Category: Treatment For Eating Disorders

The return from residential eating disorder treatment can be a hard thing for parents. When you enrolled your child in treatment, they were probably physically and emotionally at a low point. You probably spent significant time making the decision to send them to treatment and agonized over the details. And the weeks or even months apart have probably been intensely stressful for you and your child as well. So while there is relief and hope when they come home, there’s also trepidation and worry that treatment won’t stick.

This guide is designed to help you prepare for the reality of your child’s return from residential eating disorder treatment. For most families, this stage of recovery requires a tremendous amount of effort. But the payoff can also be tremendous. 

You can approach eating disorder recovery much as you would any other serious health rehabilitation and recovery. Don’t underestimate what is involved, but also don’t be afraid. I am 100% confident that you have what it taks to support your child’s recovery from an eating disorder. Here are some ways you can prepare for your child’s return from eating disorder residential treatment.

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

Education

Become educated about eating disorders, their causes, symptoms, and recovery. Imagine if your child had cancer. You would learn about their cancer, become informed about symptoms and treatment, and be engaged in recovery tasks. 

Your education about eating disorders is even more important than if your child had cancer because of two things. First, there is tremendous stigma and misunderstanding about eating disorders. You need to uncover your own biases and misunderstandings to support your child’s recovery. Second, treatment for cancer is based on vast evidence and clinical trials. Unfortunately, eating disorders suffer from a deep lack of funding and knowledge. This makes your education more important than for almost any other type of illness. 

Parents need a lot of knowledge and new skills to support eating disorder recovery. If your child returns to the exact same home and family dynamics in which their eating disorder developed, they are very likely to relapse right back into their eating disorder when they come home. 

Reasonable expectations

The hard truth is that your child will still need a lot of ongoing support and treatment when they return from a treatment program.

You should be prepared for a minimum recovery time of 6-12 months. Under the best circumstances, that’s how long it takes for a person to fully recover psychologically and physically from an eating disorder. This recovery period will be challenging, and your child will need your family’s support. During early recovery, it is easier to return to eating disorder behaviors than to abstain from using them. They will need your constant, confident support. 

Imagine your child had a stroke and is now living with you. They’ve returned home from hospitalization or rehab, but they still need daily support to get to and from physical therapy appointments. They need mobility aids, and you may need to learn new ways of communicating with them while they regain skills, mobility, language, and more post-stroke. 

You can’t anticipate everything about what recovery will entail, but you know that your life will continue to be disrupted. Eating disorders require a long recovery with ongoing care and new skills to support the reality that early recovery is harder than relapse. Luckily, full recovery is completely possible and gets easier over time and with the right support.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

• At the dinner table when behavior is getting out of control
• When you need to set boundaries – fast!
• After something happened so you can calmly review the triggers and events

Learn More

Structure

Residential treatment is highly structured. From sleeping to eating and activities, everything is planned out in advance. Even free time is scheduled. This is because any stress and chaos increase eating disorder urges and behaviors. And the return home after residential eating disorder treatment will be a major stressor. Therefore, you want to minimize stress and chaos by having a good schedule in place. 

While you may be relieved to have your child home and they may want to have freedom and little oversight, a lack of scheduled eating and activities will likely make recovery harder. It’s best if you have a firm schedule at least for the first 30 days after they return home and then taper off as long as recovery stays on track. Most people are doing some form of ongoing outpatient treatment, so this may take up several hours of their day. But avoid being too flexible with the remainder of the day.

Remember: they will not come home wholly recovered and will need your ongoing support. Structure is a big part of that. 

At a minimum, they should have structured meal times for three meals and three snacks daily. These should be planned times that your child can eat with at least one other person who will uphold the expectation that they eat. It’s best if you replicate treatment by planning, preparing, and serving all meals at a structured time and – importantly – expecting your child to eat every 2-4 hours without fail.

Empathy

Eating disorder recovery is hard on everyone. It’s hard on the person going through it, and it’s hard on every family member. So it’s essential to have an intentional empathy practice. This means understanding that everyone is trying their best and is not intentionally being difficult. 

Practicing empathy is not easy in the best of times. Most of us subconsciously assume that when people frustrate or hurt us that they are doing it on purpose or have ill intentions. But most of the time when people frustrate or hurt us, it’s because they are having a hard time. And this is almost always the case with our kids.

Kids are biologically driven to seek care and attention from their parents. One of the key ways they do this is with behavior. They act out so we know they’re having a hard time within. When your child does something “bad,” they are showing you they feel really, really bad. 

Empathy means you realize this and try to respond from a place of calm curiosity rather than defensiveness and criticism. One way to do this is to remember, no matter what your child is doing at the moment, that they are “good inside” and worthy of your love and affection.

Importantly, self-criticism (a lack of empathy) is a significant cause and symptom of an eating disorder. Your ability to practice empathy with your child will model for them how to have empathy for themselves.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

• At the dinner table when behavior is getting out of control
• When you need to set boundaries – fast!
• After something happened so you can calmly review the triggers and events

Learn More

Relationships

Eating disorders are complex because they are “biopsychosocial” disorders. This means they combine biological, psychological, and social influences. Most eating disorder treatment focuses primarily on the biological and psychological drivers. But social factors, especially your child’s relationship with you and others in your family, are critical. 

An eating disorder is not your fault. It’s not your child’s fault. But it’s also true that you have tremendous influence over your child’s psychology and environment. Parents matter a lot. Don’t lose sight of the fact that while your child has an eating disorder, everyone needs to “recover” by increasing mental health and learning new ways of communicating and relating to each other. 

Focus on building your relational skills and deepening your relationship with your child. Learn active listening skills and emotion coaching. How well you learn and grow as a parent in the next 6-12 months will impact how well your family functions far into the future. 

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

See Our Eating Disorder Treatment Guide For Parents

Family therapy when your child has an eating disorder may be the most important and the hardest thing you’ve ever done as a parent. Family therapy can help your family build belonging and resolve conflicts more easily. It can have a lifetime of benefits, including supporting eating disorder recovery.

But while therapy is ideally a safe space, when it’s family therapy, parents rarely feel safe. In fact, they usually feel uncomfortable at first. That’s because family therapy addresses family dynamics. And because you are the parent, and thus the head of the family, your behavior and parenting choices are naturally going to be evaluated and discussed. 

In family therapy, your child will get the lion’s share of talking time, for reasons I’ll explain shortly. This may make you feel shut down, shut out, disrespected and even furious. You want to be prepared for these feelings to show up. Because while they make perfect sense, they can get in the way of making progress. Family therapy is an opportunity to deepen your relationship with your child and support their recovery. It will be hard, but it will be worth it.

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

What is family therapy?

Family therapy is when family members are guided by a trained, licensed therapist to improve communication and resolve conflicts. Family therapy is different from family-based treatment (FBT), which is used for eating disorders. While FBT is about feeding, family therapy is about family dynamics. 

Family therapy is designed to help families:

• Increase empathy and understanding 
• Set and hold healthy boundaries
• Build belonging and communication
• Develop problem-solving and conflict resolution skills

If your child’s eating disorder treatment team has suggested family therapy, it’s best if you are informed and prepared. Here are the five steps you should take to prepare for family therapy: 

1. Set your goal

You want to go into family therapy with a clear goal. And while it may seem like the obvious family therapy goal is to fix your child’s eating disorder, that will not work. This is because family therapy is about working on your family dynamics, not solving a particular problem.

Family dynamics are the patterns of interactions among family members. It involves each person’s roles and relationships. Within families people adopt roles that can become fixed and unhealthy. And there are multiple dyads, triads, and other inter-relationships. These all need to be addressed individually and collectively. 

Family dynamics can either be supportive or a significant cause of stress. When we shift family dynamics from stressful to supportive, we can supercharge recovery. Thus, your goal in family therapy is to build more supportive family dynamics.  

2. Don’t expect equality

Family therapy is nothing like any other therapy you’ve experienced. If you’ve done individual therapy, you had 100% of the time to explain yourself and process your feelings. If you’ve done couples therapy, you had about 50% of the time. But in family therapy, your child’s experience of being a child in your family takes center stage.

You need to enter family therapy with a very clear understanding that this is not an equal playing field. While you may not realize it, you spent many years in a position of power over your child. That’s simply what it means to be a parent. Even if you felt powerless at times, the very nature of the parent-child dynamic is that you held tremendous power over them when they were a vulnerable infant, toddler, and child. This early dynamic shapes how they see you and relate to you, no matter how much things have changed since then.

In family therapy you and your child are not peers with equal perspectives. You will not get equal time. The therapist will encourage your child to express themselves and how they felt in the family. And that is where the healing begins. The more open you are to learning about your child’s perspective, the greater your success will be.

3. Don’t debate the “facts”

There is a good chance that your child will bring many stories and grievances to family therapy. They will have complaints about things you did and things you did not do. It is natural and normal to want to debate the facts of the situation. 

For example, if your child says you never cared about them, you will want to tell them all the ways you did care about them. If your child says you loved their sibling more, you will want to tell them the times you prioritized their feelings. 

But the facts are not the issue. And debating the facts will derail family therapy. Work on your own emotional regulation and prepare yourself to hear facts that you don’t agree with. Because you don’t have to agree with the facts. What you need to do is see the small vulnerable child who is asking you to witness the pain they experienced in childhood. What feels like criticism of you is actually a request for care from you. 

All children experience pain in childhood. No childhood is perfect. And you didn’t have to get things right in the past to be close with your child today. You just have to listen to their grievances with compassion and empathy and love them for who they are. The more you witness their pain with compassion and acceptance, the less they will suffer.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

• At the dinner table when behavior is getting out of control
• When you need to set boundaries – fast!
• After something happened so you can calmly review the triggers and events

Learn More

4. Don’t get defensive

It’s OK. You’re probably going to get defensive. It’s natural and normal to feel defensive when a child says something went wrong. But your goal is a deeper and more supportive relationship with your child. So you need to manage your defensiveness and not let it get between you and the vulnerable child who is asking you for emotional care.

Defensiveness sounds like this: 

• But I did all this for you …
• That’s not what happened
• But what I meant was …
• What I was trying to do was … 
• I can’t believe you would say that
• You’re wrong
• What else was I supposed to do?

These sorts of statements will want to tumble out of your mouth. But it’s best to manage your defensive impulses. Your goal in family therapy is to deepen your relationship with your child. And these defensive statements will not help and may even make things worse. Defensiveness from you will shut down the therapeutic process.

Work on your defense triggers in advance with a therapist or coach who can help you process your feelings with compassion and understanding. Practice managing your defensive impulses so you can hear about your child’s experience without getting defensive.

5. Listen & validate

Of course you want your child to understand you. But don’t start there. Healing begins when your child feels understood. When that happens, they will be able to see you in a new, softer light. But if you try to keep the focus on your feelings, a wall will remain between you. 

You’ll need to listen far more than you speak during family therapy. I don’t want you to repress your feelings. This is about managing your emotions during family therapy so that you’re able to hear what your child has to say. If sitting in family therapy is going to require strenuous repression, then it’s too soon for family therapy. Take more time with your own therapist or coach first so that your own feelings are well on their way to healing before you do family therapy with your child. 

During family therapy you mostly want to make validating statements. When your child speaks, they are opening a door to a relationship with you. They’re saying “can you see my pain?” And the correct answer to this is some version of “I believe you, and I’m sorry for your pain. I love you, and I will always love you.”

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

Practice validating your child’s feelings. As I said before, you’ll be tempted to focus on the facts and details, but instead focus on the feelings they are sharing with you. Listen for feelings like: 

• I felt sad when …
• I’m angry about …
• I wish you had … 
• I’m not sure that you love me …

Hearing your child have these feelings can be heartbreaking. Anticipate that your child has big feelings that will come out in therapy and practice responding to them with validating statements before you go.

I know that family therapy when your child has an eating disorder is hard. But there are tremendous benefits if you can do it. The best thing you can do is keep your goal in mind and be prepared. 

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

See Our Eating Disorder Treatment Guide For Parents

It’s not easy making the decision to send your child to an eating disorder treatment center – you probably have a lot of questions. There are so many factors to consider and so many options out there. And right now there’s added stress because so many centers are at capacity and have waiting lists. 

I’ll review the basics of what it means to send your child to an eating disorder treatment center. Before we dive in, it’s very important to say that this decision is yours to make. Nobody should make the decision on your behalf.  My goal is to help you weigh your options. And I have confidence that you will make the best choice for your unique situation.

Sending your child to an eating disorder treatment center will be hard no matter what. But ideally, you should feel on some deep level that this is the best right decision for you, your child, and your family right now. It doesn’t have to be a perfect decision to be the best right decision right now. Just do your best – that’s all anyone can do!

To write this article I consulted with John Levitt, Ph.D., an eating disorder therapist who has been in the field for more than 40 years. “Treatment centers represent a lot of money and a lot of time, and a lot of heartache and concern for your child,” he says. “You definitely want to make sure that you understand your options.”

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

Why send your child to an eating disorder treatment center?

I’ll give you the questions to ask an eating disorder treatment center. For now, let’s start with the reasons why you might be considering an eating disorder treatment center for your child. Here are the top three reasons I hear:

1. Your child is in danger. You have the help of professional dietitians, doctors, and therapists, but there is no reduction in the behaviors. Despite your best efforts and professional care, your child is in serious physical and/or emotional danger.

2. You don’t know what to do. You feel overwhelmed by your child’s eating disorder and simply don’t know what else to do. It seems like a treatment center is the only choice. 

3. You are burnt out. You have been working hard to stabilize your child’s behaviors. You’re driving all over town to appointments, and facing endless arguments and stress over meals. At this point, you are overwhelmed and frustrated by the disorder. You have reached the end of your rope. 

I support parents who are facing one or all three of these conditions. And I see eating disorder treatment centers as one tool in the toolbox of recovery. They are definitely an option to address these issues.

The benefits of an eating disorder treatment center

“Treatment centers are places where your child can stabilize their eating disorder symptoms,” says Levitt. “Their weight will hopefully improve and likely stabilize. And their eating disorder symptoms will likely be reduced or even eliminated completely while they are staying at the treatment center.”

This is very good news! The main benefits of an eating disorder treatment center are: 

• Medical and psychological stabilization
• Your child will be assessed and monitored
• They will feed your child regular meals and snacks
• Your child will be physically safe and prevented from acting on purging and self-harm behaviors
• They will provide activities and skills training to support recovery

A treatment center is ideally a safe place to get into remission from eating disorder behaviors. Your child will most likely be stabilized and make some progress toward recovery. 

The drawbacks of an eating disorder treatment center

One of the benefits of treatment centers is that your child is stabilized in a safe environment. But a drawback is that eating disorders develop in the outside world. So returning home after treatment can sometimes trigger a relapse. 

“Even if the eating disorder behaviors and symptoms get under control in a few weeks or months, there may be many more months, or even years, required to achieve remission and, ideally, full recovery,” says Levitt. “When they get home, they are faced with the same life stressors and conditions that were associated with the eating disorder prior to going to treatment. Home is where the true treatment begins. Your child needs to learn to live with a sense of self-worth and self-efficacy that is enduring and resilient across people, places, and situations, and they often won’t find that in a treatment center. You just can’t practice all of the requirements of life in a controlled setting. Full treatment does not happen in a program, it happens in life.”

In addition to the fact that there will still be work to do when they get home, there may be other drawbacks. I’ve interviewed many people who have spent time in treatment centers, and some of their complaints include:

• It felt abandoned, isolated, and/or traumatized
• Inadequate treatment and support
• Being scared by/not liking the other residents
• Developing unhealthy relationships and learning new behaviors from other residents
• Feeling controlled and dominated
• Not liking the staff and therapists

These drawbacks aren’t meant to discourage you. And many treatment centers actively try to counteract these drawbacks. But it’s important to consider them as you weigh your options.

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

• At the dinner table when behavior is getting out of control
• When you need to set boundaries – fast!
• After something happened so you can calmly review the triggers and events

Learn More

Questions to ask an eating disorder treatment center

“Treatment centers are run by good people who are generally doing good work,” says Levitt. “That said, treatment centers are businesses, and you as parents are the consumers. Don’t be afraid to be a smart consumer. Ask a lot of questions. Ensure you understand what you are getting into. That is, make sure you know what you will be paying for and what outcomes you can expect. Parents should become the experts on what they are “buying” before taking the leap to send their child anywhere.”

It’s best to interview treatment centers before making a commitment. Here are some questions to ask:

• What is your treatment approach? On what evidence is your treatment approach based? What is the data suggesting the effectiveness of your program?
• Specifically, how do you treat people with my child’s type of eating disorder? What is the general treatment plan/approach?
• How long does it usually take to stabilize a child’s eating disorder, including issues related to mood etc.
• What is the daily schedule, and who specifically will be working with my child?
• Can I see my child’s clinical team’s credentials and interview them?
• In addition to the clinical team, who else will be working with my child? What are their credentials?
• How do you control for the fact that sometimes eating disorder treatment clinics are learning opportunities for how to become better at eating disorder behavior? What control systems do you have in place to avoid this?
• What is your success rate in terms of full recovery after a person leaves the treatment center? What are your extended outcomes? What is your relapse rate?
• How do you involve parents in treatment? What are we to do while the child is in treatment?
• How will you ensure that I am an essential part of the treatment, and how will you prepare my child, and the parents, for the child’s return home?
• What will my child need following their stay at the center?
• How will you know when what you’re doing with my child isn’t being effective? If such a situation were to arrive, what are the alternatives?
• How do you ensure that a person who goes through your program is successful beyond the program?
• How much does treatment typically cost? How much is usually the parent’s share of costs? What happens if we are unable to afford the treatment or continued treatment?

“You should not receive vague answers to any of these questions,” says Levitt. “Because they are critical to efforts to achieve full recovery.”

Download The Questions

You can download a free PDF with these questions and other notes you can use to guide your evaluation of an eating disorder treatment center.

What about the cost of eating disorder treatment centers?

Of course your primary concern is your child’s health. And your child’s health is priceless. That said, treatment centers are very costly, which is why you want to be a smart consumer here. Not because you are nickel-and-diming your child’s health. Not at all. But because this is a major commitment and it makes sense to ask questions. 

I wish treatment centers had a 100% success rate. But the truth is that eating disorders are complex and challenging to treat. And residential treatment is typically just one step on the path to recovery. So it pays to be a thoughtful consumer.

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

“Don’t be afraid to ask about the costs involved,” says Levitt. “Many treatment centers are running 60 days. That’s a long time for your child to be away from home and away from school. It can also be about $60,000 plus. That doesn’t take into account post-center treatment. That can be equivalent to your child’s college tuition.”

The point here is to ask questions. Of course if your insurance company will cover everything that’s a different situation. But if the cost of treatment will fall on you and impact other financial goals that you have for yourself, then weigh the costs and benefits as clearly as possible. 

Making a decision

I wish there were a simple answer to whether to send your child to a residential treatment center and which one to pick. This is something many of my clients grapple with. And the truth is that it’s a difficult decision to make. In the end, the best you can do is do your research and make the best choice you can right now. 

Remember: it doesn’t need to be a perfect decision to be the right decision for you at this moment. Your best decision may be to send your child to residential treatment. And also, it’s OK if that doesn’t feel right for you right now.

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

The quotes from John Levitt, Ph.D. are from a series of articles published in 2017 including this one.

See Our Eating Disorder Treatment Guide For Parents

Erin was terrified when her 13-year-old daughter was diagnosed with anorexia. She spent a few months just trying to get her feet under her as she navigated the care system and tried to figure out what she was supposed to do to help her daughter get better.

“I felt like I was running through quicksand,” she says. “It was awful. Professional advice ranged from ‘wait and see’ to residential treatment, and neither option felt like the right one for us.”

Eventually, she was relieved when she was referred to a practice providing family-based treatment (FBT) for anorexia. “When I found FBT I just knew that was what we needed,” she says. “Our therapist helped us get our arms around the disorder and treat our child with respect and firmness. It made a world of difference, and she started to get better faster than I thought was possible.”

Erin’s experience with FBT is what every parent who has a child with an eating disorder wishes for: efficient recovery at home. And while FBT isn’t a fit for every child who has an eating disorder, it has been very effective for many families facing anorexia.

Eating disorder recovery

Approximately 13% of adolescents will develop an eating disorder by the age of 20. Eating disorders have been reported to be the third-most common chronic condition among adolescents. Despite this, research into the best treatment for eating disorders has been chronically underfunded. Therefore, evidence-based treatment trials for adolescents with anorexia nervosa are few, and study sizes tend to be small. As a result, many parents facing an eating disorder feel isolated and frustrated with the system of care.

Because it is one of the few anorexia treatments with scientific validation, FBT is considered by many to be the first-line treatment for adolescents with anorexia. There is also some evidence for its use with adolescents with bulimia.  In this article, I’ll review:

• The evidence for FBT for eating disorders
• How FBT can be used to treat eating disorders
• What you should know if you’re thinking about FBT for your child’s eating disorder

What is FBT?

Family-based treatment (FBT) is also sometimes known as the Maudsley method or Maudsley approach. It is considered by many to be the first treatment of choice for adolescents with anorexia. FBT is a manualized outpatient therapy designed to restore adolescents to health with the support of their parents. The primary focus of FBT is weight gain and it is seen as a viable alternative to residential treatment for that outcome.

Who does FBT work best for?

Family-based treatment (FBT) is an effective intervention for adolescents with anorexia nervosa. Also, preliminary evidence suggests that it may be effective in treating adolescents with bulimia nervosa.

Qualified therapists use FBT with all sorts of eating disorder populations. As of 2018, eight scientific studies have evaluated FBT in 657 patients with anorexia. And while it has been tested in multiple demographics, the majority of scientific evidence so far indicates positive outcomes for people who fit these criteria:

• Adolescents <18
• Female
• Anorexia
• Illness duration <3 years
• Medically stable and fit for outpatient treatment

FBT has also been evaluated for bulimia. As of 2018, three randomized controlled studies have evaluated 295 patients. These studies have indicated positive outcomes compared to individual therapy, though the results are less dramatic than those for anorexia.

How to provide Family-Based Treatment

Many parents will cobble together an FBT-like treatment for their child with an eating disorder. However, true FBT is a detailed program based on a manual. Therefore, it contains specific elements in an outpatient setting and requires sessions with a trained therapist. Studies have evaluated short-term FBT (10 sessions over 6 months) and long-term FBT (20 sessions over 12 months). FBT is delivered in 3 stages with decreasing levels of parental control over feeding.

The second session of treatment includes a family meal. During this meal the therapist can observe the child’s eating patterns and family behaviors. At each session, the therapist will weigh the person who has an eating disorder. Following that, they meet with the family to discuss progress, including a review of weight gain. These meetings begin on a weekly schedule and decrease over time. 

The central premise of FBT is that families can be central to eating disorder recovery. And while it is not a fit for every family, many find it very helpful.

Stage 1 of FBT is designed to replace inpatient treatment for an eating disorder. Eating and weight gain are the priority, similar to how they form the foundation of inpatient treatment. Typically the person with the eating disorder is able to continue attending school and participating in activities as long as they are eating and gaining weight.

Food Refusal & Picky Eating Printable Worksheets

Give your child the best tools to grow into a confident, calm, resilient eater!

Learn More

Principles of FBT

Family-based treatment for eating disorders is organized around a few basic principles:

1. Agnostic view of the illness

FBT makes no assumptions about the cause of the illness. Previously, families were blamed for eating disorders. To counteract this, FBT takes a strong position that families are not to blame. Rather, FBT focuses entirely on resolving the primary symptom of not eating. FBT is not concerned with identifying the underlying factors. Instead, it aims to get adolescents to gain weight and stop using their eating disorder behaviors.

2. Externalize the illness from the patient

FBT emphasizes that the eating disorder and the child are not one and the same. The idea is that the eating disorder has “taken over” the child and is driving their thoughts, feelings, and behaviors. Parents are asked not to blame their child or believe that the eating disorder is the child’s choice. The goal of externalizing the illness is to reduce parental criticism, which has been shown to harm treatment outcomes.

3. The therapist takes a nonauthoritarian stance

The role of the FBT therapist is to take an active role in guiding the family through the recovery process. However, an FBT therapist does not tell the family exactly how to go about helping their child recover. The therapist partners with the family to help them figure out how best to refeed their child. The therapist models an uncritical, supportive, and compassionate stance toward the patient. Meanwhile, they take a firm, zero-tolerance approach toward eating disorder behaviors. 

4. Parents are empowered

In FBT, parents are empowered as the best resource for their child’s recovery. Essentially, they are seen as the main agents of change in their child’s therapeutic process. Therefore, FBT success rests in the parents’ confidence that they can handle the eating disorder. The therapist works to put the parents in charge and communicate confidence in their ability to beat the eating disorder.

5. Unwavering focus

FBT has a pragmatic, unwavering focus on symptom reduction. It is designed to quickly and single-mindedly focus on weight gain. And, in the case of bulimia, ending binging and purging. Therefore, problems associated with the eating disorder like depression, anxiety, irritability, body image issues, trauma, loneliness, and more are not addressed in the first phase of FBT. The belief is that many of these secondary problems will lessen with the return to physical health.

What are the three phases of family-based treatment?

The FBT treatment for anorexia consists of three phases.

Phase 1

Phase 1 focuses on rapid weight gain. In cases of bulimia, the focus is on ending binge and purge behaviors. Parents are told that the disorder makes it hard for the child to make healthy decisions about food and eating. They are empowered to take over decisions about eating, much as would be done in inpatient care. Parents are responsible for deciding what their child eats, when, and how much is eaten. They typically also curtail any physical activity, much as would take place in residential treatment.

In the second session of FBT, the therapist will coordinate a family meal. During this meal, they will instruct the family on how to be more effective with the eating disorder. The goal of this meal is to give parents the confidence that they can encourage their child to eat more than they intended.

Phase 1 continues until the following conditions are met:

• Steady weight gain
• Eating disorder symptoms have begun to recede
• The child is eating without significant resistance

Phase 2

During the second phase, parents will gradually give eating decisions back to the adolescent based on what is age-appropriate. This phase is introduced gradually and managed carefully.

Phase 3

During the third phase, the therapist reviews the adolescent’s progress and ensures the family is on track to get back to normal family life. The therapist offers skills to support ongoing development. Additionally, they will help the child navigate change without reverting to eating disorder behaviors to cope.

Is FBT right for your family?

Family-based treatment can be more effective than other treatments for anorexia, especially in cases where it’s caught early. However, if it’s not a good fit for you and your child is not gaining weight, you should know within four weeks. If that is the case, you may want to try other treatment options. It’s not a failure on your part, it just means FBT is not the right treatment for your family. FBT is great when it works, but it’s not the only path to recovery. There are alternatives, and you should not feel ashamed if FBT is not the right fit for you.

What do parents say about FBT?

When it is a good fit, FBT is very effective, and parents rave about it. Parents who succeed with FBT say recovery is faster and more effective than alternative treatments. But even parents who found FBT efficacious say it is time-consuming and emotionally challenging. Implementing Phase 1 of FBT can be a full-time job for parents, and it can last up to 3 months or even longer. Therefore, in some families, one partner will take a leave of absence from work to administer the treatment.

The risk of parental burnout with FBT is high. Burnout is a major risk for any parent who has a child with an eating disorder. Also, it’s serious because parental burnout has negative consequences for eating disorder treatment outcomes, whatever the modality. Therefore, parents report that having support makes the job easier.

That’s what Erin found helpful. “We had a great therapist, and I was active on parent message boards,” she says. “But I found that parent coaching was the real game-changer for me personally. Having a coach helped me work on my side of the equation and learn better communication skills. It made me much more influential over the eating disorder.”

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

For privacy, names and identifying details have been changed in this article.

See Our Eating Disorder Treatment Guide For Parents

If your child has an eating disorder, then it may help you to keep a log of eating disorder symptoms and treatment. This is a useful tool to support you in seeking treatment, recognizing progress, and, when necessary, making decisions to switch to new or different treatment. A mental health log can help parents keep track of their kids’ mental health and support them in making strategic decisions to support recovery. 

There are many benefits to keeping a mental health log of eating disorder behaviors and treatment. The three most important reasons are so you can: 

• Maintain your focus and know what’s working and what’s not working
• Share your notes with treatment providers to keep treatment on-track
• Recognize when things are getting better or worse

An eating disorder is a constantly moving target, and getting from day to day can be a major undertaking. But if you don’t have a tool to pull yourself up from the weeds and see the big picture, you can’t make strategic decisions. And impulsive decisions based on your feelings alone are often much less effective than decisions that are made in a more strategic manner. A log that tracks symptoms and eating disorder treatment will help you keep everything straight.

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

Why keep an eating disorder treatment log?

Managing a child’s eating disorder is a big undertaking. There is so much information and many details to keep track of. Since you have other things on your plate and you’re more likely to forget details in stressful situations, it helps to write down what is going on. Doing this will help you keep track of medications, rules, and expectations so that you aren’t wasting time trying to remember what was said or tracking down different pieces of paper, medication bottles, and other things to help jog your memory. 

In times of stress, it can be dangerous to rely on memory, since facts become distorted with pressure and time. Keeping a detailed log of eating disorder symptoms and treatment means you have the information you need at your fingertips.

What is an eating disorder tracking log?

A log for eating disorder symptoms and treatment can help parents keep track of all the little and big things that take place during the various stages of having an eating disorder. Whether your child is in a very active eating disorder or in early, mid, or full recovery from an eating disorder, a log can be helpful. 

An eating disorder symptom log should track the following:

• Eating: for example, what and when did you serve food, and what was eaten. You may also include how it was eaten (e.g. easily, slowly, fast, reluctantly, etc.)

• Other behaviors: for example, track whether your child is purging and, if so, how often. Same with over-exercise. You can also observe whether body image issues are becoming more or less frequent. 

• Conversations you have with professionals: this should include notes from your meetings with therapists, doctors, dietitians, etc. This should include information about the treatment they recommend and suggest and why you did or did not follow it.

• Distressing events: you should take note of major events such as self-harming, anxiety attacks, and aggressive behavior. Describe what happened and approximately how long it lasted and its intensity.

• Conversations with important adults: note things that people like coaches, teachers, family members, etc. have said to you about your child’s behavior. Sometimes it’s hard for us to see what’s going on, and these comments, when written down, give us insight.

• Appointment notes: if your child is being monitored by a medical doctor you can keep track of vital signs like weight, heart rate, etc. Also, take note of any recommendations and suggestions. If you chose not to follow the doctor’s advice, state why.

• Medications recommended and/or prescribed: keep track of what was prescribed, when, why, by whom, and at what dosage. Also track when providers adjust medication or if they make a recommendation that you disagreed with. Note any positive impact of medication and possible side effects.

In addition, you should have a quick-reference sheet showing you the providers’ names and phone numbers and any medications your child is on. 

How to keep a quality log

You already have a lot on your plate. A parent who has a child with an eating disorder is facing tremendous work in terms of treatment and care. You’re already doing the planning, scheduling, coordinating, budgeting, and decision-making. This is a lot of work. 

So you don’t have to turn keeping a mental health log into another tedious job for yourself. But you should have a system for jotting down your notes at the end of every day. As things improve, you can reduce this to every other day, then once per week, and so on. Remember that eating disorders can be effectively treated and you probably won’t have to do this forever. But it will be a tremendous help to you if you keep track of what’s going on. Aside from anything else, a good mental health log will give you the peace of mind that you are on top of your child’s care. 

What format to use

Start by thinking through the format you will use for your log.

Some people really like paper and a pen for keeping notes. If so, get yourself a dedicated notebook and a pen and put them in a place where your child will not find them. Unless you are approaching the log as a group effort, you might want to hide it so your child cannot stumble across it. For some kids, a treatment and symptom log will bring on feelings of being vulnerable, observed, and exposed. 

If you prefer a digital record, then you have several options. You can set up a spreadsheet or a document, or even just use your note-taking app on your smartphone. Whatever you use, keep in mind privacy concerns, and password-protect your devices so your child doesn’t accidentally see your log if you don’t want them to. 

Once you know whether you’re going paper or digital, consider a standardized format. Not everyone likes this, but many people find it helpful to have a list of what they should be logging. To help, I’ve created a document with everything you need to get started. 

Getting in the habit

In the beginning, make it a habit to jot down a few notes every day. New habits are hard to start, but once you get going, they get easier. Here are some tips for starting a new habit: 

1. Get ready: gather the supplies you need and set up your worksheet, cheat sheet, or whatever you’re using to keep your log
2. Set a goal: it’s very hard to build a habit if your goal is undefined. Commit to daily notes or, if that’s not possible, a note every time you do something like visiting the pediatrician or dietitian. 
3. Set up a cue: if your goal is to make a note every day, set up the specific time and location. Many people will set a reminder on their smartphones to make sure this happens. Another option is to make the cue something like when your child goes to their therapy session, after dinner, or something else that reliably happens.
4. Set up a reward: it’s best if you feel successful when you complete your habit each day. This could be something simple like giving yourself a quick hand or temple massage, scrolling through your phone for 5 minutes, or getting a hug from your partner. 
5. Have a plan B: while you really want to stick to a regular plan to create a habit, it can be helpful to build in your plan B. This is what you will do if you don’t meet your goal. For example, can you set a second reminder on your phone? If you forget to do it after dinner, can you do it before you go to bed? Establish this in advance so it feels like a more formal and thus acceptable backup plan.

The log is not a journal for your feelings

Journaling your feelings about the eating disorder might be very helpful for you. A journal can help you process your difficult emotions and thoughts about your child’s disorder. However, this mental health log is not the same thing as a journal. I suggest you keep the two concepts separate. Remember that a good log might be helpful for you to show to your child’s treatment providers. So you want to limit your personal thoughts and feelings.

Keep the log factual, and process your feelings elsewhere. Use a reporting approach: stick to the facts! You can even use a reporter’s prompts to structure your notes: 

• What happened?
• Where did it happen?
• How did it happen?
• Who was involved?
• Why did it happen?

Parent Scripts For Eating Disorder Recovery

Scripts to help you figure out what to say to help your child with an eating disorder. Use these scripts:

• At the dinner table when behavior is getting out of control
• When you need to set boundaries – fast!
• After something happened so you can calmly review the triggers and events

Learn More

Privacy considerations

Your child’s private health information is sacred. I already mentioned this, but carefully consider whether you plan to share your log with your kid. And, if not, make sure they have no way to accidentally stumble upon it. I really can’t overstate this. What you are doing is not wrong. However, it could be hurtful for your child to discover your log without adequate preparation. Here are a few options for thinking about how you set this up: 

Keeping an open log

You may choose to make the log open and accessible to your child. This means you share with them that you are keeping the log and are willing to show it to them upon request. However, it does not mean your child is keeping the log for themselves. If their therapist suggests they journal or maintain their own notes, that’s separate from what you are doing. Even if you are providing your child with access to the log, make sure that it is your responsibility to record your observations and notes. 

Keeping a private log

A more common approach is to keep a private log. In this case, you keep your log private and in a secure location that your child cannot access. You are gathering very personal information, so it is essential that you take this very seriously. There are ways in which an eating disorder symptoms log can go awry, including: 

• The child with the eating disorder finds it and feels criticized, triggering a relapse or new symptoms
• Siblings find the log and make fun of the child or become worried about the child’s health
• Other people, from nosy neighbors to extended family members find the log and catastrophize the situation, possibly even accusing you of wrongdoing if they don’t understand what’s going on

This is why it cannot be overstated: if you keep a handwritten log, make sure that it is hidden securely in a place that nobody will find. If you keep your log on digital devices, make sure they are password-protected to make sure nobody can access them except for you. Don’t fall into the trap of relying on weak passwords that your children are likely to guess! Do not use anyone’s birthday, name, or classic combinations like 12345, abcdef, or the all-too-common mistake of using the word “password” as your password.🤣

Get started!

Keeping a mental health log of eating disorder symptoms and treatment can really help you uncover patterns of behavior. It will also help you recall facts and information that you’ve received in the past and jog your memory about why you have made the decisions you have made. Finally, it can be very helpful when you’re talking to new treatment providers who need a history of what has taken place so far.

You can get started here

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

See Our Eating Disorder Treatment Guide For Parents

Vicky is feeling really nervous because her 19-year-old Alex (they/them) wants to go back to college after eating disorder treatment. Alex is highly motivated to get back to school and manage their own life, but Vicky feels deeply unsure about exactly how that will work. 

“I can’t get over the memory of having to hospitalize them and put them in inpatient treatment last year,” says Vicky. “It was traumatic for all of us, and right now I can’t even imagine feeling good enough to send them back to school even though they say that’s what’s motivating them to recover right now.”

Vicky struggles to balance being a responsible mom with the freedom Alex wants. She wants to get clear about what Alex needs to do to show her that they are ready to go back to college.

I suggested coming up with some goals that will help Vicky feel better about sending Alex so far away again. I recommend using SMART goals for eating disorder recovery, since they are specific and attainable, and there can be no doubt as to whether they are achieved. They’re also motivating because Alex will be able to see a pathway to freedom from parental oversight.

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

What are SMART goals? 

SMART goals are often used in business and education settings to help employees and students set and achieve measurable goals. The key to SMART goals is that they are very specific and work well when you have large goals that you want to break down into smaller steps. 

SMART is an acronym that stands for “specific,” “measurable,” “attainable,” “relevant,” and “time-bound.” Every SMART goal features these essential elements to ensure the goal can be reached to satisfy both the child who will take action towards the goal and the parent who wants to see the goal achieved.

Specific: What is the goal? 

The goal should be well-defined, clear, and unambiguous. For example, it’s not enough to say “eat enough.” If the goal is to eat, get specific, like “eat 3 meals and 2 snacks every day.”

Measurable: How will I measure progress?

The goal should have specific criteria that measure progress. For example, if the goal is 3 meals and 2 snacks daily, the child could text a photo of each to their parent or dietitian.

Attainable: Do I have the resources & skills for it? 

The goal should be something that is attainable and not impossible. It should be within the child’s capacity to do. In the eating example, the child needs access to food and a smartphone.

Relevant: Why is this goal important? 

The goal should be an important step toward self-management. It should matter to you and your child. In the eating example, maintaining regular meals and snacks is a major part of being a competent eater, and thus makes sense as a relevant goal.

Time-Bound: When will I achieve the goal I’ve set?

The goal should have a clearly defined timeline, including a start date and a target date. For example, if they send photos of all three meals and snacks every day for eight weeks, you may set a new SMART goal that gives them less oversight in the next stage.

Why are SMART goals important? 

SMART goals are important because they help parents:

• Set clear intentions, not broad or vague goals
• Feel confident about the child’s path to self-management
• Focus on the specific behaviors that support recovery
• Measure progress with specific benchmarks
• Provide sensible objectives that are realistic and achievable
• Avoid the distraction of a long list of goals that is hard to manage
• Be clear about the timeline and next steps if goals are met

SMART goals increase your child’s pursuit of self-management by making your expectations really clear and unambiguous. Your college-age child wants to get out from under parental control, so setting SMART goals gives them a clear path to doing that. These goals communicate that you believe your child can succeed but also gives you the confidence to let them go away to college.

How can SMART goals help with eating disorder recovery?

SMART goals can help with eating disorder recovery, especially for college students, because they help both the child and the parents get what they need. The child wants autonomy and to return to their life back at college. But the parents want assurance that the eating disorder is not active and putting their child in danger.

Vicky was really excited about using SMART goals for Alex. “I feel like this is going to really help us put together a plan that feels good for all of us,” she says. “Alex would much prefer zero controls, and I get that, but I need something to make sure I’m not being reckless or thoughtless when sending them back to school.”

Working on SMART goals

Vicky worked on three SMART goals that she felt were important. Since they are in family therapy and Vicky was unsure how Alex would respond, she brought up the idea during a family therapy session. The therapist was encouraging and supportive of the idea, and Alex didn’t hate it. So the next week Vicky brought in the SMART goals worksheet. Together they worked with the therapist and Alex to make adjustments that felt good for everyone. 

“A big deal for Alex was the time-bound aspect, of course,” says Vicky. “Alex just wants to see a path out of being monitored all the time, and I feel like these SMART goals give us all the confidence to move forward. I want Alex to feel independent and free … and I want to be free of the eating disorder, too! This has absolutely taken over our lives, and I can’t wait to move into the next stage and reduce our monitoring.” 

This steady and clear approach to eating disorder recovery adds a lot of confidence and security for parents while also showing kids the steps they need to take to reclaim the independence they crave.

SMART goal template & examples

SMART goals for recovery example: eating

PLEASE NOTE: this is not intended as or delivered as medical advice. Please don’t make choices about your child’s recovery without consulting their treatment team. Make sure your SMART goals are appropriate and make sense in the context of your child’s eating disorder recovery.

SMART goals for recovery example: therapy

How to make a SMART goal

Like Vicky, you may be excited about SMART goals and want to dive right in. I get it! I love SMART goals! Please just remember that while Vicky drafted some SMART goals, she checked with her family therapist before introducing them to her child. Depending on your child’s eating disorder recovery status, SMART goals may not be the right approach right now. Check with your child’s eating disorder treatment team before presenting your child with SMART goals.

To make a SMART goal, begin by thinking of your big goal, then breaking it down into behaviors that will get you closer to the goal. With eating disorders, the big goal is “recovery,” but that’s hard to measure and it’s a state of being, not a behavior with measurable steps. If we make recovery the goal, we will struggle to measure and monitor it. Instead, break it down into attainable, measurable, and observable behaviors like:

• Eating regular meals and snacks
• Checking vital signs of health such as heart rate, blood pressure, etc.
• Going to therapy and nutrition appointments
• Getting blind-weighed if appropriate/necessary

Next, write down a few SMART goals that are “specific,” “measurable,” “attainable,” “relevant,” and “time-bound.” If the goal is eating regular meals and snacks, detail how many meals and snacks, and how the goal will be measured. The most common mistake is not being very specific about the goal. The more specific and measurable the goal, the greater your chances of success.

*the frequency will vary based on your child’s current medical status and is here as an example only. Please consult your child’s treatment team to set goals that make sense for their individual recovery path.

Measuring success

The most motivating eating disorder goals are those that provide a pathway out of being monitored. Show your child the path to self-management by setting multi-stage SMART goals. 

For example, if the first goal is for them to attend therapy weekly for 8 weeks, that doesn’t mean you stop all therapy if they reach that goal. Maybe the next goal is that they switch to every 2 weeks for 8 weeks after that, then monthly. A stepped approach will provide the safest structure for recovery

SMART goals should never feel punitive or shameful. The value of providing time-bound goals is so your child knows what will happen when they meet the goal. But you should not say you are disappointed if your child does not achieve the goal by a certain date. That’s why I suggest using consecutive weeks rather than a specific date. Just count the weeks that they do accomplish the goal. If they skip a week, then you start again at 0. Once they do it every week in a row for the number of weeks specified you can celebrate and set a new goal. 

Setting the clock

For example, Alex might text photos of their meals every day for two weeks in a row, then skip a few days during the third week. Alex is not bad for doing this. It’s understandable. However, that resets the clock back to 0. Once Alex texts all meals/snacks for 7 days, that puts the clock at 1. If the goal is 8 weeks, then Alex must text all meals/snacks for 7 days in a row for 8 weeks in a row to meet the goal. 

Avoid being flexible or changing the goal, because it will show your child that the goals are open for negotiation and debate. This is a slippery slope that eating disorders love to take advantage of. Instead, maintain clear, compassionate boundaries. It sucks for all of you to start at 0 again. But that’s how you make sure you aren’t accidentally accommodating the eating disorder.

Celebrating success

I checked in with Vicky after Alex had been back at college for a semester. She had been both hopeful and terrified of the return to college. And I’m pretty sure Alex felt many of the same feelings! 

Alex struggled a little bit with the transition back to school, which we expected and had prepared for. But after 4 weeks of being inconsistent with their progress, Alex stayed on track and they are almost ready to set new SMART goals that give Alex more freedom and autonomy. 

Vicky says that having SMART goals is a huge relief for her. “I just feel like I have some level of insight into what’s going on for them at college. Now I can keep an eye on their health and safety when they’re so far away from me.”

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

For privacy, names and identifying details have been changed in this article.

See Our Eating Disorder Treatment Guide For Parents

Alicia knew she had to do something soon. Her daughter Eden had been stuck in a restrictive eating disorder for a few years. Eden was medically stable and in treatment. But Alicia knew that she was still deeply affected by her eating disorder. And the eating disorder was taking up a lot of space in the family and for Alicia personally. Alicia wanted to make sure she was doing everything in her power to keep things from getting worse. 

Alicia started a parent-based treatment called SPACE (Supportive Parenting for Anxious Childhood Emotions). The program included 12 Zoom calls, plus homework and practice in between. Alicia learned ways to support Eden without accommodating anxiety-driven eating disorder behaviors. At the end of the program, Alicia noticed improvements in her daughters’ eating disorder behaviors. And she gained a new perspective on how she was parenting and skills to support Eden’s recovery.

“I was unsure how I could actually do anything to change the eating disorder. Mostly I was afraid to even try. But deep down I had a suspicion (A dream! A fear!) that there was more I could do. In SPACE training I became aware of how much I was accidentally accommodating the disorder. And in fact, it was those moments when I felt like I was being most supportive and loving that I was accidentally making things worse,” says Alicia.

“Now, I am really supportive … even more supportive than before. But I also have really good boundaries and I’m not getting into dangerous waters by accommodating Eden’s anxiety. I no longer avoid the hard things we need to do to get better,” says Alicia. “When I first learned what I had to do I thought it would be harder to parent this way. But in fact, things are running more smoothly now than they were before.”

Parent training for eating disorder recovery

As a parent, you did not cause your child’s eating disorder, but you have a critical role in recovery. New research is revealing that you can help treat your kids’ anxiety-driven eating disorder behaviors, improve your relationship, and boost your child’s flexibility and resilience by participating in SPACE parent-based treatment. These skills will last a lifetime and might change the course of your child’s recovery from their eating disorder.

SPACE is about learning to recognize parental accommodation and establish a new way of responding to anxious behaviors. When applied in eating disorder situations, SPACE can address anxious behaviors like food restriction and rituals, body-checking, and body comments. It teaches you to focus on your behavior rather than your child’s behavior since that is what is within your control. Parent training can be done either as part of a group or one-on-one. The skills taught in SPACE for eating disorders include: 

1. Creating a daily routine of consistent family meals and building family connections.

2. Identifying which eating disorder behaviors are coming from anxiety and how your responses accommodate the anxiety.

3. Creating a plan for which accommodations you want to target and how you will respond differently to anxiety in the future.

4. Implementing your plan and removing your accommodation for one anxiety-driven behavior at a time.

5. Practicing and refining your approach and choosing additional targets.

How SPACE works

The SPACE parent treatment program was developed and validated by scientists at Yale University. Its original use was with kids who have anxiety disorders and obsessive-compulsive disorder (OCD). A more recent version of SPACE was developed specifically for kids with avoidant restrictive feeding intake disorder (ARFID). SPACE has also been evaluated in children who have ASD, ADHD, and challenging behaviors like physical violence and threats of suicide.

The evidence-based parent treatment usually takes place over the course of 8-16 weeks. Parents join one 1-hour meeting per week and complete homework and practice between sessions. The first several sessions focus on parent education, and the additional sessions involve the parents implementing their plans and refining their skills.

Is anxiety a factor?

If anxiety is a factor in your child’s eating disorder behaviors, then SPACE can be appropriate. Many eating disorder behaviors are driven by anxiety, including:

• Food avoidance: eating only at particular times, in particular places, a very limited list of foods, etc.

• Food rituals: measuring, counting, arranging, hiding, mashing, throwing food, etc.

• Body checking: weighing, pinching, measuring, etc.

• Body talk: frequent questions like “am I fat?” “will this make me fat?” “I’m so fat” etc.

If your child is not medically stable and/or is in Stage 1 of family-based treatment (FBT), then your targets will not be food behaviors. But if your child is home with you then it may be appropriate to apply the treatment to body checking, body talk, or other anxious behaviors that are not directly linked to the eating disorder.

Why SPACE?

I provide SPACE parent-based treatment for eating disorders because it gives parents evidence-based skills to treat anxiety-driven eating disorder behaviors. It’s an excellent option for dedicated parents who want to do more.

“There’s a sense of action and empowerment in SPACE, and I found myself feeling more hopeful than I’ve felt since Eden first started showing signs of an eating disorder,” says Alicia. “I felt so powerless so many times in the past few years, and this is the first time I’ve seen real progress in a long time.”

“I felt really connected to the other parents in my SPACE group,” says Alicia. “It was as if we could all take a collective deep breath and feel less alone in all of this. I think we were all like shaken soda cans in the beginning. We looked fine on the outside but we were ready to burst. By the end, we were sharing our successes and sometimes laughing together. There was a real sense of community and shared safety.”

Setting goals

A key goal of SPACE parent training is seeing a reduction in anxious behaviors. Parents identify the eating disorder behaviors they want to see reduced and then work towards their goals by changing their (the parents’) behavior. You can help treat your kids’ anxiety-driven eating disorder behaviors with this parent-based treatment. Target behaviors might include: 

1. Food refusal goals might include expanding the list of “safe” foods. 

2. Food ritual goals might include eating a meal without hiding food.

3. Weight ritual goals might include not using the bathroom scale.

4. Body talk goals might include fewer meltdowns over body appearance.

5. Treatment resistance goals might include less debate and negotiation about treatment plans and participation.

At the end of SPACE treatment, parents review the goals they are achieving and the goals they still have. The parents’ focus remains on ending their accommodation of anxiety-driven eating disorder behaviors since parental accommodation is a “maintaining factor” in eating disorders. But the results of the treatment will also be apparent in the child. There is good evidence showing that SPACE parent treatment results in a reduction in the quantity and severity of anxious behaviors by the child.

Emotional Regulation Worksheets

Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!

• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

What results can I expect?

Could SPACE parent treatment be what your child needs to get further into their recovery? That depends on many factors, including how entrenched your child’s eating disorder is, your own ability to commit to and follow the treatment, and the consistency with which you practice your new skills at home. 

Kids may need to continue their own treatment even when parents change their behavior. Eating disorders are complex and multi-factorial, so the ongoing involvement of a therapist, dietitian, and physician may be necessary for the foreseeable future. The main opportunity with SPACE parent treatment is for you to know that you are doing everything in your power to support your child’s recovery and nothing that will interfere with recovery.

Some parents who complete SPACE treatment see improvements very quickly, but while things will feel easier and you’ll feel more confident in your own behavior, this is not a miracle treatment. It will take time for you and your child to learn a new way of relating to anxiety-driven eating disorder behaviors.

Facing difficulties

Sometimes your child’s behavior may get worse before you see improvements. This is a known phenomenon called an “extinction burst.” You’ll learn the skills you need to stay steady in the face of anxiety escalations and will work on your own emotional regulation in times of stress. Anxious behaviors are driven by “body-up” sensations and are therefore not intentionally manipulative or coercive, but to parents, that’s exactly what they feel like. 

Your desire to reduce your child’s distress and disruption will feel overwhelming at times, but you’ll have the knowledge and skills you need to respond without accommodation. Being a sturdy, strong parent when your child desperately wants you to accommodate their anxious demands will take time and practice. The SPACE parent-based treatment helps you treat your kids’ eating disorder behaviors and face these difficulties with confidence.

Extinction bursts don’t typically last long, and if you can stay the course, maintain the plan, and practice your skills, both you and your child will feel better soon. The result is fewer anxiety-driven eating disorder behaviors, confidence that you are doing the right thing, and a more connected and relaxed relationship with your child. 

Give it time

Learning to hold yourself steady in the face of a powerful anxiety-driven eating disorder escalation is hard. While every parent wishes for overnight success, SPACE parent-based treatment is more about consistent improvement. You might not see the magic happening every day, but if you stick with the plan you’ll see big changes over time.

A major side effect of SPACE treatment is a reduction of “caregiver burden,” which is significant with eating disorders and can impede recovery. You’ll feel more confident and less overwhelmed and hopeless. And that alone is a major benefit of the SPACE parent-based treatment to treat your kids’ anxious eating disorder behaviors.

That’s what happened with Alicia. The first few weeks of SPACE challenged everything she thought she should be doing to support Eden. But a few weeks later, she could sense a difference in their relationship. “There was a lot less stress at mealtimes and other times we spent together,” she said. “I didn’t even realize the burden I was carrying. But now I see that I was trying to do everything right, and I was constantly walking on eggshells, afraid to make things worse. I worried all the time. But then I learned that my avoidance had actually empowered the eating disorder. Now that I know how to safely stand up to anxiety, I feel stronger and more effective.”

“Eden is still seeing her therapist weekly, but she is firmly in recovery now,” says Alicia. “We still have work to do individually and as a family, but I’m at least sure that I’ve reduced my accommodations and am doing everything in my power to keep Eden healthy through eating disorder treatment.”

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

For privacy, names and identifying details have been changed in this article.

See Our Eating Disorder Treatment Guide For Parents

Sometimes a person who has an eating disorder is dropped or discharged from the care of a Registered Dietitian (RD). Parents may wonder why this happens and whether such behavior is ethical given how fragile their child is.

It’s undoubtedly hard for parents to hear their child has been discharged. If your child is under 18, you may be the one who the dietitian informs that they are terminating treatment. In this case, you will likely get the reasoning directly from them. But if your child is over 18, there’s a good chance that you will get the news second-hand. Your child will tell you their version of why they’ve been dropped or discharged by their eating disorder dietitian.

In either case, the news can be shocking, bewildering, and painful.

Grace’s story

That’s what happened to Grace*, a client of mine whose daughter Casey* is 19 years old and has bulimia. “We’ve had a terrible week because on Monday Casey’s dietitian dropped her,” she said, shaking her head in dismay. “Why would a person do that? Casey is getting worse – she’s in terrible danger. So why would her dietitian, who has been working with her for over a year, drop her right now?”

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Grace was in tremendous pain. Casey had spent the week raging against her dietitian and her whole care team. Casey’s eating disorder symptoms, which were already getting worse, ramped up to levels Grace hadn’t seen before. Her daughter was medically in danger, but because she is over 18, Grace had limited options. 

Things had been getting worse for Casey for a while. But knowing she was seeing a dietitian in person every week helped Grace feel a bit more secure. “I admit that those weekly sessions gave me hope,” she said. “At least I knew that Casey was being monitored and talking to someone who could help her.” 

“I don’t know what we’re going to do now,” she said. “I’m really at the end of my rope. And I’m so angry with the dietitian for putting us in this situation.” 

I completely understand Grace’s feelings. As we talked, we tried to understand what being dropped by the dietitian during eating disorder recovery meant for them.

Trying to find out what’s going on

I had a pretty good idea that what was going on is that Grace’s daughter’s dietitian had hit a point in treatment at which it felt medically and ethically unsafe to continue treating Grace in outpatient treatment. 

There had been months of weekly dietitian meetings and continued signs of medical instability. It sounded as if the dietitian had hit the point at which her training and expertise were at their limit. But it’s never simple, so I reached out to Leslie Schilling, MA, RDN, CEDS-S. Schilling runs a private nutrition therapy and wellness coaching business. She is also a supervisor for other dietitians working with eating disorders. 

“Ending treatment with a client is such a nuanced situation,” says Schilling. “I work really hard to avoid discharging a person from my care. Because I know how difficult it is, and it may feel like abandonment.”

“That said, there are times, particularly in a situation in which the person clearly needs a higher level of care, that I may have them sign a form or agreement acknowledging that I have recommended a higher level of care and they are choosing to continue working at this level of care instead,” she says.

“Many people don’t realize that dietitians provide a service called medical nutrition therapy. This includes some medical components like reviewing lab values, food-drug interactions, and systems assessments,” says Schilling. “And, if we see someone who is extremely medically compromised and needs to be in inpatient care, we could be at risk if we continue to treat them.”

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• Calming strategies

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Why does it happen?

There can be many reasons a person may be dropped by their eating disorder dietitian. Here are the most common reasons: 

1. Lack of specialty

Sometimes a dietitian will start working with someone without realizing how serious their eating disorder is. Maybe when they started the eating disorder was not recognized or disclosed. But then the RD realizes the person has an eating disorder. If the RD is not an eating disorder specialist, then they would probably refer the client to someone who is qualified to treat them. 

2. No team

If a dietitian is working with someone who has an eating disorder alone, they may decide that they cannot continue without the addition of a team. This is typically a medical doctor, therapist, and possibly a psychiatrist. If a client refuses to work with a team, the dietitian may need to make some difficult decisions about the ethics of continuing care alone.

“In most cases when supporting someone with an eating disorder, I do not recommend that a dietitian work alone – you really need a complete care team,” says Schilling. “I am not a therapist, and I can’t work on certain aspects of the eating disorder the way a therapist can. I also can’t admit someone to a hospital with a low glucose level, although I can read that in their lab work. Working without a team is not a good idea when we’re dealing with an active eating disorder.”

3. Personal reasons

Sometimes a professional will begin working with someone and then need to disengage for personal reasons. This could be for family reasons like pregnancy or elder care, moving to a new practice or out of state, retiring, or a number of other situations. 

In these cases, the dietitian rarely leaves their client hanging and will typically give their client plenty of notice and provide them with referrals to other professionals. Sometimes emergencies or illnesses mean a dietitian must end treatment abruptly. While not ideal, these situations are sometimes unavoidable. This is one of the reasons why eating disorder dietitians prefer to work with a team.

4. Ethical issues

There are cases in which a dietitian must make an ethical determination about care. “At a certain point, a dietitian may need to evaluate whether their client needs a higher level of care, particularly if they are medically compromised,” says Schilling.

“Sometimes there are other things that take priority over seeing the dietitian, like acute mental health concerns or stabilizing someone medically. I’ve often stepped back while other members offer more support until the client becomes stable enough to resume nutrition therapy,” she says. 

Schilling says this situation usually begins with the dietitian exploring the issue with the patient’s treatment team, and then talking to the client about recommending a higher level of care. “If the client really wants to keep working with me, or doesn’t feel safe entering a higher level of care, then I’ll use a form or waiver that clearly states my recommendation and the client’s preference to continue working together despite my recommendation,” she says. 

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• Self-Esteem
• Self-Regulation
• Mindfulness
• Calming strategies

Learn More

She says this is important since dietitians provide medical nutrition therapy and may be at risk of liability. “If we recommend a higher level of care and the client refuses to sign the waiver, then we will still give options and referrals. This is a tricky situation that would need to be discussed with the dietitian’s professional supervisor if they have one and the patient’s treatment before discharging from care. This isn’t a decision a dietitian would make hastily.”

Thinking it through

Schilling, who supervises eating disorder dietitians in addition to treating eating disorder clients in her practice, says that it’s rare that a client would be let go without extensive conversations, attempts to make progress, and referrals to other professionals or a higher level of care.

When Grace started to think about it, we were able to deduce that this is likely what happened with her daughter Casey. Casey’s entire team has been recommending a higher level of care for months, in fact almost since they started working together. Casey’s dietitian introduced a treatment contract over six months ago, which is a way that a dietitian tries to establish treatment milestones and move a client forward in their recovery.

Grace told me that Casey complained bitterly about the contract. And while we don’t know if Casey was offered a waiver to continue care under the dietitian, it’s very likely that the dietitian hit an ethical issue in treating Casey.

Grace says Casey complains that her team is pressuring her into a higher level of care, and Grace herself has been desperately trying to get Casey to enter inpatient treatment.

In fact, that’s a big part of the work we’re doing together. I’ve been coaching Grace to build influence in their relationship and have more effective conversations about Casey’s eating disorder and treatment.

Next steps

With a bit of clarity, Grace understands the dietitian’s choice. “I still hate it,” Grace says. “It puts me in a really bad place.” 

Grace is going to have some tough conversations with Casey. Based on our understanding of why the RD released Casey from her care, we can guess that Casey is severely medically compromised. 

Grace needs to get really clear with Casey about how eating disorder treatment needs to proceed. There is no easy solution here because of Casey’s age. But Grace is not willing to give up. “I’m fighting for my daughter’s life right now,” she says courageously. “I’m going to figure out how to get her the help she needs.”

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Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.

For privacy, names and identifying details have been changed in this article.

See Our Eating Disorder Treatment Guide For Parents