Family-Based Therapy (FBT) Family Mealsby Lucene Wisniewski, PhD
By Lucene Wisniewski, chief clinical officer
"How do Parents of Adolescent Patients with Anorexia Nervosa Interact with their Child at Mealtimes? A study of Parental Strategies used in the Family Meal Session of FBT." International Journal of Eating Disorders, vol 48, issue 1, p. 72-80 White, Haycraft, Madden, Rhodes, Miskovic-Wheatley, Wallis, Kohn & Meyer (2015)
This recent study examined the types of parental mealtime strategies used during a family meal session of Family-Based Therapy (FBT). Researchers studied 21 families with children between the ages of 12 to 18 who were receiving FBT for anorexia nervosa. They also were interested in the emotional tone of the meal, as well as the parents' ability to get their child to eat.
As is typical in FBT, at the end of the first session, parents were asked to bring a meal for their child to the next session. The parents were told to bring a meal that they felt was adequate to assist with recovery.
In the study, Researchers video-recorded the family meal sessions. During this session, the family ate the meal together in a therapy room. The therapist coached the parents to encourage their child to eat one more mouthful than he/she would otherwise.
When reviewing the taped sessions, researchers looked for comments or statements by the parents and then categorized them as follows:
- Direct eating prompts: "You need to eat all of the pizza." or "Pick up the sandwich and eat it."
- Non-direct eating prompts: Encouragements such as "Keep it up."
- Physical prompts: (i.e. pushing the plate toward the adolescent)
- Restriction: "That's enough for now."
- Positive incentive: "If you finish your meal, you can go out with friends tonight."
- Negative incentive: "If you throw your yogurt on the floor, you will need to eat 2 yogurts."
- Autonomous comments: "Do you want another one?"
- Information provisions: "This will make your bones strong."
Researchers also looked for comments or statements by the adolescent and categorized them as follows:
- Positive food-based comments: "This tastes good."
- Negative food-based comments: "I am not eating that."
- Global positive comments: "I enjoyed our trip to the mall."
- Global negative comments: "I hate school."
What researchers discovered was that parents used a range of strategies in the family meal and they increased use of these strategies during a more negative emotional mealtime.
These findings shouldn't come as a surprise to any parent who has tried to get their adolescent with an eating disorder to eat. It only makes sense that parents' attempts to encourage food consumption would be met with unhappy adolescents. This is the nature of the illness!
These findings make intuitive sense, and you're probably thinking we didn't need research to tell us that!
But, perhaps the more important findings are around what strategies parents used in this meal that ensured "success" (meaning the adolescent ate his/her meal).
Direct eating prompts (see above) were more successful at encouraging food intake than providing information about the food or offering food-related choices to the adolescent. For example, parents who told their adolescent they had to eat the food in front of them and then moved the plate closer to them experienced more success than those that employed other strategies.
Therefore, the authors concluded, "It may be ideal for parents to verbally prompt eating in a non-critical and warm way."
As parents, we may want to use logic and rational discussion to help our adolescents make decisions about food (just like we would in other situations involving a 15 year old). We also may have the urge to avoid the distress that can go along with telling our adolescents what to do.
This study's findings may help parents who are struggling with their adolescent's eating disorder to feel more comfortable and confident in using more direct approaches to getting their child to "take their medicine," which in this case is food.
The Emily Program offers FBT as one of the proven therapies in our adolescent eating disorder treatment programs. Parents are leaders of the treatment team, taking an active role in planning, providing and supervising all meals and snacks, and TEP supports the parents and adolescent in their journey to recovery through weekly FBT support groups.
About the Author
Lucene Wisniewski, PhD, FAED is Chief Clinical Integrity Officer of The Emily Program and is an Adjunct Assistant Professor of Psychological Sciences at Case Western Reserve University. From 2006-2014, she served as Clinical Director and co-founder of the Cleveland Center for Eating Disorders, a comprehensive eating disorder treatment program. Her research and clinical interests include using empirically founded treatments to inform clinical programs. She provides workshops on the CBT and DBT treatment of eating disorders internationally and publishes in peer reviewed journals as well as invited book chapters. Dr. Wisniewski has been elected fellow and has served on the board of directors and as the co-chair of the Borderline Personality Disorder special interest group of the Academy for Eating Disorders (AED). In 2013 the AED awarded Dr. Wisniewski the Outstanding Clinician Award to acknowledge her contribution to the field of eating disorder treatment.