Patient and Family Variables
Although FBT can be experienced by many therapists as demanding, it is fair to say that it is even more grueling for parents. A considerable time and effort commitment on the part of the parents is expected. For instance, the first part of treatment requires parents to be available for constant supervision of their adolescent at times when she or he will not be attending school and every meal is eaten at home. During this part of treatment, mealtimes are almost uniformly experienced as stressful by both the parents and their family. Compounding this potential barrier to successful treatment, parents who are critical of their child’s eating- disordered behavior (as measured by expressed emotion) could be at risk to drop out of treatment prematurely (Szmukler et al., 1985). Should such critical parents remain in treatment, there is increased probability that the symptomatic behavior will not abate and treatment outcome will be compromised (Le Grange et al., 1992). In such instances it has been shown that a separated format of FBT (meeting with the adolescent and the parents but not together) may be more advantageous (Eisler et al., 2000).
Single parents of adolescents with AN who present with high levels of obsessive and/or compulsive traits are particularly at risk for being taxed beyond their capacity and might require more treatment than in cases in which two parents are present (Lock et al., 2005). On the other hand, single parents of patients with BN do not appear to be at a disadvantage (Doyle, McLean, Washington, Hoste, & Le Grange, 2009).