Family-Based Therapy

Psychologists and psychiatrists use family-based therapy to treat a range of mental health conditions. It is often used with addiction, depression, and mental illness. The approach assumes that family is a key resource for everyone—especially adolescents and young adults, who depend on their families for all types of support.

The Maudsley Hospital in London was the first place to use family therapy to treat eating disorders. The British program focused on teens with anorexia nervosa. Today, we use this approach to help adolescents and young adults with a wide range of eating disorders. Some forms of family therapy assume that a child is acting out to express a family problem. The Maudsley approach treats the parents as a resource, not a problem. It is an evidence-based therapy that uses the latest scientific research and offers an outpatient alternative to hospitalization.

Treatment takes place once or twice a week for six to nine months. We offer therapy to the young person and supportive training to parents. The goal is to get the young person to a healthy weight and help him or her re-learn how to eat in a way that promotes good nutrition. This approach works best for those who have been ill for three years or less. It requires loving support from family members.

This approach targets anxiety related to food, eating, and body image. We address the young person’s worries, fears, and inflexible thinking. To help with inflexible thinking, we often use acceptance-based mirror exposure. We train parents to help the young person learn to tolerate or shift negative feelings about eating and daily functioning.

While we design a plan specifically for you or your child, there are three basic stages to the Maudsley Approach:

  • Phase I: Getting to a Healthy Weight: At the beginning of treatment, the young person is not making good health choices, so the parents need to step in. We assess how your family copes with mealtime and make suggestions. The goal is to help parents take charge of mealtime, help their child adjust to regular eating patterns, and encourage them to eat a little more. Our goal is a weight gain of two pounds a week.
  • Phase II: Helping Your Child Regain Control: We begin this phase when the young person is at a healthy weight, meals are going more smoothly, and there is no sign of eating disorder behaviors such as bingeing or purging. At this point, we help parents hand over control of eating to their child—and helping the child eat in a healthy manner and continue to gain weight. We strive to achieve this with minimal tension. There may be some relapse. At that point, parents may need to step in again.
  • Phase III: Establishing a Healthy Identity: Once your child can maintain a weight at 95 percent of ideal eating at an age-appropriate level of independence, we turn to helping the young person develop a healthy identity. This includes not only eating, but also independence and sexuality. We may address other mental health conditions at this point. We support increased personal autonomy, help develop appropriate parental boundaries, and assist the family reorganize out of crisis mode.

This family-based approach may not work for every family. It requires a loving, supportive family and a strong commitment from everyone involved. Our doctors will assess your family to see if the Maudsley approach would work for you.

Alternatives to Traditional FBT

Exposure-based Family Therapy (FBT-E) approaches treatment of eating disorder through anxiety.  We address three core aspects of anxiety as it relates to eating and shape/weight concerns.  First, FBT-E targets disgust-based aversion to food and the interoceptive (visceral) body image feelings associated with eating and adapts specific modules for worry (imaginal and worry-based exposure), fear (exposure with response prevention), and the inflexible thinking associated with body image disturbance (acceptance-based mirror exposure). We train the parents in how to facilitate exposures to help the patient learn to tolerate and/or shift the negative affect that interferes with eating or daily functioning.