Objective: Despite the availability of several evidence-based treatments for eating disorders (EDs), including Family-Based Treatment (FBT), therapist drift from evidence-based treatments in real-life clinical settings is common. This study explores clinicians' use of FBT techniques and identifies clinician-reported barriers to their use in real-world settings.
Methods: Clinicians (N = 54) who self-identified as using FBT for EDs were recruited through social media, professional listservs, and mental health provider databases. Participants completed an online survey comprised of questions developed alongside ED researchers (n = 5). Questions included quantitative self-rating of frequency of FBT technique use and usefulness, limitations of the treatment, and barriers to effective implementation of FBT.
Results: Descriptive statistics indicated frequent use of most FBT techniques (i.e., Ms > 75 on scales ranging from 0 [never use] to 100 [always use]). On a scale from 0 (not at all a barrier) to 100 (a major barrier), ratings of FBT barriers ranged from 25.07 (i.e., caregiver motivation decreases when learning reasons for ED) to 80.70 (i.e., low time resources). Regarding limitations of FBT, between 37% and 42.6% of participants indicated challenges in establishing an alliance with youth and validating their experiences as barriers to treatment success.
Discussion: Overall, clinicians reported frequent use of FBT techniques. Barriers that received higher mean ratings included items related to emotional processes experienced by caregivers, caregiver/patient beliefs related to weight stigma/diet culture, resource and time-related constraints, and challenges with caregiver buy-in/beliefs about treatment. Future research should explore ways to adapt FBT to address these barriers within naturalistic settings.
Keywords: eating disorders; empirically supported treatments; family‐based treatments; treatment barriers.
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