When a young person is living with an eating disorder, the effects often ripple far beyond the individual. It’s not uncommon for families may feel helpless, uncertain, or to blame. Additionally, they may feel overwhelmed and unsure how to support their child while navigating a complex and distressing illness.
Family-Based Therapy (FBT) offers a clear and compassionate structure to help families become central to recovery. Recognised as a leading evidence-based treatment for young people with eating disorders, FBT redefines how we think about recovering from an eating disorder. It’s not something that the individual has to face on their own. Instead, it is a structured approach that sees the family unit as a system and resource. This allows for collaboration, empowerment, and supports collective change to step into eating disorder recovery.
In this blog, we look closely at what FBT involves, who it’s for, and how clinicians can use it to support sustainable recovery in their clients.
What Is Family-Based Therapy (FBT)?
Family-Based Therapy (also referred to as the Maudsley Model) is a structured, outpatient treatment approach developed for young people with eating disorders. Its defining feature is the belief that families are not part of the problem, but rather a key part of the solution.
Rather than focusing on the causes of an eating disorder, FBT takes an agnostic view of how the illness developed. Instead, it channels energy into addressing the behaviours, environmental factors and dynamics that are currently maintaining it. It incorporates family members into the multidisciplinary treating team (usually involving a therapist, dietician, psychiatrist) and empowers parents and carers to take an active role in recovery, with the therapist supporting the family system to create change.
FBT has been tested in rigorous randomised controlled trials with anorexia and bulimia nervosa and has been adapted for other eating disorders such as binge eating and ARFID. Currently, a random controlled trial is underway for OSFED and to understand how FBT can support adolescents with eating disorders and co-occurring mental health conditions.
The Structure of FBT: A Three-Phase Model
FBT is typically delivered over three structured phases:
Phase 1: Taking Control of Eating
The initial phase of FBT is about stabilising the young person’s health. Families are supported to take charge of meals and eating-related decisions including preparing food, supervising meals, and ensuring the young person receives adequate nutrition. In this sense, FBT is unique due to its strict, firm approach whereby parents are encouraged to take the lead and supervise all aspects of food and eating, at least for this first stage.
For those who are underweight, this may involve weight restoration. For others, it may mean halting purging or binge behaviours. During this stage there is often a lot of worry and concern about a loved one, therefore whilst this is a difficult stage, individuals are motivated to change and commit. For many, this stage can be challenging as the eating disorder is still largely in control, and so the therapist works closely with the family to implement strategies and develop a meal plan that suits their context.
“It’s quite an unusual thing to do in therapy, to say, ‘this is what needs to happen’, but we do it because the young person may be in real danger. It’s an extraordinary approach for an extraordinary situation.” — Dr Amy K Harrison
Phase 2: Returning Responsibility with Support
Once the young person is physically safe and recovery is underway, FBT moves into a phase of gradually handing back responsibility for eating. Autonomy is reintroduced carefully, with parents maintaining oversight to ensure progress is sustained and safety is prioritised.
This stage also involves exploring the “eating disorder traps”, patterns that keep the eating disorder alive. Although behaviours may have started to shift, the eating disorder is still present. Arguments and emotional friction are common, as young people often want to keep aspects of the illness hidden, while parents are focused on keeping them well.
The therapist plays a key role in supporting communication, helping the family navigate anger, fear, or frustration, and offering tools to manage these moments constructively. It’s about learning to work together, even when it’s hard.
“Arguments and emotional friction are common, as young people often want to keep aspects of the illness hidden, while parents are focused on keeping them well.” — Dr Amy K Harrison
Phase 3: Supporting Development and Preventing Relapse
In Phase 3, FBT turns toward the young person’s identity, relationships, and long-term wellbeing. With medical stability achieved, this stage explores who they are beyond the eating disorder, including underlying emotional issues that may have contributed to or been masked by the illness.
Relapse prevention becomes a key focus. Families work together to identify early warning signs, reflect on past challenges, and build strategies to manage future setbacks. It’s not just about avoiding relapse but about strengthening the young person’s autonomy and emotional resilience.
“It can seem a bit strange that you would do that last, but risk trumps all. First, we get the person out of danger, then we explore who they are, and what they want life to be like without the eating disorder.” — Dr Amy K Harrison
Who Is FBT For?
FBT is designed for young people with an eating disorder who have at least one adult in their life who can commit to active involvement in treatment. This could be a parent, guardian, or another trusted adult, and the structure can be flexible depending on each family’s circumstances.
Importantly, research suggests that FBT is most effective when used in early intervention of an eating disorder, ideally within the first year of symptom onset. However, it may still be beneficial up to three years post-onset.
The key is a shared commitment to regular, collaborative work, typically on a weekly basis, with families forming a united front against the illness.
Common Challenges in FBT
FBT is a powerful and hopeful model, but it isn’t without its challenges. Understanding these is crucial to delivering it safely and effectively:
- Resistance from the Young Person or Family
Some young people don’t recognise they are unwell, a common characteristic of eating disorders. Families may also arrive feeling blamed or sceptical of their role. Creating a non-judgmental, supportive space is critical for relationships to develop and for honesty about the situation to be shared.
“No young person wants to sit in therapy with their parents and talk about their deepest, darkest secrets. But this is part of what makes FBT so powerful, it brings the system together.”
- Family Dynamics Under Pressure
The eating disorder may have already reshaped the family structure. Tensions, fear, or conflict are common. FBT often involves restructuring family roles, restoring parental authority, and improving communication through strategies like family meetings.
- Medical Risk and Clinical Judgement
In some cases, FBT may not be suitable, for example, where the young person requires urgent medical monitoring or higher levels of care. Clinicians must be confident in identifying red flags and knowing when to refer.
“Part of the therapist’s role is recognising when outpatient work isn’t safe, and that doesn’t mean failure. It means modelling that asking for help is a strength.”
- The Need for a Multidisciplinary Team (MDT)
From Manual to Mastery: Why Training in FBT Matters
The FBT model is supported by a published manual (Lock & Le Grange), which many clinicians find helpful in understanding the treatment structure. But FBT is more than a set of guidelines, it’s a dynamic, experiential process that requires confidence, flexibility, and skill.
That’s why experiential training is so valuable.
Through live workshops, role play, and case discussion, clinicians can:
- Practice core interventions like externalising the illness and family meal planning.
- Develop key skills in family therapy techniques like circular questioning
- Troubleshoot real-world challenges, from resistant clients to complex family dynamics
- Build confidence to deliver FBT safely and collaboratively in diverse settings
Final Thoughts
FBT offers a uniquely empowering approach – one that brings families together, restores agency, and supports young people in reclaiming their lives from eating disorders. But while the model is structured, delivering it safely and effectively requires nuance, adaptability, and confidence. Understanding how and why FBT works, including the challenges, delivering in the context of an MDT and how this works in a private setting is essential to providing care that is not only evidence-based, but deeply human. That’s why investing in meaningful, practice-focused training is so important.
With this in mind, we have developed a 3-day training package that goes beyond the FBT manual. Across the training, clinicians will gain the practical skills, clinical insight, and confidence to apply FBT safely and effectively in real-world settings.
What’s included:
- 1 online day covering core FBT principles, phases of treatment, and theoretical foundations
- 2 in-person days focused on experiential learning, role plays, case discussion, and troubleshooting real-life clinical challenges
- Guidance on risk assessment, liaising with MDTs, and adapting FBT for diverse family contexts
Whether you’re new to FBT or looking to deepen your practice, this training is designed to empower you to deliver structured, compassionate, and collaborative care.
“Reading the manual is helpful. But practising with others, learning from different perspectives — that’s how you bring the intervention to life.” — Dr Amy K Harrison
📅 9th June (Online), 13th & 14th June (In Person)
🔗 Read more and book your place
Final Thoughts: Supporting Families to Heal Together
Family-Based Therapy represents a powerful shift in how we support young people with eating disorders. It places the families at the heart of recovery and challenges the idea that therapy must happen behind closed doors.
As clinicians, understanding FBT equips us to offer hope, structure, and support when families need it most. And while the theory is essential, it’s through thoughtful, experiential training that many practitioners find the confidence to truly apply it in clinical practice.
