TREATMENT
The Silent Suffering
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UNDER CONSTRUCTION
CONTENTS (these are not links, please scroll through information):
What To Expect
Individual Therapy
Partial
Inpatient
Residential
Types of Treatment
Outpatient
Types of Therapy
CBT
DBT
Group
Nutrition
Art
Music
Equine
Canine
Intensive Outpatient
Inpatient/Residential
I have been involved in every level of treatment for eating disorders, so I wanted to give you some information on treatment - what it's like, what I found beneficial, and so on. I hope that you find this information helpful! Please contact me if you have any questions.
WHAT TO EXPECT
Individual therapy: [aka outaptient, or OP] The first session is typically informative-your therapist getting to know you, getting general information about your life, family history, and so on. It can involve a lot of paper work, and a lot of 'surface' work [i.e. weight history, any other medical issues, family medical history, previous hospitalizations]. It is mostly 'business', getting the need-to-knows out of the way so that you can begin working and your therapist will be able to develop a treatment plan that is unique to you.
Intensive Outpatient: [aka IOP] This will be similar to your first OP appointment, but IOP will encompass more types of therapy, and usually meets more often.
Partial Hospitalization: [aka PHP, or Day Program] I was involved in a partial hospitalization program at MUSC in Charleston, SC. I was first in the inpatient program and then stepped down to partial. Partial may be a step down program, or it may be a starting point, depending on your individual needs. The first day was a bit intimidating because it was all new. Programs will vary from place to place, but typically they involve a lot of intake info, interviews, becoming acquainted with the program, and medical and psychiatric evaluations.
Basically, I arrived at the psych unit and filled out a lot of paperwork, and then i was taken in for interviews with a few psychiatrists and asked a lot of questions. Mostly, they evaluate your 'mental stability' and try to figure out what is going on with you - if you have any other mental disorders that need attention. They test your memory and alertness also [spell WORLD frontwards and backwards! remember 3 objects and tell me what they are in 5 minutes!] Then, I went to see the nurse and was checked medically - complete physical, bloodwork drawn. After all that is done, i met the saff, my treatment team, and the other people who were in the same boat as me.
It is called partial hospitalization because you spend your whole day and evening there, and go home at night to sleep. Your days are filled with meals and various forms of individual and group therapies.
Partial is suited for the 'medically stable". Those who are not in immediate danger medically but still need an intensive program that is highly structured. You may have to do 1 meal on your own, it really depends on the structure of the program.
Inpatient: Inpatient, also called IP, is a type of program that involves 24/7 care and monitoring. Inpatient is typically in a hospital setting. the program I participated in [twice, actually] was an inpatient program. Some may allow for you to be involved in inpatient as long as necessary, while others [like the one i did]use inpatient status as a method of getting the patient to medical stability so that they can be moved along to partial program.
The only difference between PHP and IP at the program I was at was that you slept at the hospital rather than at home and all of your meals were done with a staff member. This program also had a specialized ED treatment program, but you may be housed with someone with a different mental disorder. I am not a huge fan of this, but they are hospitals.Some examples of Inpatient programs are Wekiva Springs [Jacksonville, FL] and Ridgeview [Atlanta, GA] The program I was in, MUSC ED Program at the Institute of Psyhciatry, closed in 2003, which means there is currently no intensive treatment in SC.
Residential: Residential is similar to Inpatient, but are usually focused on one particular issue. Remuda Ranch [which is were i attended] is an example of residential. They also provide 24/7 care and monitoring. They are often"nicer" programs and don't seem like hospitals or medical care facilites at first glance. Other examples of residentail treatment: Renfrew, Castlewood.
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TYPES OF TREATMENT
OUTPATIENT
Most people start with some form of outpatient treatment. To get started, you can contact a therapist of your choice, or you could get a referral from your family doctor. Insurance companies may provide lists of psychiatric care providers. You may also try the ED Referral website. For additional resources, please visit the links page on this site. You may also contact me if you are unable to find anything, and I will do what I can to point you in the right direction.
There are many types of therapies available.
TYPES OF THERAPY
Individual therapy
Individual therapy can be done as often or as little as desired. I have done anywhere from every other week to 4 times a week, depending on the extent of struggle and financial capabilities. Typically, individual therapy is primarily focused on one-to-one work with a counselor or psychiatric nurse, or another psychiatric provider. Methods may be incorporated, such as CBT [see below], and individual therapy will usually involve some type of family therapy, though most sessions will be one-to-one.
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Cognitive Behavior Therapy [CBT]: A psychotherapeutic approach that aims to influence dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. CBT can be seen as an umbrella term for a number of psychological techniques that share a theoretical basis in behavioristic learning theory and cognitive psychology.
There is empirical evidence that CBT is effective for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, and psychotic disorders. CBT is used in individual therapy as well as group settings, and the techniques are often adapted for self-help applications. Some CBT therapies are more orientated towards predominantly cognitive interventions, while others are more behaviorally orientated.
In recent years, cognitive behavioral approaches have become widespread in correctional settings. These programs are designed to teach offenders cognitive skills that may reduce criminal behaviors. In many countries, it has become commonplace to find cognitive behavioral program strategies in use in prisons and jails. In cognitive orientated therapies, the objective is typically to identify and monitor thoughts, assumptions, beliefs and behaviors that accompany and are related to negative emotions, and to identify those which are dysfunctional, inaccurate, or unhelpful. The aim is to replace or transcend them with those which are more realistic and useful.
CBT was primarily developed through a merging of behavior therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the "here and now", and on alleviating symptoms.Many CBT treatment programs for specific disorders have been evaluated for efficacy and effectiveness; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments.In the United Kingdom, the National Institute for Health and Clinical Excellence recommends CBT as the treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression.
Source: Wikipedia on CBT
CBT is the method I have most experience with. Most of the programs and therapists I have seen have heavily used CBT. Please visit source for further information-Wikipedia
Dialectical Behavioral Therapy [DBT]: A psychological method developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat persons with borderline personality disorder (BPD). DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD. Research indicates that DBT is also effective in treating patients who represent varied symptoms and behaviors associated with spectrum mood disorders, including self-injury.
Linehan created DBT in response to her observation of therapist burnout after repudiating patients motivation to cooperate in successful treatment. Her first core insight was to recognize that the chronically (para)suicidal patients she studied had been raised in profoundly invalidating environments and required a climate of unconditional acceptance (not Carl Rogers humanistically "positive" version, but Thich Nhat Hanhs metaphysically neutral one) in which to develop a successful therapeutic alliance. Her second insight concerned the need for a commensurate commitment from patients to (be willing to) changesubject to their skillfulness in the present moment--based on 'radical acceptance' of their dire level of emotional dysfunction.
Linehan united commitment to the core conditions of acceptance and change through the Hegelian principle of dialectical progress, in which thesis + antithesis → synthesis, and proceeded to assemble a modular array of skills for emotional self-regulation, drawn from Western (e.g., CBT and an interpersonal variant, assertiveness training) and Eastern (e.g., Buddhist mindfulness meditation) psychological traditions. Arguably her signal contribution was to elide the adversarial paradigm implicit in the hierarchical modernist therapeutic alliance, using the deconstructive spirit of Hegel and the Buddha to substitute a postmodern alliance based on intersubjective tough love.
All DBT involves two components:
1.An individual component in which the therapist and patient discuss issues that come up during the week, recorded on diary cards and follow a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority, followed by therapy interfering behaviors. Then there are quality of life issues and finally working towards improving one's life generally. During the individual therapy, the therapist and patient work towards improving skill use. Often, skills group is discussed and obstacles to acting skillfully are addressed.
2.The group, which ordinarily meets once weekly for two to two-and-a-half hours, learns to use specific skills that are broken down into four modules: core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills.
Neither component is used by itself; the individual component is considered necessary to keep suicidal urges or uncontrolled emotional issues from disrupting group sessions, while the group sessions teach the skills unique to DBT, and also provide practice with regulating emotions and behavior in a social context.
Source: Wikipedia on DBT
I don't really have any experience with this method, just points here and there that may have been pulled from DBT ideas by my treatment team. Please visit here for further information on DBT.
Group therapy
Group therapy can be used in both an inpatient and outpatient setting. Usually group therapy is led by a therapist or facilitator. It may be a week to week discussion or it may involve a specific scope of treatment. Group therapy is a wonderful outlet to be able to talk and listen and receive understanding because the people there are in the same boat, essentially, as you. Groups have, in many ways, impacted my life even more than individual counseling. There is something about being able to talk to and interact with others who understand.
I do believe, that while it should be a safe place to talk and people should be able to speak without judgment, that it is necessary to keep your group or community 'recovery' focused. Otherwise, group therapy could be counterproductive. This is probably more of an issue in peer-led groups. We all struggle. We all need support and help. But you want to build each other up, not bring one another down. Make sure your group or community is a healthy and safe environment that promotes recovery.
There are also various organizations that offer group therapy, such as Eating Disorders Anonymous, ANAD, and Anorexics and Bulimics Anonymous.
Nutrition therapy
Nutritionists and Dieticians are also available in both outpatient and inpatient treatment. Many people have Nutrition therapy regularly while others only occasionally, if at all. Nutrition therapy paired with individual counseling can allow for you to work on thoughts and behaviors with your therapist while handling the more 'physical aspects' such as weight and meal plans with your dietician.
The first visit with a dietician will involve taking care of 'businesses' - finances, medical history, and so on. It will also give your dietician a chance to learn about you and your eating disorder and help her to develop a meal plan according to your individual needs and your body. He/she will determine if weight restoration is needed, how much, and what method to use. As you progress, your meal plan may be adjusted. Once you reach maintenance your dietician will help you to maintain a healthy and balanced diet.
Some nutritionists and dieticians use the exhange system [which is also used for diabetics], while others follow the food pyramid. I have been involved with and used both. [I will be adding a page on nutrition explaining these further.]
Art therapy
{under construction}
Music therapy
Equine therapy involves the care of and interaction with horses. This type of therapy is common in treatment facilities.
Benefits of Equine, from the Remuda Ranch website -
•Confidence: The learning and mastery of a new skillhorsemanship--enhances patients confidence in their ability to tackle new projects, such as recovery, and leads to improved self-esteem.
•Self-Efficacy: Learning to communicate and achieve harmony with a large animal promotes renewed feelings of efficacy. A motivated I can do it! replaces feelings of helplessness and amotivation, empowering the person to take on challenges in other areas of recovery.
•Self-Concept: Riding helps patients to develop a more realistic view of themselves through awareness of their size in relation to the horse. This is especially important in treating patients with eating disorders as well as those with interpersonal aggression problems.
•Communication: Horses sensitivity to non-verbal communication assists patients in developing greater awareness of their emotions, the non-verbal cues that they may be communicating, and the important role of non-verbal communication in relationships.
•Trust: Learning to trust an animal such as a horse also aides in the development, or restoration, of trust for those whose ability to trust has been violated by difficult life experiences such as physical or sexual abuse, abandonment, neglect, or marital infidelity.
•Perspective: Through grooming activities and other types of care for a specific horse, patients are able to put aside the absorbing focus of their mental illness, such as depressive ruminations, and instead to direct their attention and interests outwardly toward safe and caring interactions.
•Anxiety Reduction: Many studies of human-animal interaction indicate that contact with animals significantly reduces physiological anxiety levels. Some patients are initially afraid of horses. But horses genuineness and affection allay these fears, helping patients to embrace exposure therapy for their anxiety issues.
•Decreasing Isolation: For many individuals with mental illness, there is a long-term or recent history of feeling rejected by, and different from, other people. Mental illnesses are intrinsically isolating experiences. The horses unconditional acceptance invites patients back into the fellowship of life.
•Self-Acceptance: Many patients are initially concerned that they will do something embarrassing while learning about or riding the horses. Yet patients quickly learn that the other participants are engaged in their own equine experiences, and they observe the comfort of the horses in their own skin. Fears of embarrassment in public are thereby often reduced and self-acceptance increased.
•Impulse Modulation: Particularly for those whose mental illness involves the experience of lost control over impulses, the need to communicate with a horse calmly and non-reactively promotes the skills of emotional awareness, emotion regulation, self-control, and impulse modulation. Research clearly indicates that animal-assisted therapy reduces patient agitation and aggressiveness and increases cooperativeness and behavioral control.
•Social Skills: Many individuals with mental illness are socially isolated or withdrawn. A positive relationship with a horse is often a first, safe step toward practicing the social skills needed to initiate closer relationships with people.
•Assertiveness: Communicating effectively with a horse requires the rider to demonstrate assertiveness, direction, and initiative, important skills that enable the patient to express her needs and rights more effectively in other relationships.
•Boundaries: Many patients have experienced prior relationships as controlling or abusive. Healing takes place as patients discover that riding occurs within the context of a respectful relationship between a rider and a horse, and that, although physically powerful, each horse typically operates within the boundaries of this mutually respectful relationship.
•Creative Freedom: Many persons with mental illness have been emotionally inhibited or over-controlled, and have lost some measure of spontaneity. The playful aspects of riding and team equine activities can help restore spontaneity and an ability for healthy recreation and play.
•Spiritual Growth: Through Equine Therapy trail rides, patients have a unique opportunity to encounter the outdoors from a new perspective. Feelings of joy and spiritual connection are often discovered or revived as patients experience the earths beauty in a renewed way.
Centers that offer Equine: Remuda Ranch, Canopy Cove, Avalon Hills, Center for Hope of the Sierras, Carolina House, Casa Palmera,
Centers that offer Canine therapy: Remuda Ranch
INTENSIVE OUTPATIENT
PARTIAL HOSPITALIZATION
RESIDENTIAL/INPATIENT
