I remember walking into my interview with Eating Recovery Center feeling completely shocked that I had no idea that this kind of mental health treatment existed. Each treatment facility operates a little differently but most have much more in common than they have different. As an outpatient provider please know that you can use the intake team to support you in encouraging a patient to step-up to a higher level of care, they can help guide you through understanding what level of care would be best. IOP or Intensive Outpatient is the least restrictive higher level of care. At this level, patients receive meal support for 3-5 meals per week and participate in between 12 and 15 hours of group and individual therapy per week but are still very involved in their day to day life. This level of care is appropriate for someone that is very motivated to interrupt eating disorder behaviors and are able to articulate good insight into the functions and maintaining factors of their eating disorder behaviors.
PHP or Partial Hospitalization Programs range between 40 and 77 hours and 5-7 days per week and often require the patient to put work or school on hold in order to focus on treatment. This level of care is recommended when a patient is underweight and/or is engaging in behaviors multiple times per week. PHP offers the support and containment needed to undergo the very difficult and complex process of weight restoration and to help patients handle the intense emotions their behaviors have served to help them avoid. If your patient needs to gain a significant amount of weight or engaging in behaviors daily, most treatment facilities will recommend a Residential level of care. This is 24-hour care, with the patient living on the treatment unit so that complications of early weight restoration can be monitored. It is very important to have adequate medical monitoring when a patient is severely malnourished because electrolyte imbalances, potassium drops, sodium imbalances, edema, and other complications can occur very quickly when nutrition is reintroduced.
It can be tempting to believe your patient when they say that they are able to do the work at an outpatient level of care, but it is important to remind yourself that eating disorders are incredibly complex and that medical complications are common. As a therapist at the higher levels of care, my primary goal is to get your patient to a physically healthy place in order to do the great emotional and cognitive work with you!
Information for Families
I also wanted to share a bit of information that may be more specifically helpful to readers that may not be a clinician but have someone they care about that is suffering from an eating disorder. I hope the blog so far has been informative but the families I work with often ask “but what do I do to help my loved one?” I could probably write several separate articles on why it is so important for someone with an eating disorder to have the support of friends and family (and if there is interest I can!), but I believe that the single most important thing for you to know is that your loved one is trying to cope the best way they know how. Telling them to ‘just eat’ or ‘just keep it down’ won’t work, because interrupting behaviors will bring on the intense, overwhelming thoughts and emotions they have been avoiding.
In order to help your loved one navigate the process of facing what they have been avoiding it can be immeasurably helpful for you to seek your own support through support groups or therapy. Education can help you feel less lost or helpless, but your ability to provide emotional validation and support will make the biggest difference in their recovery. The best way to do that is to make sure that you are taking care of your own mental health and that you have a space to share what is coming up for you. Supporting someone that is giving up their way of coping is going to take patience, compassion, and empathy for your loved one and for yourself!
Additional Resources
To take advantage of learning more about eating disorders from the leaders in the field please consider attending the Eating Recovery Foundation Annual Eating Disorder Conference in beautiful Denver Colorado October 11 and 12! Click here for information.
For additional resources for families that want to know more about how to support a loved one with an eating disorder please check out the free Emotionally Focused Family Therapy videos available here.
About the Author
Melody has worked at the Eating Recovery Center in Denver for the past 5 years facilitating both individual and family therapy for individuals at all levels of care. She is the Secretary for the local chapter of the Advanced Contextual Behavioral Sciences professional organization. She is a graduate of Chapman University’s Marriage and Family Therapy Master’s program.
