Treatment Manual for Anorexia Nervosa: A Family-Based Approach

by James Lock, Daniel le Grange

This indispensable manual presents the leading empirically supported treatment approach for adolescents with anorexia nervosa (AN). What sets family-based treatment apart is the central role played by parents and siblings throughout therapy. The book gives practitioners a clear framework for mobilizing parents to promote their child's weight restoration and healthy eating; improving parent-child relationships; and getting adolescent development back on track. Each phase of therapy is described in session-by-session detail. In-depth case illustrations show how to engage clients while flexibly implementing the validated treatment procedures.

New to This Edition

*Reflects the latest knowledge on AN and its treatment, including additional research supporting the approach.

*Clarifies key concepts and techniques.

*Chapter on emerging directions in training and treatment dissemination.

*Many new clinical strategies.

Family-based treatment is recognized as a best practice for the treatment of anorexia nervosa in adolescents by the U.K. National Institute for Health and Care Excellence (NICE).

Genres: Psychology, Counselling

324 pages, Paperback

Published November 25, 2025

Reviews

[Sasha]

An honestly very helpful work read and yes I’m counting it!!

[Alison Raman · Rating 4 out of 5]

This manual is a great introduction to the increasingly promising family-based treatment (FBT) model of anorexia nervosa in adolescents initially created by the Maudsley Hospital in London. Lock and Le Grange are clinical and research experts in adolescent psychology and psychiatry with numerous peer-reviewed research publications and books.

Although controversy in the field of eating disorder treatment exists for implementing this method of treatment for a variety of reasons, the manual presents compelling evidence to try this approach with the caveat that the practitioner has clinical competency in eating disorders, family dynamics, and adolescent development. The manual is not a self-help book for families, and providers using this approach are encouraged to seek additional training and ongoing supervision or consultation to ensure the provider delivers treatment according to established protocols. Additionally, this approach requires a collaborative approach with the patient's pediatrician and supports medical hospitalization to stabilize complications when needed. After the patient discharges, this approach may be adopted to maintain and continue weight restoration that began while hospitalized.

FBT takes place in three phases with the first phase focused solely on empowering the parents to restore the adolescents weight while emphasizing the seriousness and medical dangers associated with anorexia. Phase II focuses on cautiously returning feeding to the adolescent after weight restoration has stabilized and the adolescent can manage to feed him/herself without additional support. Phase III of FBT addressed developmental milestones that have been interrupted due to the onset of the disorder. FBT is not designed to be full-fledged family therapy. A referral for such may be required in some families after the anorexia has remitted.

FBT requires tremendous dedication on the part of the parents to monitor and encourage eating, with at least one parent being available to take over meals and be available to monitor intake at every meal initially. Parents or caregivers often have to take time off from work to successfully restore weight. However, with the long-term consequence of starvation being death and other medical complications, parents should carefully consider the cost of not doing so. Some families and cases are not recommended for this approach.

The manual uses case studies to demonstrate how to use this method as well as common questions and difficulties encountered during the treatment progression. While the examples presented seem like relatively common and straight-forward cases, it would be helpful to include more complicated cases as it seems some nuances and other difficulties commonly seen in the anorexia were not addressed. This highlights the need for additional training and consultation to effectively implement this treatment.

The authors have created a training institute to further disseminate this training train2treat4ed.com based at Stanford.

[Meredith]

3rd edition (2026). Updates to research on FBT. Main addition is a chapter on Intensive Parental Coaching (IPC). IPC is intended for families who don’t show progress with weight gain (5 lb in first 4 sessions) AND who struggle with knowledge and empowerment. It adds 2 sessions: a parent-only session (session 5) and a second family meal (session 6). This change is backed by research. It’s estimated that 25% of families will need these extra sessions. I suspect some FBT therapists had already been intuitively doing some of this (parent only sessions to allow for more candor). But it’s good to see it spelled out, especially if a therapist is nearer to the work. Session 5 could also be a place to incorporate useful parts of Emotion Focused Family Therapy by LaFrance, et al. I still find the FBT lacking in emotional processing (for both parents and adolescent) and EFFT helps fill this gap. Also some discussion of the trend to incorporate FBT into HLOC. Minor additions about Atypical Anorexia. Could have used more here.

[Reganne · Rating 3 out of 5]

For a treatment manual, this was less dry than I was anticipating and easy to follow along. I felt the example sessions were helpful as long as explaining how and why each intervention is utilized. Very helpful read!

[Becky Douthit · Rating 5 out of 5]

A must read manual to learn how to properly treat anorexia using family based treatment. Its a bit dry so beware

[Danielle Branton · Rating 5 out of 5]

Necessary to read if you're planning to treat anorexia in adolescents.

[Alexis · Rating 4 out of 5]

For some families of young people with anorexia, I think this approach would be perfect. This is a well researched and clearly formulated intervention with a (relatively) high success rate in this population. I appreciate the role of the parents in spearheading weight restoration, the focus on increasing parenting self-efficacy for parenting an adolescent in general (rather than limiting this to the eating disorder symptoms), the separation of the illness from the adolescent, and the reestablishment of appropriate intergenerational boundaries within the family. This approach supports the whole family, which increases the wellbeing of both the adolescent and the family as a whole.

However, I'm left thinking that of course this isn't going to work for some families. I strongly advocate for parents to be key components in their child/youth's treatment. However, this manual makes the assumption that parents actually have the knowledge, skills, and resources to take on the role of ensuring weight restoration and recovery. I worry that the non-directive coaching approach prescribed to clinicians (which is intended to demonstrate to parents that they already have what they need and know what to do, and that they don't need the clinician to tell them these things) may prevent parents from filling in the gaps in the parents' skills and knowledge. This may make the parents' role considerably more challenging and ineffective than it otherwise needs to be. That said, I tend to work with clients with high comorbidity (rather than just dealing with an eating disorder), which would undoubtably complicate the implementation of this intervention. I am really keen to see more research exploring which client groups benefit most from this intervention, and which clients may be more successful with alternate (e.g., CBT, DBT, or SFT?), integrated (e.g. EFFT?) or supplementary (e.g., MFG?) treatments.

[Zhuo Zhang · Rating 5 out of 5]

Need to execute

[Pete · Rating 2 out of 5]

Some good tips and techniques, but I simply don't believe it in toto.