Written by: Ava Pollack, MA, LCMHC, Team Leader and Alumni Representative at The Renfrew Center of Charlotte
For those fortunate enough to access eating disorder care, completing treatment is a significant and courageous step toward recovery. Understandably, shifting from having access to this safe environment daily or almost daily to previous environments, schedules and routines can feel daunting. In this post, we review tips for a smooth transition.
Eating disorder treatment is a unique environment in which many daily responsibilities are typically set aside to prioritize recovery and focus on healing.
In Residential treatment, individuals live on-site and receive 24-hour support. In Partial Hospitalization Program (PHP), individuals participate in six hours of programming, five days per week, in addition to individual therapy, family therapy, nutrition therapy, and psychiatry.
In Intensive Outpatient Program (IOP), individuals engage in three hours of programming, three days per week, in addition to individual therapy, family therapy, and nutrition therapy.
Ideally, these “step downs” happen gradually, allowing clients to adjust and master the new structure, support, and supervision at each level. When a patient transitions to a lower level of care, planning for less support from their treatment team is important to successfully manage eating disorder behaviors.
This is especially imperative when the patient approaches discharge to outpatient services for several reasons: they will no longer meet with their current treatment team, they will receive professional support for significantly less time weekly and they will likely return to a similar environment (school, work, etc.) in which they previously struggled with their eating disorder.
How Do I Prepare To Leave Treatment?
Although working with your higher level of care team is temporary, they will recommend the next level of care that best fits your needs. Eventually, they will help you establish outpatient support services so you can continue working on your long-term goals.
Regardless of the progress made in higher levels of care treatment, continuing long-term treatment with outpatient providers is recommended to maintain headway and prevent relapse.
Recommended outpatient providers include:
- Therapist (Psychologist, Social Worker, Mental Health Counselor, Licensed Marriage and Family Therapist, etc.)
- Registered Dietitian (RD— requires specific training as opposed to nutritionists, who may or may not have received a professional degree)
- Psychiatrist (MD, DO, PA, or NP)
- PCP, DO, or CRNP to monitor medical issues
Outpatient providers who specialize in or have vast experience working with eating disorders are recommended after completing eating disorder treatment. Even if you trust a specific provider because they helped work through difficulties in the past, they may not be equipped to support you with eating disorder-specific concerns if they did not acquire specific eating disorder training.
Some individuals choose to continue working with their previous non-eating disorder therapist in addition to an eating disorder specialist, particularly if they struggle with comorbid conditions such as substance use or trauma.
4 Supportive Strategies Post-Treatment
1. Lean On Your Support System
Identify support people who you trust to provide helpful interventions or space to feel your feelings. This does not mean that every person you consider a friend or family member MUST be identified as a supporter in your recovery. It is helpful to recognize who you trust to provide you with what you need in challenging moments, even if it’s not necessarily what you want.
Sometimes support people can serve different purposes in recovery. Maybe one support person is great at providing meal accountability but struggles to allow you to feel your emotions without trying to convince you out of them. It is okay to ask for support when you need it, and it is okay to decline support when you find a certain approach unhelpful.
No one is expected to go through eating disorder recovery alone. If you hesitate to ask for help due to feeling burdensome or worried about the response, try to remind yourself how you would respond in the other person’s position. Role playing with your therapist or re-appraising your predictions and thoughts can be helpful strategies, as well. You deserve the support.
2. Continue To Follow Your Meal Plan
The ultimate goal is to learn intuitive eating, meaning feeding your body based on what it tells you it needs rather than labeling foods as either “good” or “bad” and ignoring physical cues. This goal is usually not yet attained at the time of discharge – that’s okay! There is no set timeline in which you must learn how to appropriately feed your body using intuitive eating.
For nutritional accountability, following the meal plan assigned by your dietitian in treatment can be helpful. Your outpatient dietitian can continue to check in about your nutritional needs and support you in moving toward listening to your body’s cues.
3. Use Skills You Learned In Treatment
Just because you no longer have assigned self-work or treatment model-specific groups doesn’t mean you lose access to skills! Consistently using the skills designed to heighten your emotional awareness and increase tolerance can allow you to feel connected to the work and strengthen motivation to maintain your progress.
4. Identify Routines That Serve You
When several transitions occur at once, it can feel overwhelming. Initiate routines that feel attainable and best support your relapse prevention plan. For example, try to set aside 30 minutes each morning to journal, or perhaps establish a consistent time at work to eat a snack and take your lunch break.
As your confidence increases and your needs change, you can always make adjustments to this structure at various points on your recovery journey. Discussing ideas and creating a plan with your treatment team may be helpful.
Life after treatment in a higher level of care looks different for everyone, but one truth remains: recovery is possible. Transitions are often challenging, and it is normal to feel nervous about a significant shift in care. Support is available!
Although you may not be able to predict all of life’s upcoming challenges, completing treatment means you have developed resilience. This will allow you to build confidence in your ability to tolerate adversity. You can learn that you do not need to revert to your eating disorder to feel safe in your daily life; you can build tolerance to distressing emotions and live fully. Show yourself how resilient you have become, one day at a time.