Eating Disorders

Family-Based Therapy for Eating Disorders

Training Parents to Help Care for Their Children

The family-based therapy (FBT) program at Mayo Clinic is a highly successful alternative treatment for eating disorders. Mayo's program is one of the few family-based inpatient programs in the United States.

In family-based therapy, parents are directly involved in the patient's treatment and recovery process. Patients with an eating disorder are often in denial about the seriousness of their disease and generally incapable of making good choices regarding their health and eating habits. Mayo Clinic therapists believe that family involvement is crucial to restoring the patient's health.

"The patient is very sick, and needs their parents to help them get better."
— Leslie Sim, Ph.D.

"At Mayo, the eating disorder is treated like a medical illness. The patient is very sick, and needs their parents to help them get better. We train the parents how to take charge of the treatment," explains Leslie Sim, Ph.D., clinical director of the Child and Adolescent Eating Disorders Program at Mayo Clinic.

Care Consultant Offers Continuity

Each patient in FBT is assigned an individual care consultant: a psychologist or psychiatrist trained in family-based therapy techniques. Unlike many treatment programs, the consultant at Mayo cares for the patient through the entire inpatient and outpatient program.

The care consultant trains the patient and family members in "refeeding" and helps develop an eating management plan. For bulimia, that plan focuses on food intake several times a day to help demonstrate self-control and to teach a more normal, scheduled eating plan. For anorexia, the eating management plan involves an intake of a certain amount of calories per meal, per day.

The care consultant may also teach skills such as effective communication styles and how to incorporate incentives to encourage weight gain. This training prepares family members to take over management of the patient's care in the outpatient program. While physical and psychological healing occurs, the patient will begin to manage his or her eating plan.

In the outpatient program, the care consultant meets with or contacts the patient and family members every week. The care consultant may offer family or individual therapy, or prescribe medications to treat other conditions, depending on the patient's needs. During the outpatient program, care consultants work with parents on meal monitoring and are available to answer parents' questions. Patients typically respond well to the structured meals and monitoring that parents provide.

Promoting Healthy Relationships

Family-based therapy promotes healthy family relationships and normal adolescent development. Parents are taught how to effectively parent their adolescent, correct faulty communication skills, and help guide their child into a new world of relationships and activities. Since family-based therapy relies heavily on services provided by parents, fewer treatment services, such as nutritional and psychological therapy, are needed. The result is a more cost-effective program.

Family-based therapy is not recommended for all patients with eating disorders. For the program to succeed, a family must fully commit to extensive time for therapy sessions and meal preparation. A family must be willing to modify schedules and put aside other concerns during the treatment.

Demonstrated Success

For those who commit to family-based therapy, the treatment success rate is excellent. Nearly 96 percent of patients treated with FBT at Mayo since 2004 (about 50) have successfully recovered. Less than 5 percent have needed to re-enter treatment programs. This compares to a long-term recovery rate of about 50 percent for patients in standard treatment programs, which commonly include multiple hospitalizations and long-term treatment. The FBT program often eliminates the need for follow-up programs and helps patients adjust more quickly to their outpatient program.