# What factors do parents/caregivers think impact change in family therapy for anorexia nervosa?: a qualitative study

## TL;DR

This study explores what parents and caregivers believe helps their families make progress in family therapy for anorexia nervosa.

## Contribution

The study provides new insights into the parent/caregiver perspective on factors that facilitate change in family therapy for anorexia nervosa.

## Key findings

- Parents emphasized the importance of collaboration within the family and with clinicians to build a support network.
- A balance between structure and flexibility, along with maintaining a life outside the illness, was seen as critical for recovery.
- Themes like commitment and strengthening family connections were identified as central to the therapy process.

## Abstract

While the efficacy of family therapy for adolescents with anorexia nervosa is well documented, the process of change across treatment is less well understood. Emerging research has looked at the young person experience, however, little is known about the parent/caregiver perspective. This study aimed to understand factors that parents/caregivers perceive as facilitating change in family therapy for anorexia nervosa (FT-AN).

Twenty-three parents/caregivers of young people (age 12–18 years) with anorexia nervosa who had completed FT-AN participated in individual semi-structured interviews online. Interviews were transcribed verbatim and analysed using reflexive thematic analysis.

Five interconnected themes were generated: Not alone, Strong foundations, Commitment, Both/and rather than either/or, and Strengthening family connection. Parents /caregivers highlighted the importance of collaboration—both within the family and with the clinical team—in building a support network. This collaborative foundation was seen as central to facilitating change, initially through structure and boundaries, and later through increased flexibility and safe risk-taking. Maintaining a life outside the illness and ensuring a balance between physical and emotional needs across all stages of treatment emerged as critical to the recovery journey.

This qualitative study explored parental experiences of supporting a young person through FT-AN. Themes generated in this study closely mirror the change processes reported by young people and align with the theoretical underpinnings of FT-AN. Parents reported that change was supported through collaboration with knowledgeable clinicians, setting clear expectations and reduced isolation. A holistic, person-centred approach to treatment that considered life outside the illness was considered as key in promoting change and building commitment from the young person and family. Additionally, finding the right balance in safe risks taking, flexibility within the approach and gradual spacing out of sessions were all described as key to promoting change.

The online version contains supplementary material available at 10.1186/s40337-025-01368-x.

Family therapy for anorexia nervosa (FT-AN) is a first-line recommended treatment for adolescents with anorexia nervosa. While it is helpful for most, there are many who require more or something different to reach recovery. This study aimed to understand factors that parents/caregivers perceive as impacting change in FT-AN. Twenty-three parents/caregivers of young people (age 12-18 years) with anorexia nervosa who had completed FT-AN participated in individual semi-structured interviews. Analysis of transcripts using reflexive thematic analysis generated five interconnected themes: 1) Not alone, 2) Strong foundations, 3) Commitment, 4) Both/and rather than either/or, and 5) Strengthening family connection. Parents/caregivers highlighted the importance of collaboration—both within the family and with the clinical team—in building a support network. This collaborative foundation was seen as central to facilitating change, initially through structure and boundaries, and later through increased flexibility and safe risktaking. Parents/caregivers reported that change was supported through collaboration with knowledgeable clinicians, setting clear expectations and reduced isolation. A holistic, person-centred approach to treatment that considered life outside the illness was considered as key in promoting change and building commitment from the young person and family.

The online version contains supplementary material available at 10.1186/s40337-025-01368-x.