Family-Based Treatment (FBT), also known as the Maudsley Approach, is a highly structured, evidence-based outpatient therapy for young people with eating disorders. FBT aims to restore the patient’s weight and interrupt disordered behaviors within the home environment. Typically conducted over six to twelve months, this approach mobilizes the family unit as the primary resource for recovery, offering an alternative to residential treatment.
Defining Family-Based Treatment
FBT operates on the principle that the eating disorder is an external force separate from the young person’s identity. This philosophy allows the therapist to maintain a non-blaming stance, ensuring parents are not held responsible for the disorder. The therapy takes an agnostic view, concentrating intensely on immediate symptoms and behavioral change rather than exploring causes. The focus remains squarely on nutritional rehabilitation and ending disordered behaviors.
Parents are viewed as the most qualified agents to facilitate their child’s recovery, leveraging their intimate knowledge and emotional connection. The therapist functions as a consultant, guiding the family on how to manage the eating disorder behaviors at home. Since the treatment is delivered in an outpatient setting, the family assumes responsibility for the day-to-day work of renourishment. This parent-empowered model is a distinguishing feature focused on tangible outcomes.
Who FBT is Designed For
FBT is primarily indicated for children and adolescents, though adaptations exist for young adults. The treatment has the strongest evidence base for individuals diagnosed with Anorexia Nervosa, with promising results also seen in cases of Bulimia Nervosa. Suitability requires a relatively short duration of illness, often less than three years, as research suggests better outcomes with acute cases.
The patient must be medically stable enough to receive care outside of a hospital setting, as the family manages the physical aspects of refeeding at home. FBT is the first-line, evidence-based treatment for adolescents with Anorexia Nervosa. Studies have shown it to be superior to individual therapy for this age group in achieving full remission.
The Three Phases of FBT
FBT is a three-phase treatment where each phase is initiated only after the goals of the preceding phase have been successfully met. This structured progression ensures the young person is supported at every step toward full recovery and independence.
Phase I: Weight Restoration/Refeeding
Phase I focuses on the young person achieving nutritional and weight restoration, which is managed by the parents. Parents are coached by the therapist to take full control over all meals and snacks, including planning, preparation, and supervision. The therapist also helps the family identify and manage behaviors designed to maintain the illness, such as excessive exercise or purging.
Phase II: Shifting Control
Phase II begins once the young person has achieved sustained weight gain and eating disorder behaviors have significantly subsided. The focus shifts to the gradual return of control over eating back to the adolescent. This transition is managed through carefully negotiated trials, where the young person may take responsibility for a single meal or snack. Parents continue to offer support and intervene if progress lapses, ensuring nutritional stability is maintained.
Phase III: Adolescent Autonomy/Termination
Phase III is initiated when the adolescent is weight-restored and can consistently maintain healthy eating patterns independently. Treatment shifts away from food and weight to address broader issues of adolescent development. The focus is on establishing a healthy sense of identity and addressing any developmental delays that occurred during the illness. The family and therapist also develop strategies for relapse prevention before the termination of therapy.