Family-based treatment (Maudsley)

Domain V · Systemic, relational, group & community · Lock, Le Grange · London, UK

What it is

Family-based treatment (FBT) is an outpatient family therapy for children and adolescents with anorexia nervosa. It grew out of family therapy work at the Maudsley Hospital, London, and Lock and Le Grange later manualised it in the USA. Its core idea of change is this. Starvation keeps the illness…

Format

• Dose and format. About 20 sessions of 50–60 minutes over 6–12 months. Rienecke's review describes a 10-session/6-month short form and a 20-session/12-month long form. The 2020 adaptive trial protocol used 18 one-hour sessions over 9 months and defined 8 sessions as an adequate dose. Frequency is…
• Decision point at session 4. Weight gain by session 4 is the strongest predictor of end-of-treatment remission: about 2.2 kg (2.88%) in Rienecke's summary, and 2.4 kg as used in the adaptive trial. Families below this mark are offered intensive parental coaching (4.17).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The talk sliding into causes or blame. Stay agnostic.
• Confidentiality limits around risk. State them at the start.
• The adolescent shutting down after critical exchanges, which is an early sign the format needs changing.
• Lecturing that loses the adolescent. Keep it brief, specific to this young person, and tied to the next step.
• The family relaxing too early, or the therapist slipping into social chat that weakens the intense scene that follows.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.