Eating Disorders: When Outpatient Treatment Is Not Enough - Eating Disorders Treatment

Written by HealthyPlace.com Staff Writer

Throughout this discussion Alana played a major role in decision making for her treatment. She got to have her mom "off her back," and she helped determine the weight criterion for hospitalization. I did have to spend some time with Alana's mother to reassure her that this was the best approach and that letting Alana in on this criterion would help us out in the event that hospitalization was necessary. I also wanted to give Alana the chance to maintain her weight and improve her diet through outpatient therapy. However, in Alana's case, the writing was on the wall. All of Alana's behaviors described to me earlier in the session by her mother pointed to the fact that she probably would indeed continue to lose weight because, as with most anorexics, her extreme fear of gaining would keep her restricting to the point where she would most likely continue to lose. Alana did get down to 90 pounds and reluctantly, though compliantly, went into a treatment program. The process of having Alana establish the weight criterion made a huge difference in her willingness to go when it became necessary. Additionally, there was no panic or crisis when the time came, and the therapeutic relationship bond was not disrupted by me "doing something to her" or fostering the "me against them" attitude I discussed earlier. I reminded Alana that she herself had agreed that if her weight were to get this low, it would mean that she needed more help.

In Alana's case there was no medical condition or emergency situation necessitating hospitalization. Rather, hospitalization was followed through with when outpatient therapy was not working and an eating disorder treatment program was a means for her to get the help she really needed to get better. A good eating disorder program provides not only structure and monitoring but also a number of curative factors that facilitate eating disorders recovery.

CURATIVE FACTORS OF INPATIENT OR RESIDENTIAL TREATMENT

(The term patient or inpatient will be used to refer to an individual in a round-the-clock treatment program, and the term hospital, or hospitalization will refer to any round-the-clock program.)

A. SEPARATES PATIENT FROM HOME LIFE, FAMILY, AND FRIENDS

• Family members may have had a significant role in the development or sustaining of the disorder. Secondary gains with the family or with friends may be exposed and may even diminish when patients are removed from those people.
• The therapist can take a more active role as both authoritarian and nurturer and facilitate the necessary trust and relationship needed for recovery.
• When the patient is absent from the family, the therapist can see the functional significance that the patient had in the family. The "role" the patient plays in the family may be an important aspect of treatment. Furthermore, how the family functions without the patient will be helpful in determining causes and treatment goals.
• Being away from normal routines such as work, taking care of children, and daily living responsibilities, which often serve as distractions from dealing with the issues and behaviors, can help patients to focus attention where it is needed.

B. PROVIDES A CONTROLLED ENVIRONMENT

• Putting a patient in a controlled environment exposes otherwise hidden issues such as food rituals, laxative abuse, rigidity in eating behaviors, mood around mealtimes, reactions to weighing, and so on. Exposing the patient's true patterns and behaviors is necessary in order to deal with these issues, discovering the meaning they have for the patient and finding alternative, more suitable behaviors.
• A controlled, structured environment assists the patient in breaking addictive patterns. Popcorn and frozen yogurt diets will not be able to be continued. Vomiting directly after meals will be difficult in programs providing direct supervision after meals. Weight is usually monitored and yet kept from the patients in order to protect them from their own reactions to the information and to break them from being addicted to weighing and to the number on the scale. Furthermore, having a certain schedule to follow, including planned meals, helps reintroduce structure into what is often a chaotic pattern. A healthy, realistic schedule may be learned and then utilized on returning home.
• Another useful aspect of the controlled environment is medication monitoring. If medication is warranted, such as an antidepressant, it can be more carefully monitored as to compliance, side effects, and how well it is working. Observation of the reaction to medication, blood tests, and dosage adjustments is more easily carried out in a hospital setting.