Family-Based Treatment (FBT), also called the Maudsley approach, is a therapy for children and adolescents with eating disorders in which parents and caregivers take an active role in recovery. Sessions are available in person and online.
FBT starts from the understanding that parents and caregivers do not cause eating disorders. The eating disorder is treated as separate from the young person, and the family works together, with the therapist’s guidance, to support their child’s return to health. PPG’s Eating Disorders Program is directed by Heather Rosen, PhD, a certified FBT supervisor.
Dr. Heather Rosen, Director of PPG’s Eating Disorders Program, describes how FBT works and how we partner with families.
Who FBT Is For
FBT has the strongest research support for adolescents with anorexia nervosa and is also used for adolescent bulimia nervosa. Adapted versions are used for ARFID and other eating disorders. It works best when a parent or caregiver can take part in meals and attend sessions, and when the young person is medically stable enough to be treated at home. If your child needs a higher level of medical care first, we help you find it and plan the return to outpatient treatment.
How recovery works
The 3 Phases of Family-Based Treatment
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Phase 1: Restoring Health
Parents take full charge of meals to restore a healthy weight. Because starvation clouds rational thinking, the adolescent is relieved of food decisions while the clinical team coaches the family and coordinates with the pediatrician.
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Phase 2: Returning Control
As weight restores and mealtime conflict eases, control over eating is gradually and safely handed back to the adolescent in developmentally appropriate steps.
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Phase 3: Supporting Independence
With the eating disorder no longer dominating, the work shifts to normal adolescent development — identity, autonomy, relationships, and the return of typical teen life.
What Happens in Phase 1
Restoring Weight and Health
Weight restoration and physical recovery come first, with medical monitoring alongside.
Parent-Led Meals
Parents or caregivers plan, serve, and support their child at meals and snacks, with strategies from the therapist for resistance and distress.
Interrupting Behaviors
The family works to stop restricting, purging, compulsive exercise, and similar behaviors.
Aligned Caregivers
Caregivers work toward consistent expectations so that their child hears the same message at home.
What Happens in Phase 2
Gradual Choices
Choices return in small steps, such as serving their own portions or packing their own lunch.
Watchful Support
Parents step back from direct control while staying attentive to early signs of relapse.
Eating Outside the Home
The work includes meals with friends, school events, and other social situations.
Lingering Eating Disorder Thoughts
We continue working on remaining thoughts while supporting steady eating.
What Happens in Phase 3
A Sense of Self Beyond the Eating Disorder
Sessions support identity and interests that have nothing to do with food or weight.
Adolescent Milestones
The focus shifts to friendships, school, and growing independence.
Coping Without Food Behaviors
Your child learns other ways to handle stress, anxiety, and distress.
Relapse Prevention and Tapering
The family builds a plan for early warning signs, and sessions space out as things stabilize.
What We Help With
Restricted Eating and Weight Loss
A child who is eating too little, losing weight, or avoiding foods.
Binge Eating and Purging
Cycles of eating large amounts, vomiting, or misusing laxatives or other methods.
Avoidant or Limited Eating
A very narrow range of foods or a fear of eating that affects growth and health, as in ARFID.
Compulsive Exercise
Exercise that is rigid, driven by distress, or continues despite illness or injury.
Mealtime Conflict
Meals that end in arguments, tears, or standoffs, and parents unsure how to respond.
Caregiver Stress and Disagreement
Parents and caregivers who feel overwhelmed or disagree about how to respond.
The FBT Approach to Care
Family-Based Treatment is a structured outpatient therapy, and it asks a lot of families. Parents and caregivers attend sessions, take part in meals, and carry out the plan at home, with the therapist guiding each step.
Care is coordinated across a team. This typically includes an FBT-trained therapist, a pediatrician or medical doctor who monitors vital signs and physical health, and sometimes a dietitian. Because treatment happens at home, your child stays close to the people they rely on, and the skills your family builds are practiced where meals and routines actually take place.
What to Expect
Initial Consultation
You tell us about your concerns, and we talk through whether FBT fits your child’s situation.
Assessment and Medical Coordination
We learn about your child’s eating, health, and family routines, and connect with their pediatrician.
Family Sessions
Sessions include your child and the caregivers involved in meals, with a focus on practical next steps for home.
Ongoing Review
We check progress regularly and adjust the plan as the family moves through the phases.
Care That Connects Across Specialties
FBT is one part of PPG’s Eating Disorder Therapy program. Families often work with more than one area of care, and our clinicians coordinate when they do.
Anorexia Therapy for restriction, weight loss, and fear of weight gain
Bulimia Therapy for binge-purge cycles and related behaviors
ARFID Therapy for limited eating that is not driven by body image
Family-Based Treatment, also called the Maudsley approach, is a therapy for children and adolescents with eating disorders in which parents and caregivers take an active role in recovery. The therapist guides the family through three phases: restoring health, returning control of eating to the young person, and supporting healthy development.
Does FBT blame parents for the eating disorder?
No. FBT is based on the understanding that parents and caregivers do not cause eating disorders. The eating disorder is treated as separate from the young person, and parents are seen as an essential support in recovery.
Which eating disorders is FBT used for?
FBT has the strongest research support for adolescent anorexia nervosa and is also used for adolescent bulimia nervosa. Adapted versions are used for ARFID and other eating disorders. During a consultation, we can talk through whether FBT fits your child’s situation.
What ages is FBT for?
FBT is designed for children and adolescents who live at home with parents or caregivers. Young adults may benefit from an adapted approach with family support, depending on their situation and goals.
Do parents really take charge of meals?
In the first phase, yes. Parents and caregivers take the lead in meals and snacks, because an eating disorder makes it very hard for a young person to make these decisions alone. The therapist provides strategies for managing resistance and distress, and control returns to the young person gradually as eating becomes steadier.
Does my child need to be medically stable for FBT?
FBT is an outpatient treatment, so a young person needs to be medically stable enough to be treated at home. We coordinate with your child’s pediatrician to monitor physical health. If your child needs a higher level of medical care, we help you find it and plan the return to outpatient treatment.
How long does FBT take?
The length varies with the diagnosis and how the family and young person respond. FBT often lasts several months to a year or longer, with sessions that are more frequent at the start and spaced out as things stabilize.
Do you offer FBT online?
Yes. Sessions are available in person at our Chappaqua and Hartsdale offices and by secure video.
What if there is an emergency?
PPG provides outpatient care and is not an emergency service. If you are having thoughts of harming yourself, call or text 988, the Suicide & Crisis Lifeline, at any time. If you are in immediate danger, call 911. For eating disorder information, support, and referrals, you can also call the National Alliance for Eating Disorders helpline at 866-662-1235, Monday through Friday, 9 a.m. to 7 p.m. Eastern Time.
