F.E.A.S.T's Around The Dinner Table forum

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Stulken
Hello,

I have been reading and listening quite a bit lately about FBT- today I listened to a podcast by Laura Collins Lyster-Mensh who interviewed Drs. Lock and LeGrange about the myths surrounding Maudsley and FBT.  I became intrigued when they discussed the highly trained clinicians who specialize in FBT.  I am under the impression that not many people have this training- is that correct?  I am in the U.S.

My daughter is in residential treatment in Minnesota and we are on the FBT pathway- but now beginning to doubt that our therapist at the facility has her credentials in this field.  I am in charge of her meal plans while she is there.  I understand the first phase is weight restoration, and we are about 8 pounds away from the low end of her goal weight range.  But sometimes I wonder if we are truly in "treatment."  

I guess my questions are:  If our therapist is not a certified FBT therapist, but works in a facility that uses FBT practices, and our dietician is coaching and supporting us through meals, can we truly say we are receiving family based treatment?  And as we have no crystal ball, do we assume we are getting the best treatment for her, even if our therapist is not specialized?  Can our therapist follow the manual for FBT and be successful in treating clients?

Thank you for any insights- sometimes I get awfully overwhelmed...😖
"There is no magic cure, no making it all go away forever.  There are only small steps upward, an easier day, an unexpected laugh, a mirror that doesn't matter anymore."
---Laurie Halse Anderson
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debra18
That is a very good question with a complicated answer. I did not use a FBT therapist but I refed my daughter at home with medical monitoring and she is doing well now. I can say that I think the goal of treatment is full recovery. Initially the child needs full nutrition and weight restoration. After that the child needs to be able to eat all of the foods they ate before getting sick, no ED behaviors, ability to continue gaining weight according to their growth curve , and comfort with eating without trying to restrict intake . Common mistakes that most therapists seem to make are stopping treatment too early, setting target weights too low, and giving back control to quickly to kids. It takes a long time to retrain kids how to eat on their own and rewire the brain. If the therapist is giving you support to feed your child and she is gaining weight than I think you are on the right track.
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Foodsupport_AUS
You ask a very interesting question. This is the list of therapists currently listed on the FBT trained to treat website http://train2treat4ed.com/certified-therapists-list

I am not at all clear when this was last updated. This is the "official" training for FBT as manualised and certified by Lock and Le Grange. That being said, I don't think you have to be on the list to be a good FBT therapist, and I don't think we can assume that all on the list are good either. It just means they have done the training officially. Note that Australia for example has 8 therapists, Canada 4, New Zealand 2, UK none, Germany 1. 

It is important to note that the manualised therapy in trials still has an average success rate. I don't think we really know if that is the "best" treatment it is just better than other manualised therapies. The problem with manualised psychiatric therapies is that it does not account for all of the variances there are between those with the illness, it does not account for what other resources may be at hand. It is the only way to standardise care so we can compare things - a great issue with an illness that takes many months to treat. 

There are however central tenets that seem to be important in FBT. That parents are empowered to do the re-feeding. That weight restoration (early) appears to be critical to success. That ED behaviours and thoughts are managed. Why FBT does not work is even harder to work out. Is it because the child is just too ill. Is it because the resources to support the parents are insufficient. Is it because there parents themselves don't have the ability to tolerate distress or have their own issues. 

For most of us, who don't have access to a certified FBT we then need to work with what is available. Does that mean our chances of recovery are less? I think that is unclear. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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Mamaroo
Hi Stulken
I understand that you are feeling overwhelmed. This is a steep learning curve. Here we understand what you are going through.

Our hospital where my d was treated didn't follow the manualised FBT method. They didn't even call their treatment FBT, but, in my opinion, they did a great job. They took the best of all treatment methods and applied it at the eating disorder program. Unlike FBT (correct me if I'm wrong) they did blind weighing and at no point did they transfer control of food to her, leaving it in my hands (where it belonged, in my opinion). 

What you should look for in treatment is that they focus on full nutrition first and then only after WR, the introduction of talk therapy, if needed. The proof of the pudding is in the tasting as they say. So if your d is gaining weight and getting over her fear foods, then they are doing their job.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Stulken
Thank you All!  After reading your responses, I do think we are on the right path and things are going the way they should.  We began back in April in the intensive day program, but residential began at the end of May because she was not gaining fast enough.  The promise that she would restore faster there has been fulfilled- she has gone from her low of 90 pounds to now being 117.  We are getting closer to her goal weight range.  She has been eating everything we have chosen for her, which has been a fairly recent victory since she had been having carry-over from every meal and snack, and feeding tube was being discussed.  Once she gets to the high end of her goal, I know I will be needing to continue the exact routines they have there in res in our home.  And I do feel, with all of the research and reading that I have done, that I have a pretty good handle on Phase 1.  This will be ongoing for a long time.  She is only 13 so I suppose I am lucky in that she is still pretty dependent on me.
"There is no magic cure, no making it all go away forever.  There are only small steps upward, an easier day, an unexpected laugh, a mirror that doesn't matter anymore."
---Laurie Halse Anderson
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ValentinaGermania
This sounds like you are doing really well. I think it is like always in life - you can have good therapists and bad ones - and official license does not mean they are great, just that they did that program. Trust your gut, if your gut says it is all o.k. then it normally is. 🙂
Keep feeding. There is light at the end of the tunnel.
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mamabear
May I ask if you are at Melrose? 

To make a ling long story short- it sounds to me like you have a good head on your shoulders. You understand that none of these kids come home “ fixed”. This will be years and bc she is so young, you will have a moving target for weight. 

Heres the key for all if us who have kids  in recovery ( mine was dx at ten and is now 19 ED free)- 

1) high cals 
2( high FATS 
3) weight held stable and gaining long term without losses 
4) supervision as long as it takes 

when my d got home from inpt ( at Melrose - it was a disaster but was 2011).. I slept with her for a year, sat outside showers and toilet etc etc. 3 meals and 3 snacks. Are at school with her daily for mist of 2.5 school years. Made our home like  Inpt. We had no team where I live. We did it on our own using this forum for help. 

Remember that the “ stages” thing is a bit of BS. They go in and out of each one many many times. I will up a thread I wrote about that. 

Get yourselves ready. Get house ready. Even stock your freezer. 

You can do this ! PM me if you ever want to talk! 
Persistent, consistent vigilance!
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Stulken
Mamabear, we are at the Emily Program in St. Paul.  I looked at Melrose briefly.

Thank you!
"There is no magic cure, no making it all go away forever.  There are only small steps upward, an easier day, an unexpected laugh, a mirror that doesn't matter anymore."
---Laurie Halse Anderson
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mamabear
That program is notorious for setting target weights way to low just so you are aware. 
Persistent, consistent vigilance!
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pheim
Hi Stulken, I happened upon this thread and wanted to chime in with support, as my D14 was a resident at the Emily Program and we are doing FBT as well. She was there for 7 weeks, discharged May 22nd so has been home for a month now. She gained 25lbs during her stay and hit the mid-range of her goal weight...sounds like you and her team are following the same plan that we did. I appreciated being able to plan her meals and snacks, as that helped me understand what she needs to eat/how much/how often so that we could continue the work at home. I wish you and her much luck! Push for the top end of goal weight range, take care of yourself and keep learning and absorbing all you can about FBT. I believe it's the best way to put ED in it's place and get your daughter's health restored.
"What's comin' will come and we'll meet it when it does."
-Hagrid
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Stulken
Thank you pheim!
"There is no magic cure, no making it all go away forever.  There are only small steps upward, an easier day, an unexpected laugh, a mirror that doesn't matter anymore."
---Laurie Halse Anderson
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