Who is not a candidate for family-based treatments (FBTs)? We don’t like to think about this question, and we like to talk about it openly even less. As a community eating disorder professionals and families have for the most part only recently come to grips with the concept that family-based treatments are the most successful. They are – to date – the strongest tools in our treatment toolbox. And because they can be so successful, we like to think that family-based treatments are for everybody. But they’re not.
Now before I take one step further, let’s be perfectly clear: parents and families do not cause eating disorders. They couldn't cause them even if they wanted to.
This is important to understand because discussing who is not a candidate for FBTs (please note the plural) is not a subtle way of suggesting that some families do cause eating disorders. Not at all. They don’t. They can’t.
Involving a child’s or young adult’s parents in treatment is now considered the most effective way to get an eating disorder into remission and to keep it there. Styles of treatment that involve the patient only, and not their support system, often take longer and have a historically mixed success rate, especially when it comes to keeping a patient in remission.
So who is not a good candidate for FBTs in our experience?
a family in which the parent in charge of caring for the child’s nutritional needs is actively eating disordered themselves and refuses treatment
a family where physical or sexual abuse is strongly suspected
a family with one or more severely mentally ill parents who simply cannot participate in or understand the need for a family-based approach to treatment
a single parent with many children (five or more comes to mind) and no help
a single parent with no help who cannot commit to cooking for and eating with their child because of the pressure of being the sole bread winner.
- a family where both parents have demanding high pressure jobs and neither are willing/able to step back for a period of time and make their child’s treatment their own priority
Why even talk about this? Because, although such families are relatively rare, they do exist and to pretend that all families are candidates for a family-based approach is to tempt the FBT-approach naysayers into concluding that what we have here is a religion, not a recommendation for the best possible treatment.