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

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evamusby_UK
The creators of FBT (Lock, Le Grange and others) are trying out family therapy on young adults (17-25 years).
They wrote this up in an expensive book and I'm keen to get parents and clinicians to know about it because the approach uses more buy-in (more teamwork) from your youngster. 

Like this:

FBT-AN and FBT-TAY - Eva Musby - family therapy -550 hi.jpg  

My summary is in an article for mirror-mirror: http://www.mirror-mirror.org/treatment-for-young-adults-with-anorexia.htm (and the authors of the chapter are happy with how I've summarised it.)

Mirror-Young adults anorexia family therapy.JPG  

I hope this is helpful to some of you.

Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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Foodsupport_AUS
Brilliant article Eva. It makes for interesting reading.
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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Psycho_Mom
Everyone please note: There is a "Relapse Prevention Plan" embedded in this article, and it looks extremely useful.
Thank you, Eva!
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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Rayney
Really useful article, thanks for sharing.x
17 years old, well into recovery and taking full control of food herself and gaining weight, she's loving life at the minute, it does get better!!
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floating
sounds very interesting Eva. 
I think it is a step forward and can see no reason why this will not work with young adults.

It can be very frustrating for parents of young adults when they reach the "magic" age of 18 and clinicians try to shut them out of treatment and promote independence when parents know that their teen/YA is emotionally/socially/cognitively compromised and way behind the norm for their age due to illness and damage to the brain and have "catch up" to do.........

Parents/carers know what is best for their child and can see that independent eating will not aid recovery and a good outcome


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Linda2
Hi Eva, 

Thank you Eva, I too think this is very useful.

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I hope it will prompt health services to coordinate themselves to remove their sharp divides between adolescent and adult service, and to provide evidence-based approaches for all ages.


Yes I totally agree. It is a very scary moment for the child/ young adult. The best they can hope for is that the parent realises 'my child is emotionally not at the adult stage' and not join in with this way of thinking ("You are an adult now; you should be more responsible"). Recovery never happened in one day.

Linda
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K63
Hi Eva, very interesting article am a parent of 18 year old , we are fully preparing and supervising all meals she is showing no signs of taking over any independence of meals.Since discharge from ip in March she initially started to restrict it's been a struggle every day and still haven't gotten fully weight restored but things are a whole lot better she is 18 in a lot of aspects of her life but not where her eating is concerned and if she had taken over looking after her nutritional intake after discharge she would have been back ip in a few weeks. We are lucky that she allows me some involvement with therapist .
Daughter started restricting in February 2014, tried re feeding at home hospital admission 4 1/2 months weight restored started restricting post discharge, back on meal plan full supervision weight restored april 2016. Starting to hand back responsibility for meals it's scary. 
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evamusby_UK
Thanks everyone for your comments!
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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OneToughMomma
Thanks, Eva,

I found this article very interesting as the parent of a recovered 18 yr old currently experiencing a 'blip'.

While there is no doubt in my mind that FBT saved our D, H and I were both disappointed at the end of treatment.  Basically d was told, 'Don't ever diet. You'll be fine.' 

The problem is that she was almost 18 and we stepped back from the feeding role.  To her she has not dieted, but she 'doesn't like' certain foods or 'isn't hungry' or whatever, and over time she slowly fell back into old ways. 

It was never explained to her that she has a natural tendency towards restriction and she must actively fight those thoughts.  I had begun to wonder if she should keep the dreaded food diary.  Or at least a daily checklist of, say,
  • one serving of full-cream dairy
  • one complete protein
  • something extra

to remind her of her needs.  And I do think it was explained poorly to her that her weight would continue to go up and that she should be weighed (at least blind weighed) to ensure that she was on target with that.

She thought she would never have to think about food or weight again.  And she thought that her discharge weight was her ideal weight for the rest of her life. 

She came out of FBT alive, well, and WR, and for that we are eternally grateful.  However, I think she needed more YA stuff about managing... not a chronic illness...but a life-long health challenge.

It would be wonderful for clinicians to have the tools to work with YA's and almost YA's.

OTM
D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
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evamusby_UK
Yes, education and plans around relapse prevention seem essential and it's good to see it on the FBT protocol for young adults (FBT-TAY). The standard FBT (tested on under-18s) does not spell this out, if I'm correct ( I'm conscious I don't have the latest editions of the FBT manual and parents' books), and if that's so then we are relying on the individual therapist's judgement. Every now and again I get a chance to chat with FBT experts and I will remember to try and discuss this with them. 
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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kljkm
Thank-you for sharing this information!  We are currently in the transition stage (from Adolescent  Day Treatment(PIP) to Adult Out-pt with 12 weeks of CBT-E)with a transition age daughter (turned 18 Aug. 31)  
Much needs to be clarified with regard to transitioning from one program to another (adolescent to adult). Our dtr lost 10 pounds in 2 weeks, after going from FULL Meals support both in hospital and at home, to the new 'Transition program'.  As far as I am concerned it was a failure.  We, the parents knew she was not ready, but our opinion did not count, as from the moment she turned 18, they were 'transitioning' her out of the adolescent program, even though she was not ready.  

I do believe the clinicians/entire team need to respect the caregivers opinion.  

Our 'transition therapist', had an adult program approach.  I feel this might have gone better if the transition therapist met with our dtr/parents/adolescent therapist in the adolescent program and discussed her prior progress and current level of meal support. Knowledge is power! 

In order to have successes with this age and program transition, you really need good communication with both therapists, the client and the family!

 Clear expectations need to be laid out for both our dtr and us as to what the consequences would be if she did not have adequate nutrition/full meal completion or had repeated weight losses while in the adult program.  If we had taken over even after the first week, I feel ED would not have had an opportunity to get so strong and she would not have continued to loose so much weight! 

Now, she...and we are trying to climb our way back up!




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evamusby_UK
Having a program and a therapist for "Transition" sounds good, and how it has been executed in your case sounds not at all like "transition". How utterly frustrating.
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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mumto3
Thank you Eva,

Think this is going to be the approach for my older D (18).  Thought she was hanging in there... but I was wrong.  Hubby says we should find her another therapist - not sure if it's going to help.  In the meantime, she has agreed to eat more - she lost 2 pounds this past week while home on break - blamed it on "all the holiday parties" - I pointed out that we've been to one and it was only one meal... 

Ate a better lunch under my eye, hopefully can turn this around.
worried mom
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