FBT / Maudsley

Core Mechanism

Empowered parents take charge of refeeding; externalization separates illness from identity; control gradually returns to adolescent

View of the Person

An ill adolescent who cannot recover alone: parental empowerment is necessary and non-blaming

Evidence

Conditions

Epistemology

Blind Spots

Requires parents able to supervise every meal, which assumes a household with the time and flexibility to do it; the etiology-agnostic stance can frustrate families who want to understand what happened; adolescents frequently experience the refeeding phase as coercive, a critique voiced more often in first-person accounts than in the trial literature

Contraindications

Medical instability requiring inpatient stabilization first (FBT is an outpatient treatment), families unable to participate in meal supervision, active domestic violence in the home, patient with severe comorbid conditions requiring separate treatment (e.g., active psychosis), households with high parental criticism, where separated FBT (parents and adolescent seen apart) generally outperforms the conjoint form

Training

Equity & Cultural Adaptations

Philosophical Roots

Pragmatism (agnostic about etiology: just refeed); family systems (externalization); medical model (anorexia as illness requiring parental intervention); anti-blame stance

Related Modalities

FBT / Maudsley in 1 Comparative Clinical Vignette

Each vignette presents the same client through multiple theoretical lenses side by side — showing how FBT / Maudsley formulates presenting problems, sets treatment focus, and sounds in the consulting room compared with other approaches. This comparative pedagogy is unique to Epoché Clinical; no other clinical reference systematically formulates the same case across traditions.

Sources