The Role Of The Caregiver In Family-Based Treatment
From a clinical standpoint, the most crucial role in Family Based Treatment (FBT) is not necessarily the child’s role but their parents’. When a person is in the midst of an eating disorder like anorexia it is often very difficult for them to see outside of their preoccupation with continuing to use eating disorder behaviors, and that is exactly where the parents become so important. A parent, or parental figure, is able to remove the responsibility of eating from the child, and become the authority on meal preparation and planning. We know this is a crucial step towards recovery because it removes power from the eating disorder, and the conflict within the child can lessen since they no longer have the same control over food, and in turn produce some relief (although they might never admit it to you).
Often we hear parents state that they feel as though their adolescent has become a small child again because they are having to supervise their child so closely and take back responsibility around meals and snacks. In some ways that seems very true; the eating disorder is preventing your child from safely caring for them self and effectively making sure they are eating what they need, so it becomes the parents’ responsibility again. Thankfully, this phase is temporary, and as the child begins to improve and challenge the eating disorder more regularly, it becomes clear that they are ready to take on more responsibilities around their self-care again. Taking back that responsibility can be the hardest part for a parent when they know how much their adolescent wants to be independent as they form their identify, and it may feel unfair to both parties at times.
Evidence-based studies show that FBT has a very high efficacy rate and the hard work and struggles are worth the effort when it means allowing your family to return to their lives, pre-eating disorder. When a parent feels ambivalent towards the treatment modality, or does not buy-in to the intervention, it can reduce the effectiveness of FBT. Children are savvy and intuitive and if they see their parent wavering on limits they have set, an opportunity can arise for the eating disorder to worsen. It can be extremely difficult for a parent to put all their trust in the FBT approach when it is new and they are feeling vulnerable and out of control, so it is important to communicate those concerns to the clinician the family is working with. If the family can come to a decision on what limits they are comfortable enforcing, then the treatment can still be effective. The main characteristics of FBT include removing blame from any one thing or person and focusing on how to move forward; parents becoming the authority on all food related activities; increased supervision around meal completion; and exposure therapy. Once a child or adolescent has restored weight and decreased eating disorder behaviors, parents can begin to return control to the child, and eventually that child will continue to work towards establishing a healthy identity and return to more typical development.
“You must be on top of change or change will be on top of you.” -Mark Victor Hansen
Nathalie Paquette, LICSW, is a clinician in the Waltham Adolescent Intensive Outpatient Program. She received her MSW from Tulane University in 2010 and has primarily worked therapeutically with adolescents and families. Nathalie joined Walden Behavioral Care in the fall of 2014 and enjoys using frameworks including Family Based Treatment, Cognitive Behavioral Therapy, and Dialectical Behavior Therapy. In her free time she enjoys spending time with her family and pets and being outdoors.