Opinion: Looking at the missing pieces of residential eating disorder treatment programs
- Category: Psychotherapy and Recovery Work
In social media where people with eating disorders call out to each other look for support, try to find recovery, and give warnings to others about what treatment didn't work, the shared pain, fear and frustration is clear.
*pix (Functioning in the world without an eating disorder can be just as daunting as functioning on the moon. Both require new learning and practice.)
One young woman with an implanted feeding tube was dismissed from an eating disorder treatment center and sent to an intensive outpatient program when she was certain she was not ready. The IOP was many hundreds of miles from her home so she was isolated from her family. There too she was released before she thought she was ready. After so much time, work, and money spent she still reverted to her eating disorder behaviors. She couldn't cope with the world without her eating disorder.
In my practice I've talked with women who've been in and out of three or four in-patient treatment centers, at great emotional and financial cost, only to be still at the mercy of their eating disorders soon after discharge.
As a mental health professional treating women with eating disorders, I've been a week-end guest at several residential treatment centers and have visited many in Los Angeles on a day basis or for lunch or dinner. Many offered quality treatment experiences. However, from my perspective treatment quality varied. Some providers were therapists in training. Some were in the 12-step recovery world with rich personal experience and a modicum of training. Some providers were highly skilled professionals. Often the combination of these variety of skill sets and experience were therapeutically beneficial overall. All the programs were in beautiful locations and offered spa like amenities.
What's missing? Why are complaints so severe? People complain that the treatment is terrible. But they also complain that they can't get into the treatment because of insurance restrictions. They protest that recovery programs are for the wealthy. Yet wealthy patients have trouble finding recovery too.
Yes, some people with eating disorders take pride in their symptoms and seek to support each other's illnesses on pro eating disorder sites.
But a large number of people with eating disorders want freedom from their illness. They are in fear and despair as they look for ways to find their recovery. I think part of the problem is a combination of economic drivers used to attract people to residential treatment providers and the vulnerability and limited awareness of the patients.
Recovery work is hard. People in their eating disordered life are frightened, lonely and in pain.
The reality is that treatment centers need to attract patients. Can they attract patients with the promise of painful, stressful emotional and physical work, even if accompanied with kindness and support? The frightened person looking for recovery is looking for relief, looking to be saved, looking to get an answer to questions she can barely articulate. Most of all, she's looking for safety and soothing. She's exhausted from the trials and agonies of her disorder. She doesn't know why her eating disorder has such a powerful grip on her life or what is really needed to bring her freedom.
The result of this mismatch, i.e. promise hard work and stress to someone who is already stressed to the maximum by the demands of her eating disorder, is the creation of the treatment center based on the spa model.
The would be patient sees a pool, Jacuzzi, horses, rock climbing walls, nature walks, fine dining geared to eating disorder recovery needs and lovely rooms. This is in addition to treatment rooms. The view is appealing. She could be safe, held and cured in a loving and beautiful place. Is this realistic or is it fulfilling a wish fantasy?
The cost of maintaining a beautiful spa setting is high. Would people register for an inpatient program that didn't supply all these amenities?
Yet a common complaint is that the patient is released too soon and is ill equipped to function in the real world. The stresses of everyday living call upon her eating disorder coping styles to get her through her day. The spa amenities soothe but also create a barrier between her treatment experience and living in the real world.
Beauty, grace, harmony, experiences in the natural world are all, in my opinion, necessary facets of recovery. But so is rubbing against the grit of the real world and functioning without the eating disorder.
I've often thought that the treatment model needed is not spa but astronaut training. As a person preparing to live in a real world full of challenges she has not been able to cope with so far the eating disorder woman needs graduated and focused training. The treatment center would provide therapy and also strength and skill training and practice for the real world. Beauty and relaxation settings would be present or accessible, but in a much smaller proportion than is usual in a residential setting.
Goal: Astronaut "... training is geared to the special conditions and environments astronauts will be confronted with during launch, in space, and during landing. * Astronaut training Wikipedia
Goal: Eating disorder patients need therapy and training for the conditions they will confront in leaving treatment, being in the world and building a relationship and career.
Psychotherapy with Joanna
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*pix Apollo 15 Lunar Module Pilot James Irwin salutes the U.S. flag. This file is in the public domain in the United States because it was solely created by NASA . NASA copyright policy states that "NASA material is not protected by copyright unless noted".