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The Family Therapy Fidelity and Adherence Check (FBT\u2010FACT) was created to evaluate therapist adherence and competency on the core interventions in FBT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Participants were 45 adolescents and their families sampled from three randomized clinical trials evaluating treatment for AN. Trained fidelity raters evaluated 19 therapists across 90 early session recordings using the FBT\u2010FACT. They also rated an additional 15 session 1 recordings of an alternate form of family therapy\u2014Systemic Family Therapy for the purpose of evaluating discriminant validity of the FBT\u2010FACT. The process of development and the psychometric properties of the FBT\u2010FACT are presented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall fidelity ratings for each session demonstrated moderate to strong inter\u2010rater agreement. Internal consistency of the measure was strong for sessions 1 and 2 and poor for session 3. Principal components analysis suggests sessions 1 and 2 are distinct interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The FBT\u2010FACT demonstrates good reliability and validity as a measure of treatment fidelity in the early phase of FBT. \u00a9 2014 Wiley Periodicals, Inc. 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