Eating Disorders: When Outpatient Treatment Is Not Enough - Residential Facility for Eating Disorder Treatment

Written by HealthyPlace.com Staff Writer

Alana, a seventeen-year-old high school senior, first came in for eating disorder therapy when she weighed 102 pounds. Alana's mother brought her to see me because of her concern for Alana's recent weight loss and her fear that Alana was overly restricting her food intake, having taken her diet too far for her 5' 5" frame and her propensity for exercise. Alana was reluctant and angry that her mother had dragged her to a therapist's office; "It's my mother who has a problem, not me. She won't get off my back."

I sent Alana's mother out of the room and asked Alana if perhaps there was anything I could possibly help her with since she and I both had at least another thirty minutes to kill. When Alana couldn't really think of anything, I suggested that one thing I might do is help her get her mother off her back. This, of course, perked her up a little and she immediately agreed. After talking to her for a while and explaining how I work on getting parents to stay out of their kid's eating, I invited Alana's mother in and explained to both of them that, for right now, as long as Alana was going to be seeing me there would be no reason for her mother to discuss her eating habits or her weight. Her mother was unhappy about this and offered several protests, but I held firm that this was no longer her territory and that her involvement in fact made matters worse, which she conceded. However, Alana's mother needed reassurance that Alana would not be allowed to starve herself to death, which was an almost obsessive fear for this parent due to the recent unexpected death of her husband. Therefore, I told them that I would not allow Alana's condition to worsen without more intense intervention and that I was sure Alana had no intention of that, either. Here is where I let Alana in on a major treatment decision:

Carolyn: Alana, at what weight do you think you would need to be hospitalized?

Alana: I don't know, but I'm not going to let that happen. I'm not going to lose any more weight. I've already told everybody that. I don't need to go to a hospital.

Carolyn: Okay, so you've agreed to not lose more weight, but you're a smart girl. To reassure your mom, let her know that you do have some idea of what would be unreasonable or unhealthy to the point where you would need to go to a treatment program for more help.

Alana: (Fidgeting a bit and looking uncomfortable, not willing to say anything, most likely for fear of being trapped and held to it.)

Carolyn: Well, do you think 80 pounds would be taking it too far? Would this be so low that you need to go to a hospital then?

Alana: Of course, I'm not stupid. (Most, but not all, anorexics think they can control the weight loss and don't imagine they will ever be at the extreme weight often seen in other anorexics.)

Carolyn: I know, I already said I thought you were smart. So do you think 85 pounds would be too low?

Alana: Yes.

Carolyn: What about 95?

Alana: (Now Alana really squirms. She is trapped. She doesn't want to continue this, as it is getting too close to her current weight and perhaps she desires to lose "just a little bit more.") Well, no not really. I don't think I'd need a hospital or anything but it's not going to happen anyway.

Carolyn: (At this point I know I have her in a position to settle on a weight criterion for going into a treatment program.) Okay, so I think we can agree that you think that 85 is too low but 95 is not, so somewhere in between there you would cross the line where outpatient therapy wouldn't be working and you'd need something else. In any case, you are willing to stay at your current weight of 102. Is that right?

Alana: Yes.

Carolyn: So then for your mom's sake and since you have said you will not lose any more weight, let's make an agreement. If you do lose weight to the point where you get down to, say, 90 pounds, you will in essence be telling us that you cannot stop and therefore you need to go to a treatment program?

Alana: Sure, yeah, I can agree to that.