THREE: Know and Practice your FBT Assumptions
RDNs who interact with parents, professionals and clients need to operate and communicate with five key FBT assumptions. It is vital that professionals remain consistent with what we say in our counseling sessions and in our written communication to the treatment team.
1. Do not focus on the why (Agnostic view of causation).
“Instead of focusing on why this happened; can we use our time to focus on solutions?“
“You did not cause this illness.”
“It was a perfect storm.”
Maintain a “no-blame” stance. Guilt leads to immobilization. Empower parents and help families see their strengths or enhance their skills. Join with family and collaborate to combat the eating disorder.
Eating disorders are genetically influenced by personality traits and cognitive patterns that reveal core biological risks factors. Direct to resources on neurobiology, genetics, and the Ancel Keys research.
2. Externalize the eating disorders.
“Your child/adolescent/teen has been hijacked by ED and she is under the influence.”
“If your child had cancer you would insist they takes their medicine.”
“Food in the medicine for malnutrition.”
The eating disorder is viewed as separate from the child or as an outside entity (like the diseases model in which the disease is not seen as the person). The eating disorder is the problem not your child.
3, Parents are experts on their child. RDNs serve as consultants.
“You know how to feed your child.”
“Your commitment to their recovery is key to their success.”
“You have successfully fed your older/other children with success.”
“Would you be interested in nutrition resources?”
“How can I be of help?”
RDNs who offer parent coaching; referred to as parent intensive counseling (PIC) or Parent Assisted Meals and Snacks (PAMS). Encourage re-integration of previously consumed foods and caloric density. Offer support with food planning as needed. This is done in a non-authoritative way.
4. Empower Parents and caregivers.
“You are doing a great job with….”
“Your child’s health and nutrition must come first.”
“If I were to write a check at the end of the month for the work you are doing for your child it would be over $?0,000 dollars.”
RDNs may feel more comfortable with a direct approach in nutritional counseling. We need to pivot to offer coaching and empowerment. We can address nutritional beliefs that are barriers to recovery. We can support parental empowerment and build confidence through competence. Assist parents in understanding how current food practices affect weight progress.
5. Initial focus is on weight restoration & symptom management.
“From the EDGE results I am concerned for your child’s health.”
“I am seeing some red flags (physical symptoms) and without an increase in food and nutrition we may need a higher level of care.”
“Everything stops until they eat.”
Use the shock of the parents to create a therapeutic bind to create energy, urgency and momentum for nutritional rehabilitation. Provide a simple explanation on metabolism to help parents and possibly the mature teen to understand the consequences of poor energy balance and what symptoms reveal. Validate progress as you see symptoms improve with weight restoration and adequate nutrition.
For more information on how the RDN can implement FBT informed treatment.
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Melanie Jacob RDN is a seasoned eating disorder professional that found her niche in treating adolescents with eating disorders. When the FBT research surfaced in 2006 she transitioned her approach to follow the evidence.