The decision to seek treatment for an eating disorder is one that is often not taken lightly. The decision may come after months (or even years) of debate or you may have come to the decision to seek treatment quickly due to an emergency arising. Some people have decided on their own to prioritize their recovery and others decide to seek treatment due to the persistent urging of friends and loved ones. No matter what your particular situation is that has led you to this decision, you most likely have a number of questions about what to expect, and it is quite normal to feel overwhelmed in the process. Many people with eating disorders find help via outpatient therapy from a therapist, counselor, or psychologist, often with the support of a dietician or nutritionist and hopefully with monitoring from a physician. However, sometimes a higher, more intensive level of care is necessary. This article is to help you to prepare for admission into an eating disorder treatment center, and gain some insight into what to expect during the treatment process.
Understanding Levels of Care
The first step is to do some research and to gather resources. If you are already working with a treatment professional such as a counselor, therapist, or psychologist, be honest with them if you are feeling like you need a higher level of care. Allow them to support you through the process and provide you some appropriate referrals. If you are not working with a treatment professional yet, research providers in your area and find one that specializes in eating disorders. You want to feel comfortable asking providers any questions or concerns you have and work collaboratively with them to help find the appropriate level of care and the right placement for you.
There are various treatment options and levels of care, which can often become confusing. Below is an outline of each level of care to help provide a better understanding of their differences and benefits. Keep in mind that these are general overviews. Actual programming and structure can vary dependent on clinicians and treatment center approach. Length of stay is individually based but roughly estimated to be 30 days at each level of care with the exception of outpatient therapy, which can be longer-term.
- Outpatient Therapy: Sessions typically held weekly or twice weekly for ongoing support of recovery or when behaviors are well-managed, and mood and physical health are relatively stable. Sessions may be held individually or jointly with family/support members. Outpatient therapy for an eating disorder should be conducted with a treatment professional with expertise specifically with eating disorders and should also include an outpatient connection with a nutritionist with experience supporting patients with eating disorders and a physician to conduct exams and order labs etc. as needed.
- Intensive Outpatient Program (IOP): 3-5 days per week, 3 hours per day. Typically consists of 1-2 therapeutic group(s) and 1 meal and/or snack daily as well as weekly sessions with a therapist and dietitian. IOP allows clients stepping down from higher levels of care a chance to return to their normal activities with the ongoing support of the treatment team. It offers a transition period between higher levels of care and outpatient therapy.
- Partial Hospitalization Program (PHP): 5-6 days per week, 6-10 hours per day. A day at PHP consists of several therapeutic groups, 2-3 meals and/or snacks, individual therapy and dietary sessions. Clients are able to go home in the evening and have some of their usual activities but are still in a structured program offering containment throughout the majority of the day.
- Residential Treatment Center (RTC): RTC offers 24hr support and containment for clients. Programs are structured throughout the day involving therapeutic groups, individual therapy, family therapy, dietary support and supervised meals. Adjunctive therapies are also offered such as Yoga therapy and Art therapy. Nursing staff will check vitals regularly and monitor any medical concerns. Clients are seen by a psychiatrist at least weekly and a medical doctor as needed.
- Inpatient Psychiatric Stabilization (IP): Program is highly structured and focused on stabilizing psychiatric concerns. Providing safety and containment is the primary goal of Inpatient care. Nursing staff is available 24 hours per day to monitor clients’ vitals and provide any needed medical support. Clients are seen by a psychiatrist daily and a medical doctor as needed. Programming at this level of care is typically similar to RTC.
- Inpatient Medical Stabilization: Medical Stabilization in a Medical Unit within a hospital setting. Treatment at this stage is about stabilizing any emergent medical complications. Treatment is typically focused on nutritional restoration. Limited individual or group therapy at this level of care due to medical stabilization being the primary focus of treatment.
If you believe you are in immediate need of residential or inpatient treatment, you can also reach out to a treatment center directly. There may be a treatment center in your area but it is also not uncommon to have to travel across the country for the right treatment. The admissions team of any treatment center should walk you through their admissions process and answer any questions you have in regard to their program. Here is more on how to choose the right eating disorder treatment center.
The Admissions Process
The admissions process can be overwhelming. The treatment team needs to gather a significant amount of information to make sure they are making the best recommendations for your individual care. Here are some parts of the process you can expect:
- Intake Assessment: Typically, about an hour-long assessment completed in-person or over the phone and completed by a clinician. The purpose of this assessment is to gather information regarding your symptoms, history, prior treatment, etc. It is important to try and be as honest as possible during the assessment to allow the clinical team to provide you with the most appropriate recommendation.
- Medical Clearance: In most cases, you will be asked to have a medical evaluation including labs (bloodwork) and EKG for heart function. If you are experiencing any medical concerns/complications, you may have to get extra tests and approvals from a medical doctor prior to admitting into treatment. Hospitalization may be recommended if you are experiencing serious medical complications or are at high risk for medical complications arising.
- Financial Consultation: The treatment center will check your benefits and review your financial responsibilities with you. The finances of treatment can be stressful and a deterrent for treatment but open communication with the provider can help them determine ways to make treatment more financially accessible for you. Do not shy away from these conversations. Ultimately, the treatment center wants to work with you to get the care that you need.
- Treatment Recommendation and Schedule Admission: Once the steps above are completed the treatment center will provide you a recommendation and schedule your admission date. The treatment center is going to provide you with a recommendation for a level of care. This recommendation is based on the information the clinical team has gathered and guided by the APA (American Psychiatric Association) Practice Guidelines. The recommendation is based on the full clinical picture and not just on one factor. It may be the case that the treatment team determines that you need a higher level of care than you anticipated. Don’t let this be a deterrent, as the team simply wants to set you up for success by offering you more support and containment. Also, keep in mind the level of care you admit into is not an indefinite placement. You may begin treatment and then come to realize that you need more or less support. With your treatment team, your treatment plan can continue to evolve depending on your individual needs. It can often be tempting to delay treatment due to other commitments, however, it is important to know the sooner you admit to treatment the sooner you can begin the recovery process. You do not deserve to struggle longer than necessary. Whether you think you are “not sick enough” or “too sick” the sooner you can get into treatment the sooner you can start to heal and get your life back.
What to Expect When Treatment Begins
You are going to be anxious. You are going to have all sorts of fears. That is normal and expected when entering into treatment. After working in admission for over 10 years, I have come to learn that clients have so many questions and at some point, we just cannot provide answers for all those questions. Clients want to have their questions answered to help manage their anxiety but the reality is you are never going to fully know what to expect until you arrive in treatment. We can prepare you with basic lists of what to bring and what the schedule will look like, but you are still going to have to walk those doors and into your own treatment journey. It does take a bit of a leap of faith.
You may feel desperate for immediate relief. There is often some magical thinking around treatment for the individual and also for loved ones, that perhaps the moment you admit into a treatment center, eating disorder behaviors will change, mood will improve, and the body will be restored. Those are the ultimate goals of treatment. However, the reality is that things may get worse before they get better. Typically mood and even eating disorder behaviors worsen at the beginning of treatment as you acclimate to a new environment and your eating disorder fights to keep hold of you. The treatment team will provide support, structure, skills, etc. but they are also taking away your key coping skills (eating disorder behaviors, drugs, alcohol, etc.), which tends to be extremely overwhelming. In treatment, the providers are asking you to do the most difficult things for you to do day in and out, over and over again, which is challenging. Know that your providers are pushing you to go through this process out of compassion and because they believe you can do this. Recovery is possible. Do not stop when it gets hard. It will get better. Life will be better, but the beginning will be difficult.
The treatment team is there solely for your well being and they are your best asset in treatment. They want to help set you up for success. If you disagree with something, talk to them. If you are struggling with something, let them know. There are inevitably going to be points where you feel like they are pushing you on something you are not comfortable with, but it is only out of a desire to help you through your most challenging times. Part of their job is to challenge you through meals, food exposures, and processing through painful content, otherwise they are allowing your eating disorder to control treatment. If you ever doubt your team’s motivation, know it is always for you to find healing. When you have made progress, the time will come to “step down,” to a lower level of care. You may need additional support during this process so it is important to ask for this from your team. They cannot do the work for you, but they can support you and provide you with the tools and resources for the best outcome.
Be proud of yourself for making a decision to pursue treatment for your eating disorder. The treatment journey is anything but easy, but the growth that can happen on this journey is immense. You are worth finding recovery and living a life without an eating disorder. Taking these steps takes courage. Give yourself credit for getting to this place. Practice grace in the areas you are struggling. You can recover.
Types of Eating Disorder Treatment Professionals
Dual Diagnosis or Co-Occurring Disorders
Approaching Someone With An Eating Disorder
Anosognosia (Denial) in Patients with Eating Disorders
Importance Of Getting Help And Being Honest In Medical And Therapy Appointments
Who Gets Eating Disorders
Food Allergies and Eating Disorders
About the Author:
Alyson Lischer, LMFT has over 10 years of experience working in Admissions and Business Development for eating disorder treatment centers. She believes deeply in the importance of collaboration to help provide clients with the best care possible. She is an active member of the eating disorder professional community and is the immediate past president for the San Diego Chapter of iaedp (International Association of Eating Disorder Professionals). Currently, Alyson is a Licensed Marriage and Family Therapist (CA LMFT#84748) working in Private Practice in San Diego, CA and is passionate about working alongside individuals and their families throughout the eating disorder recovery process.
Written – 2020