As more and more clinicians implement FBT in their practice it is important to recognise what FBT is and is not.

Perhaps the most common misunderstanding is that FBT is just about weight recovery and ignores the young person's individual needs.
Both these ideas couldn't be further from the truth. This misunderstanding can lead some therapists or services to only offer the first phase of treatment or to not engage the young person.
FBT aims to support the family to work together to bring about a full recovery from the eating disorder. It provides a clear role for the parents, sibling and young person and while change is intially placed primarily in the hands of the parents, as treatment progresses, the young person's goals become increasingly important as they transition back to a more developmentally appropriate independent eating and their adolescent journey. Thus after Phase 1 the remaining 2/3's includes a strong adolescent development focus.
What about FBT informed treatment?
It is important to say that FBT light or FBT informed treatment is not the way FBT was developed or researched. FBT is an integrated model of principles and other directives that work in concert together.
“It is really important that FBT is delivered with precision so that families get the treatment they think they are getting.”
FBT is also not psychoeducation or a prescription provided by the therapist. An essential incredient is that parents are empowered to work out for their child how to go about the directives. Of course this occurs with therapist support but leadership needs to sit with the parents. From another perspective the parents are supported to re-establish a secure base for their unwell adolescent, and for that to feel right, the teen needs to see and feel the parents in the drivers seat.
If we don't implement FBT as close as possible to the model as researched then we also get further from feeling confident in the evidence base. We know from research work done in North America that therapists tend to drift quickly from training in FBT and the percentage of therraspists that substantially add or subtract aspects of the model is very high.
Simple sign's of fidelity to FBT include -
Involving the whole family and supporting the parents to be an executive role and the adolescent and siblings to be a subsystem together.
Following the treatment schedule of weekly, two weekly, monthly appointments depending on the treatment phase.
Weighing the young person, openly using a weight chart and using the weight to guide the sessions agenda
When in Phase 1 the discussions center around pragmatic ways to bring about the adolescents nutritional recovery.
What about other concerns the family and young person have?
While we need to establish a precise and pragmatic process in Phase 1 to disrupt the behavioural symptoms and bring about nutritional recovery we also need to help the family appreciate that we understand the broader concerns they may have about their adolescents well being. Without doing this enagagement can wain and the young person will be less likely to feel that the adults are trying to understand their experience.
To achieve this balance it is important at the assessment phase to listen to everyones concerns and experience, and as therapy progresses to have space to hear concerns, but without losing the Phase 1 focus. The individual time (remember to keep it relatively brief ~5-10 min) before each session can really help with this balance as can the occassional parents only session. If the adolescent is really bothered by something like friends or returning to school this needs some airtime even in Phase 1 and it is a good opportunity to help the adolescent feel you care and that their parents can discuss and work with them if there are some simple solutions.
Easy to understand but not always easy to achieve
“The basic principals and aims of FBT are easy to understand, enacting a process that holds the initial nutritional focus and also helps the family feel held with all their concerns requires nuance.”
While the principals of FBT are easy to understand, enacting a process that holds the initial nutritional focus and also helps the family feel held with all their concerns requires nuance. In future blogs we will look more at process related issues in FBT and how that can help a precise focus on the content.
Commentaires