Theory-based Treatment Planning for Marriage and Family Therapists

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Family-based treatment (FBT, also sometimes referred to as the Maudsley method) is a leading handling for adolescent eating disorders including anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder (OSFED).

It is a manualized handling delivered by trained professionals. Information technology is primarily delivered in outpatient settings, although there are some residential and partial hospitalization (PHP) programs that incorporate FBT.

While FBT may not exist for every family unit, research shows that it is highly effective and faster to act than many other treatments.

It should therefore usually be considered as a first-line approach to treatment for children, adolescents, and some young adults with eating disorders.

Alternative Arroyo

FBT represents a radical departure from more traditional treatments. Older theories about anorexia and eating disorders, advanced by Hilde Bruch and others, ascribed their onset to family enmeshment or other dysfunction inside the family. Mothers were believed to be the primary cause of the eating disorders of their children, equally they were in the case of schizophrenia and autism.

The typical treatment instructed parents to step aside and plough their children with anorexia over to individual handling or residential handling centers—an approach we now know to have been, in many cases, detrimental to both the families and the patients.

Contempo research has debunked the theory of parental causation of eating disorders, just every bit it has for schizophrenia and autism.

Genetic studies indicate that approximately l% to 80% of a person's risk of an eating disorder is due to genetic factors.

Research

The literature has rediscovered older starvation studies demonstrating that a number of characteristic behaviors of anorexia are really the result of malnutrition that accompanies anorexia.

Information technology is besides believed that many clinicians made a basic option bias error: observing the dynamics of families as they were seeking handling, clinicians naturally saw families locked in a life-and-expiry struggle over nutrient. This struggle is, however, a symptom of the disorder, not a cause—in the years preceding the eating disorder, their dynamics likely looked no different than other families.

Acknowledging that the weight of evidence had shifted, in 2010, the University for Eating Disorders published a position paper specifically refuting the idea that family factors are a primary mechanism in the development of an eating disorder. This is a positive shift because it has resulted in the greater inclusion of parents in treatment in general and greater acceptance of and need for FBT.

FBT vs. Family Therapy

FBT should not exist dislocated with the similarly-named merely potentially fundamentally unlike approaches under the umbrella of family unit therapy. Traditional family therapy oft takes the view that the child with an eating disorder is expressing a family unit trouble.

It focuses on identifying and solving that problem in society to cure the eating disorder. This approach has not been supported by research and is challenged by the AED position newspaper.

In the 1970s and early 1980s, the clinicians at the Maudsley Infirmary in London, England, conceived a very different grade of family therapy, treating parents every bit a resource, non a source of harm. The Maudsley team has connected to develop and teach the approach, which they do not refer to as the Maudsley approach, just as anorexia-focused family therapy.

Meanwhile Drs. Daniel Le Grange and James Lock farther developed the model in a manual (published in 2002 and updated in 2013), naming their manualized version Family-Based Treatment (FBT).

The FBT approach is rooted in aspects of behavioral therapy, narrative therapy, and structural family unit therapy. Lock and Le Grange take established the Training Institute for Kid and Adolescent Eating Disorders, an organization that trains therapists in this handling and maintains a list of certified therapists and therapists in training.

Principles of FBT

FBT takes an agnostic view of the eating disorder, meaning therapists practice not try to analyze why the eating disorder developed. FBT does not blame families for the disorder. On the contrary, it presumes the powerful bond between parents and children and empowers the parents to use their dear to help their child.

In FBT, parents are viewed as experts on their kid, an essential role of the solution, and members of the handling team.

In FBT, the eating disorder is viewed as an external force that is possessing the kid. Parents are asked to join with the healthy part of the child against the eating disorder which is threatening to take their child abroad. Full nutrition is viewed as a critical first stride in recovery; the role of parents is to provide this nutrition past actively feeding their child.

FBT sessions usually involve the entire family and include at least one family meal in the therapist'south office. This gives the therapist an opportunity to observe the behaviors of different family members during a meal and to passenger vehicle the parents to aid their child swallow.

Considering patients with eating disorders may present with medical complications, they should be monitored by a medico during the course of handling.

3 Phases of FBT

FBT has three phases:

• Phase 1: Full parental control. Parents are usually in complete charge of meals equally they help their child to reestablish regular patterns of eating and interrupt problematic eating disorder behaviors such as bingeing, purging, and overexercise. If weight gain is indicated, the goal is 1 to two pounds per calendar week. The therapist works to empower the parents to accept on these tasks and helps the parents learn to manage the child at mealtimes.
• Phase 2: A gradual return of command to the adolescent. This stage typically begins in one case weight is generally restored, when meals are going more smoothly, and when behaviors are more than under command. Control is gradually handed back to the adolescent in an historic period-appropriate fashion: for example, the kid may start to have some meals or snacks away from the parent. There tin can exist recidivism and parents may accept to reassert control from fourth dimension to time until the boyish is fully ready; this is office of the process.
• Stage 3: Establishing healthy independence. When the adolescent is able to consume with an age-appropriate level of independence and does not showroom eating disorder behaviors, the focus of handling shifts to helping them develop a salubrious identity and catch up on other developmental issues. Other comorbid problems may be addressed. The family is helped to reorganize now that the child is healthier.

Advantages of FBT

Brain starvation tin can cause anosognosia, a lack of awareness that ane is ill. As a result, there tin be a long fourth dimension lag before the minds of adolescents in recovery are capable of the motivation or insight to maintain their own recovery.

FBT assigns the work of behavioral change and full nutrition to the parents and gives them skills and coaching to encounter these goals. As a upshot, information technology helps the kid to recover fifty-fifty before they take the chapters to do then on their ain.

Because it tends to work faster than other treatments, FBT reduces medical repercussions and increases the chances of a complete recovery. It allows the kid to remain at dwelling house with their parents and is oftentimes more cost-effective than residential treatment.

Research on FBT

Enquiry has shown that adolescents who receive FBT recover at college rates than adolescents who receive individual therapy:

• A written report out of the Academy of Chicago and Stanford shows that at the terminate of a grade of FBT, two-thirds of adolescents with anorexia nervosa take recovered; 75 percent to 90 percent are weight-recovered at a 5-year follow-up.
• A contempo study compared FBT for bulimia nervosa with CBT for bulimia nervosa. The findings indicated that FBT led to faster and sustained forbearance rates for teens.
• Preliminary research and example studies also indicate that FBT is an acceptable approach for young adults.

FBT appears to exist most effective for families in which the length of disease is less than iii years. An early positive response to the treatment (commonly by week four) is prognostic of a long-term successful outcome.

FBT Is Not for Every Family

Parents often believe that FBT volition not work for them. "My child is as well old." "My child is too independent." "I'm not strong enough." "We are likewise busy." Still none of these bug accept shown to necessarily be a barrier for a successful FBT treatment execution. Inquiry and clinical experience demonstrate that many various families are able to successfully implement FBT.

However, it is not for every family. It is rigorous and requires a stiff delivery by the family members. It is not recommended for families in which the parents are physically or sexually abusive or are abusing substances.

FBT may non be recommended for families in which the parents are overly critical.

For families where parents tend to exist critical, a variation of FBT, called separated FBT, can be a dandy option. In this approach, the therapist meets just with the parents while the child's weight is monitored past medical personnel.

A Word From Verywell

The above exceptions represent only a minority of cases. Families who take used this approach are generally very enthusiastic and grateful to have been a function of the solution. Helping to play an active role in your child'south recovery can be a very rewarding feel.

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Source: https://www.verywellmind.com/what-is-family-based-treatment-fbt-for-eating-disorders-4052371

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