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A Safe Harbor: Inviting Caregivers To Learn About Family-Based Treatment

By Oona Hanson

Accessing eating disorder treatment for a child isn’t easy. Unjust barriers–ranging from stigma and shame to provider shortages and cost–get in the way far too often. Sometimes the hurdles are more subtle, more personal.

When a worried parent reaches out for help from someone who’s “been there,” our words and tone can make all the difference. While individuals can feel powerless in the face of structural and financial obstacles, we can make Family Based Treatment (FBT)–one of the most effective and least expensive interventions–available to more people simply by adjusting our communication strategies.

Based on my personal experience–as the mother of a child who had anorexia and now as a parent coach working with families navigating an eating disorder diagnosis–I offer some suggestions that may help us better connect with and support others in need:

1. Adopt a calm, neutral stance. This can be tough. When we’ve witnessed the way a life-saving treatment can seem to work miracles, it’s tempting to want to shout from the rooftops. I initially had the zealotry of the newly converted, too, but I’ve come to see the benefits of taking a gentler approach. Remember that parents in the throes of caring for a sick child are likely raw, terrified, and exhausted; they may be more reactive and resistant to intense emotions. Coming on too strong or with a proselytizing tone may make our listener less open to what we have to say. Instead, we can matter-of-factly share our experience or knowledge, and then offer to share more if they are curious.

2.  Ask what they already know, if anything, about FBT. The alphabet soup of acronyms in eating disorder treatment can be overwhelming. I once started a conversation about FBT with a client, and several minutes in, I realized they thought we were talking about CBT. It’s a good idea to take it slow, acknowledge how confusing the terminology can be, and get a sense of what their current understanding may be. Only then are we ready to have a productive dialogue.

3. Clear up any misconceptions about the terms. The name FBT has confused many a caregiver. Family-Based Treatment–sometimes even referred to as Family-Based Therapy–can lead people to make logical but false assumptions. People fear the approach might blame the family for the eating disorder. Still others worry that anything “family-based” must require abandoning all professionals. And those parents seeking conventional “family therapy” are likely to be frustrated with the focus on a manualized re-feeding protocol. I’ve found it helpful to suggest that parents think of the “F” as “food”: it’s “food-based treatment” rooted in robust science. Food is the medicine.

4. Empathize with their skepticism. Misconceptions about FBT are common, even among some physicians and eating disorder treatment providers. I know I’m not the only parent who was warned that being the “food police” would worsen the eating disorder. Or that FBT amounted to inhumane “force-feeding.” Even families who are open to FBT may assume it cannot be used if there are siblings in the home or if the sick child has co-occurring mental health conditions. Rather than rushing in to correct someone’s false beliefs, we can start by validating their ideas with something like this: “It makes sense you would have that impression.”

5. Avoid disparaging other forms of treatment. When someone we love has been harmed in any level of care, we have a right to be angry. And it’s important to be critical of problematic institutions and individuals. We need to be aware, however, that our scorn for particular programs or providers may feel like a harsh judgment of vulnerable families who have ever used those services. Parents with a child in crisis already struggle with painful guilt and self-doubt; sensing contempt from another parent is the last thing they need. We don’t have to quash our outrage; we can harness that energy and use it to hold powerful people accountable. When it comes to other families, however, let’s offer grace.

Those of us with lived experience often feel a calling to help others in need of guidance. This community of supportive parents is a force for good. With attention to our language and approach, we can help invite even more families to discover this powerful tool in the fight against eating disorders.

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