Restoration
THE PHASES OF FAMILY-BASED TREATMENT OF EATING DISORDERS
Weight restoration (Anorexia) or Return to normal eating patterns (Bulimia)
PHASE
I
After the adolescent has received a thorough medical examination to ensure she or he is sufficiently stable for outpatient treatment, treatment begins by taking a history and conducting an initial psychological assessment to quickly gather relevant information used to guide treatment.
Both anorexia and bulimia are associated with severe, potentially deadly medical complications. The initial three sessions are held as close together as possible to get the family engaged in new behaviors in order to quickly respond to the physical threat faced by the adolescent.
The first session will include the assessment of the adolescent. Dr. Thomas meets with the entire family in the second session to gather information from each person's perspective and educate them about treatment. The third session includes a family meal which Dr. Thomas observes and offers coaching to family members.
During this phase, it is necessary to focus on returning the adolescent to a state of physical safety. Parents are coached and equipped to lead a united family front against the disorder and successfully re-establish healthy eating behavior. Siblings learn to provide needed encouragement and support as their sister or brother faces unwavering requirements for healthy nutrition. The presence of the entire family is necessary in every session during this phase.
Returning control over eating to the adolescent
PHASE
II
The adolescent is ready to enter Phase II as the physical risk is diminished and she or he demonstrates compliance to parental demands for healthy eating behaviors. She has experienced steady weight gain (anorexia) or consistent normal eating behaviors (bulimia). During this phase, parents assist their child in resuming control over eating.
Relational, situational, and logistical challenges associated with this incremental transfer of responsibility are brought forward for review to guard against relapse. As this phase progresses, less attention is needed on adolescent compliance. Therefore, the family can begin to examine more closely other factors associated with the adolecent's disordered eating.
Establishing healthy adolescent identity
PHASE
III
When symptoms completely abate and weight is maintained above 95% of ideal weight, attention is turned toward addressing adolescent issues such as autonomy and separation that have been impacted by the eating disorder so the adolescent is back on a normal trajectory for healthy development.
Further assessment may be conducted to review potential areas that may need to be addressed in more depth to safeguard against future relapse. Examples of such potential areas include body image disturbance, problematic thinking patterns, and social skills. If there are comorbid conditions remaining, such as depression or anxiety, these now become the clinical focus.