lack of progress or worsening symptoms in your child's condition, it's essential to reassess whether FBT is the most effective approach for your family. Lack of progress can come from a multitude of factors, including length of illness, family dynamics, co-occurring mental health conditions, barriers to care, and more. It's important to consult with your treatment team to explore where there may be barriers to progress and collaboratively determine the best course of action.
Unaddressed Co-Occuring Issues: Eating disorders often stem from deeper psychological issues that may require more comprehensive therapeutic interventions. FBT focuses on meal support and weight restoration initially to support medical and nutritional rehabilitation. The idea being that psychological recovery typically doesn’t happen in an undernourished brain. However, for some, not addressing these underlying issues may keep them in a cycle of distress and maladaptive coping mechanisms, or it may not lead to sustainable recovery.
Parental Burnout: FBT places a significant burden on parents, requiring them to take an active role in their child's recovery process. If you're experiencing burnout or feeling overwhelmed by the demands of FBT, it's crucial to consider alternative resources and approaches that may offer more support and relief.
FBT is a challenging and intensive treatment approach that requires time, patience, and persistence. Setbacks are expected along the way. Setting realistic expectations for progress and preparing for the more challenging moments can be a useful way to stay grounded and not get discouraged when setbacks rear their ugly heads. Be willing to adapt and modify your approach based on your child's individual needs and responses. What works for one family may not work for another, so don't be afraid to try different strategies and approaches until you find what works best for your child and your family.
So, what should you do if you find that FBT isn't the right fit for your family? It's essential to consult with your treatment team when exploring alternative treatment options. Here are some alternatives to consider:
Individual Therapy: Both for your child and for yourself as a parent, individual therapy can provide a safe space to explore underlying issues contributing to the eating disorder and develop coping strategies for managing symptoms.
Group Therapy: Group therapy can offer valuable support and validation from peers who are going through similar challenges. It can also provide an opportunity for your child to practice social skills and build connections outside of the family unit.
Nutritional Counseling: Working with a registered dietitian who specializes in eating disorders can provide tailored guidance and support for establishing a healthy relationship with food and body image.
Partial Hospitalization (PHP) or Intensive Outpatient Treatment (IOP): There are day treatment options available for those who need more structured and comprehensive treatment, but are eager to remain close to home and have the ongoing support of caregivers. Some Day Treatment Programs can adhere to the FBT philosophy by incorporating parents more directly in the treatment process, while also providing your child with meal support, individual therapy, and group therapies.
Residential Treatment: In cases where the eating disorder is severe or complex, residential treatment programs offer intensive, round-the-clock care in a structured environment. Parents are often still involved throughout residential treatment, but usually for weekly family therapy that focuses on a supportive, rather than directive role.
Remember, the goal of treatment is not just to manage symptoms but to promote long-term recovery and well-being for your child and your family as a whole. It's okay to reassess and pivot if you find that FBT isn't the right fit for you. If you're unsure about the next steps or need guidance in finding alternative treatment options, reach out to your treatment team who can provide personalized support and recommendations. Trust your instincts as a parent and advocate for the approach that best supports your family's needs.
If you are seeking eating disorder treatment or mental health therapy for you or your adolescent, Cypress Wellness Collective can help. Cypress Wellness Collective is located in the San Francisco Bay Area where they specialize in Family Based Treatment (FBT), therapy, and nutrition counseling for teens, adults, and families going through eating disorder recovery. They offer in person and virtual appointments throughout all of California. Call today for your free consultation to see if Cypress Wellness Collective is right for you!
References:
Lock, J., Le Grange, D. (2015). Treatment Manual for Anorexia Nervosa: A Family-Based Approach. Guilford Press.
National Eating Disorders Association. (2022). Parent Toolkit: Family-Based Treatment (FBT). Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/family-based-treatment
Eisler, I., Simic, M., Russell, G. F., & Dare, C. (2007). A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. Journal of Child Psychology and Psychiatry, 48(6), 552-560.