Family-based treatment (FBT) has become well established as the first-line evidence-based treatment for adolescents with anorexia nervosa. However, fidelity to the FBT model can be poor, and treatment is often augmented or modified in various untested forms in the hope of increasing its effectiveness and acceptability. Kellie Lavender from NZEDC has been seeing increasing numbers of families presenting for treatment reporting an experience of “failed FBT”. This clinical perspective essay describes how these identified issues were addressed when FBT was administered again.