Family-Based Treatment (FBT), often referred to as the Maudsley Approach, is an evidence-based intervention for adolescent eating disorders. FBT empowers parents to be the primary agents of their child’s recovery, allowing treatment to occur in the home setting rather than in a residential facility. The therapy is typically delivered in an outpatient setting and is designed to leverage the family’s strength to interrupt the life-threatening symptoms of the eating disorder.
Foundational Principles of FBT
A core philosophical tenet of FBT is the “agnostic view of causation,” which means the therapist does not focus on determining why the illness began. Since eating disorders are complex conditions with genetic, psychological, and environmental influences, the treatment focuses only on immediate behavioral change rather than exploring root causes. This pragmatic approach allows the family and therapist to concentrate their energy on the present crisis of malnutrition and disordered behaviors.
The model views parents as the most effective resource for recovery, a concept called parental empowerment. The therapist coaches and supports the parents to take full responsibility for refeeding and weight restoration, positioning them as an active part of the treatment team. This is a significant shift from older treatment models that often excluded parents or mistakenly blamed them for the disorder.
Another important principle is externalizing the illness, which involves separating the eating disorder symptoms from the adolescent’s true identity. The family is encouraged to view the eating disorder as an external force or entity that has temporarily taken hold of their child. This reframing helps reduce parental criticism and aligns the entire family, including siblings, to fight against the illness together.
The Three Distinct Phases of Treatment
The FBT process is divided into three distinct and sequential phases, which generally take about 6 to 12 months to complete. The initial phase is designed to be highly intensive, with the primary goal of physical stabilization and weight restoration. This period, known as Phase I, or Weight Restoration and Symptom Interruption, requires parents to take complete control over all aspects of their child’s eating.
Parents are responsible for deciding what, when, and how much their child eats, ensuring consistent meal and snack times. The therapist coaches parents on how to manage mealtime challenges and interrupt behaviors like excessive exercise or purging. The focus is on measurable physical progress, aiming for a steady weight gain, such as one to two pounds per week in cases of Anorexia Nervosa. This intensive parental supervision continues until the patient is medically stable and eating disorder behaviors have significantly receded.
Phase II, or Return Control to the Adolescent, begins once the patient has achieved a stable weight and is consistently eating with minimal resistance. This transition is a gradual, structured process where parents slowly hand over age-appropriate autonomy around food back to the adolescent. The therapist guides the family through this delicate negotiation, ensuring that control is only returned as the adolescent demonstrates competence and responsibility.
For example, the adolescent may begin by plating their own meals or having a supervised snack away from home, with the parents maintaining the right to intervene if symptoms reappear. This phase focuses on building the adolescent’s self-trust and independence while maintaining vigilance against any relapse of disordered eating behaviors. The final stage is Phase III, which focuses on Establishing Healthy Adolescent Identity.
In Phase III, the focus shifts away from food and weight, as the adolescent is now maintaining a healthy weight independently and eating normally. The family and therapist work on addressing broader developmental issues and family dynamics that were put on hold during the crisis. This includes helping the young person transition back to a normal adolescent life, catch up on any missed developmental milestones, and explore their identity free from the eating disorder.
Who FBT Is Designed To Help
FBT is primarily designed for children and adolescents under the age of 18 who are living at home with their family. The model is most effective when the patient has a relatively short duration of illness, typically less than three years. This population is generally more responsive to treatment, which is why FBT is considered the first-line, evidence-based treatment for adolescent Anorexia Nervosa.
The treatment is delivered in an outpatient setting, allowing the young person to recover within their normal daily environment. While FBT was originally developed for Anorexia Nervosa, it has been adapted for other disorders like Bulimia Nervosa. For the treatment to be successful, the patient must be medically stable enough to avoid the need for immediate inpatient hospitalization.