The five tenets of family-based treatment for adolescent eating disorders

Abstract

Family-based treatment (FBT) is the leading treatment for adolescent eating disorders and is based on five tenets, or fundamental assumptions: (1) the therapist holds an agnostic view of the cause of the illness; (2) the therapist takes a non-authoritarian stance in treatment; (3) parents are empowered to bring about the recovery of their child; (4) the eating disorder is separated from the patient and externalized; and (5) FBT utilizes a pragmatic approach to treatment. Learning these tenets is crucial to the correct practice and implementation of manualized FBT. The purpose of the current paper is to provide an in-depth overview of these five tenets and to illustrate how they are used in clinical practice. This overview will aid clinicians who are learning FBT.

Preventing eating disorders and disordered eating in genetically vulnerable, high‐risk families

“…The prevention program is designed for families in which an older child or adolescent is at risk because a biological parent has an ED history. We would further delimit this group by selecting families who have participated in FBT, because the parents will likely already have confidence in their ability to make important changes in the family (Rienecke & Le Grange, 2022). This choice reflects the practical matter of beginning with the approach most familiar to the authors (Sadeh‐Sharvit & Lock, 2018).…”

“…The prevention paradigm, to be discussed and ultimately determined by the stakeholders, will likely be a creative amalgam of common principles and practices in the prevention of depression and anxiety in high‐risk families (Loechner et al, 2018), in the effective prevention of EDs (Levine & Smolak, 2021), and in FBT for adolescents (Gorrell et al, 2019; Rienecke & Le Grange, 2022). Table 2 lists the targets for this preventive intervention.…”

“… Source : Baudinet et al, 2021; Levine & Smolak, 2021; Piran, 2010; Rienecke and Le Grange (2022); Sadeh‐Sharvit et al (2018). …”

“…In that regard, in discussing the importance of the “therapist's non‐authoritarian stance,” Rienecke and Le Grange (2022, p. 4) note that in FBT, “The therapist is the expert on EDs and on treatment, and the parents are seen as the experts on their child and their family.” This humble, collaborative perspective applies to a degree in FBT‐informed prevention, but for prevention professionals a more relevant concept than non‐authoritarian is “authoritative” (Steinberg, 2001). Prevention specialists are advised to allow the family as much warmth, caring, attentiveness, autonomy, and creativity as possible in facilitating change, all within boundaries set by the scientific knowledge that, for example, weight‐and‐shape based teasing, criticism, and stigmatizing attitudes are antithetical to both prevention and the ethical obligation to do—and countenance—no harm.…”

“…These issues are non‐specific to EDs, but systematically addressing them is integral to Sadeh‐Sharvit's effective program for helping new parents with an ED to effectively feed and otherwise nurture their child. Focusing on these issues supports the person who is recovering from an ED and increases the probability that the family will provide protective factors for those at risk (Rienecke & Le Grange, 2022; Sadeh‐Sharvit et al, 2016, 2020b). It also promotes the consistency, predictability, stability, and flexibility that facilitate application of the knowledge and skills developed to address the other two areas (Matthews et al, 2021).…”