ALTERNATIVE TO RESIDENTIAL TREATMENT

Presently, she offers an alternative to inpatient treatment in cases where the individual is suffering from a severe case of Anorexia, Bulimia or a combination of the two.

In terms of in-patient care, the high failure rate is partly due to the pressure to reduce costs by limiting the length of stay, but also due to the tendency to use a cookie cutter approach to treatment, which, though less expensive, is also less effective. While the provider may profit more from a standardized approach, the research strongly suggests that it is not more cost-effective for the patient, who often pays an extraordinarily high price for inpatient treatment and usually returns several times, each time getting worse.

“From my point of view, this is simply unacceptable. We need a method of treatment for this population that is patient-centric, i.e. it needs to be focused on the individual and not the diagnosis. It must also be comprehensive enough to ensure that the gains made in treatment generalize to the patient’s life outside of treatment. Putting an individual in the hospital, who has control issues, and taking away her freedom of choice, only delays the inevitable, i.e. that she herself has to choose a healthy relationship with food in order to live a normal life. Likewise, making the right decision in a treatment facility where there are very few life stressors and minimal opportunities to make the wrong choices, does not prepare the patient for the realities of daily living when she returns home.”

According to Dr.John Grohol, founder and Editor-in-Chief of Psych Central. “Proponents of residential treatment admit there’s little research to back its use for eating disorders….”

Treatment must be comprehensive enough to ensure that the gains made in treatment generalize to the patient’s life outside of treatment. Putting an individual in a residential treatment center, especially if she has control issues, and taking away her freedom of choice, only delays the inevitable, i.e. that she herself must choose a healthy relationship with food in order to live a normal life. Likewise, making the right decision in a treatment facility where there are very few life stressors and minimal opportunities to make choices, does not usually prepare the patient for the realities of daily living when she returns home.

Residential treatment isn’t working for most patients.  This is what the research shows for residential versus outpatient treatment for Anorexia:

TreatmentWell at 2 YearsWell at 5 Years
Inpatient17.2%33.3%
Outpatient20.0%47.1%

As you can see the success rates for outpatient treatment are considerably higher.  Dr. Norton believes there are several reasons that residential treatment does not work.

Anorexia takes place within the context of the family or at home.  Recovery must take place there as well.   While in residential treatment, the individual is not given choices about what or when to eat.  She must leave treatment, usually after 21 days, which is when insurance runs out, and at that point she is on her own.  She has not learned how to manage the stressors that life throws at her in 21 days because she is removed from them. 

Intensive outpatient treatment involving the family works much better.  Dr. Norton’s outcomes for patients who remain in treatment are in the 90% range and relapse rates are very low.  The individual learns coping skills in the context in which she must use them; her home, school, or workplace.  Dr. Norton offers 5 to 10 hours of intensive outpatient treatment per week.  Treatment includes family members or a significant other, many of whom desperately need the support in order to cope with their own fears and non-productive urges when it comes to interacting with the individual suffering from an eating disorder. 

“In my experience, parents are never neutral. They are either helping or hurting, no matter how well-intended they are. In fact the ‘best’ parents can have the worst impact, because they try harder. It’s just that what they do naturally has an effect opposite of what they intend, making matters worse.“

This is why it is so important to involve the family and significant others in the therapeutic process. Research consistently points to the value of family involvement and yet the vast majority of professionals treating these disorders do not appear[3] to include family members as part of the treatment.  Some practitioners go to great lengths to prevent family involvement in a misguided effort to protect the privacy and confidentiality of the patient. While both privacy and confidentiality are of the utmost importance, they do not have to be violated in order to use a family-based approach.

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