Is Residential “Treatment” Really Treatment?

Nothing worth having wasnever achieved without effortI have been saying publicly that residential treatment centers for eating disorders don’t work. Behind the scenes, I have lamented the atrocities my patients have undergone while in residential treatment. Given that this problem has finally been exposed, I would like to share with you some of the experiences my patients have shared with me, as well as my own experience with this exploitive form of “treatment.”

Let’s start with the patient that was effectively incarcerated in a residential treatment center for nearly a year. She entered the center at 90 pounds and eleven months later, and only after a court order, she escaped weighing 180 pounds. She described the state of her body at that point as consisting primarily of “pasty white blubber.”

While she was in “treatment” she was not allowed to communicate with her parents, who were not allowed to communicate with her either. She was forced to eat 4000 to 5000 calories per day in the form of cereal, bagels, candy bars, soft drinks, and highly processed proteins such as hot dogs, hamburgers, chicken fingers etc. If she refused to eat this polluted excuse for real food, she was isolated and tube fed. She was not allowed to do any fitness work, despite being healthy physically. She pleaded, begged and threatened staff, but to no avail until her parents got a court order to have her released.

The trust between psychologist and patient, which is truly the foundation of healing for any patient, but especially for patients with eating disorders, had been so damaged as a result of her experience at this residential treatment center, that she could not bring herself to engage in treatment again. Her trust for practitioners had been damaged beyond repair at that point. (If you’re out there, CJ, and you’re reading this, I pray you found your way back to good health. Sending you positive vibes and good wishes. You can do it.)

This residential treatment center was charging $10,000 a week ($40,000 a month) and the parents were paying about $10,000 of that out-of-pocket per month. In other words, they paid close to a hundred thousand dollars for the so-called treatment that their daughter received. The insurance company paid a tidy sum as well. No wonder the treatment center kept this young woman against her will and against the wishes of her parents! They were making a fortune. One thing is for sure, they were not particularly interested in her well-being. Their motive was clearly profit.

Think that sounds harsh? According to the most recent article in the New York Times, for profit residential eating disorder facilities have grown over the past few years, along with their elaborate marketing efforts and business development plans. Private equity investment companies are responsible for the proliferation of these treatment centers. Why? Because there is money to be made in exploiting a disorder that is not very well understood and becomes increasingly difficult to treat the longer the patient goes untreated. For parents grappling with their worst nightmare, these facilities promote their facilities as being critical to the survival of a loved one. They use scare tactics to coerce parents and significant others into signing their loved ones into treatment. In the case of the patient above they threw away the key.

When scare tactics don’t work, some treatment centers market their businesses, using expensive brochures, as something akin to a luxury spa or a drug and alcohol treatment center for the uber rich. The question is, do these programs actually help? Not according to the research. Their success rates are abysmal, at around 30%. My experience is that they make things worse. The example above may sound extreme, but I could share many more like it.

A question the consumer should be asking is who regulates these places? As far as I can tell, apparently no one regulates them, which sets the stage for people who desperately need good treatment to be exploited. For example, in order to do business they have to have referrals, right? I have seen first hand how this plays out. A therapist, who used residential treatment as a “consequence” for continuing to purge, refers an unwilling teen to a residential treatment center. The parents, who are at their wits end, agree to relinquish the responsibility of trying to save their daughter’s life to the treatment center. The treatment center plays on their fear and insists that this is the only course of action in order to protect their child. So the unwilling child ends up in residential treatment half a continent away.

But, and this is the kicker, the child can only get out of the residential treatment center if she agrees to go back to the referring therapist! Don’t forget, she wasn’t doing well with that therapist. However, since she would do anything to get out, she agrees. The therapist and the treatment center refer back and forth, patting each other’s backs and padding each other’s wallets.

In my humble opinion, this is a conflict of interest that has the potential to be damaging to the client. In this case, the patient went through this scenario 3 times with this therapist and in the end it backfired. The child decided she wanted to stay in the residential treatment instead of living her life. (No homework, no chores, no decisions…..just a lot of TV and the occasional art class and group therapy session.) She had already missed two and a half years of high school and wasn’t used to the demands of going to school. In addition, her friends were no longer her friends. When she came to me and I declined to put her back in a residential program, what do you think she did? Went back to that therapist and ended up back in the residential treatment center, again!

As you might imagine, despite courting me relentlessly to refer to them, I have never received a referral from a residential treatment center looking for after care for their Cincinnati clients. It does not seem to matter that I am qualified or that I can demonstrate excellent outcomes, as soon as they realize I will not be referring to them, they are uninterested in referring their graduates. Huh!

I was recently contacted by an investigative reporter, who is planning to file a class action suit against residential treatment centers in California, where she had been a “victim” of such treatment herself. I hope that she wins or that she is at least able to shine some light on a seemingly unregulated industry.

On a more positive note, relatively speaking, let’s take my patient who is currently in remission after only nine months of treatment here at the Norton Center. She came to me from a residential treatment center where she had been on bed rest for 14 days prior to being released. Why was she on bed rest despite the fact that she was medically stable? Because she was refusing to eat any of the institutional processed and highly polluted foods that she was being offered. The bed rest was a “consequence” for not eating. Another consequence was that the staff were instructed not to speak with her. She was to have (in her words) “no human contact.”

She was also being forced to either drink or be tube fed 6 to 8 Boosts a day. If you read the ingredients of a boost, there is almost no food in it. The first ingredient is water, the next ingredient is a GMO sugar. The third ingredient is high fructose corn syrup, another sugar, only this time a sugar on steroids, which is also genetically engineered. Finally, we get something that resembles a food in protein concentrate. However, because it is from a concentrate, the protein has been denatured, which renders it more dangerous than healthy. Then, we start with all of the hydrogenated processed oils, including vegetable oil, canola oil, high Oleic sunflower oil and corn oil. Hydrogenated oils are dangerous. Awesome! Right?

Try to imagine what this would be like: lying in a small room in your bed, unable to get out of bed except for your supervised bathroom visits, and all you have to look forward to is trying to get down a Boost. And when you can’t, or when you throw up because you are so sick of it, no worries—a tube is inserted into your little body and you are fed the Boost through the tube. Let’s see you throw that up.

The insurance company for this patient was being billed around $1500 a day. The Boosts cost $20.21 per day. What were they charging for? She received therapy from a social worker for a short period sporatically during the week, had art therapy every day and spent “maybe 5 minutes a day” with an M.D.

This patient is currently in complete remission, her weight restored to normal. She is back in school full-time, getting straight A’s, setting her sights on law school, traveling with her orchestra, doing amazing art, and voluntarily eating about 2500 clean calories a day, which is good considering that she is fairly petite.

Why do I bring this client up? I firmly believe that the majority of eating disorder patients belong in outpatient therapy. When a patient is able to still participate in work, school, family life, extracurriculars, and friendships, they are able to stay connected with their real life, with its problems and challenges. Inevitably, those challenges and problems are discussed and dissected during session. Her recovery is tied to the successes she has in coping in a different way with those issues.

Another reason intensive outpatient treatment (IOP) works better is that it allows the family to participate. In the case of this patient, (and most of my patients) I could not have been nearly as successful without the involvement the mom. The research is clear, family treatment is the only form of treatment that has been shown to be effective in treating Anorexia. Most families cannot relocate to be with their child throughout the months that she is in residential treatment, such that she is alone and all too often isolated from her loved ones. In addition, the cost of IOP in my practice is closer to $1500 a week instead of the $1500 a day charged by residential programs.

The main thing though is that recovery doesn’t happen locked in a beautiful tower with spa amenities. It doesn’t happen locked in a small prison like room with supervised bathroom visits. Recovery happens when a patient encounters a difficult moment in her real life, among her family and friends, and makes a choice to consciously try a new behavior, instead of relying on the more comfortable Eating Disorder (ED) behaviors.

My advice for anyone considering treatment would be this: look past all the packaging. Resist the fear and guilt tactics. Ask yourself the following: Do you connect with the therapist? Does your child connect with the therapist? Is there even a therapist? (In most treatment centers, the actual therapist sees your child for an hour a week.) Does the treating practitioner understand the role that polluted food plays in the development and escalation of disordered eating? Or the role that clean food plays in recovery? Will they include the family in treatment? Is treatment individualized or is it a one size fits all approach? Can his/her life continue while getting treatment assuming s/he is medically stable?

Answers to these questions should help you make an informed decision.

-Dr. Norton


Dr. J. Renae Norton is a clinical psychologist, specializing in the outpatient treatment of eating disorders such as anorexia, bulimia, bulimarexia, and binge eating disorder (BED), as well as obesity. She is also the author of The Sun Plus Diet, due out in summer 2016.
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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship. This information is not necessarily the position of Dr. J. Renae Norton or The Norton Center for Eating Disorders and Obesity.

©2016, Dr. J. Renae Norton. This information is intellectual property of Dr. J. Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2016, Dr. J. Renae Norton. //