Clinical Spotlight
Understanding Residential Eating Disorder Treatment
-Buck Runyan, MFT, LPC, CEDS

Residential Treatment Centers (RTC) hold an important role in the treatment of eating disorders. RTC’s are designed to prevent a need for the sometimes medical necessity of a higher level of care known as Inpatient Hospitalization (IP) and can also help to facilitate a successful transition to the lesser restrictive level of care known as Partial Hospitalization (PHP) or Day Treatment. By providing a 24-hour supervised environment with an extensive treatment program, clients are encouraged to cease their destructive behaviors, restore an appropriate Body Mass Index (BMI) and enhance their overall gains.

In June 2006, The American Psychological Association (APA) established the Practice Guidelines for Eating Disorders Third Edition. The APA delineates five levels of care and clarifies within each, characteristics that qualify a client’s treatment to occur at a particular level. The five levels of care include Level 1: Outpatient, Level 2: Intensive Outpatient (IOP), Level 3: Partial Hospitalization (PHP/full day outpatient care), Level 4: Residential Treatment Center (RTC), and Level 5: Inpatient Hospitalization.

There are ten characteristics which guide an admission to RTC, including:

1. Medical Complications: Medically stable to the extent that there is no need for intravenous fluids, nasogastric tube feedings, or multiple laboratory tests.
2. Suicide: Possible plan but no intent.
3. Weight as percentage of healthy body weight: (for children, determining factor is rate of weight loss): Generally <85%.
4. Motivation to recover: including cooperativeness, insight, and ability to control obsessive thoughts: Poor to fair; preoccupied with ego-sybtonic thoughts 4-6 hours a day; cooperative with highly structured treatment.
5. Co-morbid disorders: (substance abuse, depression, anxiety): Presence of co-morbid condition may influence choice of level of care.
6. Structure needed for eating/gaining weight: Needs supervision at all meals or will restrict eating.
7. Impairment and ability to care for self: ability to control exercise: Complete role impairment, cannot eat and gain weight by self; structure required to prevent patient from compulsive exercising. 
8. Purging behavior: ( laxatives and diuretics): Can ask for and use support or skills if desires to purge.
9. Environmental stress: Severe family conflict, problems, or absence so as unable to provide structured treatment in home, or lives alone without adequate support system.
10. Treatment availability/ living situation: Too distant to live at home.

The circumstance under which a resident admits to RTC is evident when their ability to function at home has been significantly disturbed. They and their family are in crisis and most, if not all, social supports have broken down. A resident’s transition from the home environment to RTC as a step down from IP or as a step up from PHP is a vital part of preventing the deterioration that is occurring.

Residents will most likely have some anxiety when entering residential treatment. They are entering a new and unfamiliar environment where other people who struggle with eating disorders are present. Resident’s endure a strict daily scheduled from the time they wake up to the time they go to bed. The Multidisciplinary staff treating the patient is comprised of unfamiliar people who manage different treatment roles. The professional credentials of this staff include a Primary Care Physician, Psychiatrist, Registered Nurse, Psychologist, Masters level therapists, Registered Dietitian, Mental/Behavioral Health Technicians and auxiliary staff. Based upon the program’s design and structure, each primary staff member will meet with the client on a daily or weekly basis. 

While in residential treatment, a variety of therapy sessions occur on a daily basis. The therapy sessions can include individual, group and family psychotherapy, psychological education, behavioral change education, nutrition education, nutrition exposure therapy, nutrition behavioral management, health education, self care skills, relaxation skills, exercise management, social skills, communication skills, art therapy, body awareness, self esteem development and after care treatment preparation, to name a few. The variety of groups provided will be determined in part by the theoretical foundation guiding the program. There are several kinds of programs which orient from a basis in medical criteria; individual, family or group psychotherapy; behavioral therapy or experiential therapies. All programs contain some of each discipline mentioned, yet their treatment provision may include a proportionally higher amount of one type of orientation than another.  

In general, residents who enter RTC programs are having difficulty achieving stabilization within several of the APA treatment guidelines. RTC programs are an excellent setting to obtain stabilization, become familiar with the root causes that have facilitated the origination of the malnutrition, and can provide a means to identify the factors that maintain it. During assessments, it generally becomes clear that the resident has been struggling with obsessive self-depreciating thoughts, uncomfortably intense emotions and compulsively based ritualistic behaviors. The client may or may not be concerned with their behavioral patterns or the consequences that have developed because of these patterns.

Anger is a common emotional response of residents entering treatment. Often, the expression of anger will be directed towards family members and the referring treatment professional. Everyone involved with the transition to residential treatment must remain focused on the need of treatment. A solid conviction will help the family to maintain their strength during admission when the resident is exhibiting such behavior.

Therapy begins with a fundamental perspective that eating disorders are compulsive by nature and originate from a multitude of primary factors including but not limited to: a genetic predisposition, temperament, vulnerable personality, family functioning style, dieting, exercise behaviors, major life changes, onset of puberty, social developmental influences, societal influences for extreme thinness, media, illness and medical procedures. One or more of these factors experienced may facilitate emotional chaos for those who have a sensitive temperament. The psychological and emotional chaos then overwhelms a resident’s ability to accommodate skills needed for adaptation. Due to the unsuccessful adaptation, a resident will internalize the extreme emotional tensions and strive to accommodate through cognitive rationalization. This is when the extreme obsessive thought process begins. Residents often recognize the unusual nature of their obsessions and compulsions, yet are fearful to speak about them afraid that people may view them as insane. They do not want to impose their difficulties on others. Ultimately the resident experiences shame and fear believing other people will take management of their circumstances sending them into a shame spiral from which they have difficulties escaping.

Unusual eating habits need to stop quickly. Chronic malnutrition significantly disturbs the resident’s biochemical processes. Hormone levels change and the brains ability to stabilize serotonin usage alters. The body can begin relying upon Endorphins, Enkephalin and Beta Endorphins to relax their autonomic nervous system as well as calm their psychological experiences. Signs of these changes are seen in the resident’s unusual moodiness, irrational thought patterns, and strange behavior rituals.

Originating as compulsive disorders, eating disorders can become a coping mechanism that successfully assists the resident to manage overwhelming life stressors and feelings. This is accomplished through the body’s use of endorphins, Enkephalin and beta endorphins to sooth their emotion states. By the time a resident enters residential treatment, behaviors and thoughts around the eating disorder fully consume them.  Residential program staff members are aware of the despair residents and family are in. The staff strives to provide a sense of security for everyone by facilitating an intensive therapeutic structure aimed at addressing key behavioral, emotional, and nutritional supports.

Due to the multifaceted nature of eating disorders, Discovery Practice Management utilizes a comprehensive, strategic and methodical treatment approach. There are certain attributes we must ensure our residents learn while they are with us. This is why Discovery guides every resident through a process of understanding the origins of their eating disorder. We structure treatment so that personal exploration of one’s life history including personal attributes, experiences, relationships, stress management strategies and their eating disorder development are safely considered. We also integrate the family into assisting this exploration. It is essential for everyone to understand the complex interactions of all the contributing factors. The family is given education in effective communication skills, emotion management skills, and nutrition support skills. They are assisted with discovering environmental changes that will promote a secure setting to calm the resident’s sensitivity to stress.

Discovery’s treatment is structured in a treatment “phase” process which places the responsibility of change with the resident. They are responsible to fully engage in the program and complete treatment assignments. The progression in Discovery’s program will largely depend on the degree to which the resident exhibits honesty to disclose all the contributing factors to their eating disorder, openness to address them, willingness to consider change and a favorable attitude.

It is common for a resident to successfully progress in one area of a treatment phase (i.e. family relationships) and yet become “stuck” in another part of a treatment phase (i.e. nutrition management). The staff wants to observe the resident putting forth efforts addressing their resistances with some success before progressing to the next treatment phase. Therefore it becomes vital for staff to monitor all aspects of a resident's efforts and minute success during treatment.

It is also important that a thorough Continuum of Care plan is created prior to the resident's discharge, because it is often during transitions between levels of care that they may relapse. When a thorough Continuum of Care plan is established for the resident, it is much easier for him or her to continue along their road to recovery.

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Join the Preferred Partner Network
It is important to us that our patients have a quality team to go to after treatment. We look for quality Psychiatrists, Psychologists, Medical Doctors, Therapists and Dieticians across the country to refer our patients out to. Simply click here, complete the online form, and a representative from Discovery Practice Management will contact you.

Alumni Groups

Center for Discovery
Eating Disorder Alumni
For more information please call
Lisa Arndt at 562-698-8888

Dual Diagnosis Alumni
Free Alumni Group for all former residents and their parents of La Habra , Long Beach , and Whittier 's Dual Diagnosis Programs.

Thursday evenings at 8:00 PM
For more information please call
562-981-0700

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Free and Confidential Assessments
offered by Discovery Practice Management

Discovery offers a free and confidential assessment for those who are seeking to understand what level of care is suitable for them. If you are currently working with, or have been recently referred an eating disorder client who may be in need of a higher level of care, please contact our Intake department for a free assessment. This assessment will take approximately 60 minutes and includes physical, social, emotional and behavioral aspects, as well as a thorough history of the disordered eating.

We understand that not all individuals struggling with an eating disorder are in need of residential treatment. This is why Discovery’s Intake department has an extensive list of resources at all levels of care suitable for most circumstances. Please feel free to contact our Intake Representatives to obtain information for resources in your area.

Contact
For more information, please contact our Intake Department at 800.760.3934 or info@centerfordiscovery.com
We have immediate placement availability for eating disorder residential treatment!

24 hours a day, 7 days a week
Center for Discovery: 800.760.3934.
Oceanaire: 866.406.1066.

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Center for Discovery
At-A-Glance
Center for Discovery is a residential treatment program dedicated exclusively to adolescents struggling with eating disorders and dual diagnosis issues. We believe that just as eating disorders and dual diagnosis disorders require specialized treatment, so do adolescents. Discovery offers professional, structured environments with the comfort and nurturing of serene home-like settings where adolescents can safely address their challenges. Our individualized treatment approach is provided by a multidisciplinary team and a low staff to resident ratio. At Center for Discovery , we assist hundreds of adolescents and their families annually across our six JCAHO accredited and California licensed campuses. Since 1997 we have been privately owned and operated. Discovery is contracted with most major healthcare insurance providers and will assist families in verifying their insurance benefits. Our Intake Department is available for both professionals and families 24 hours a day, 7 days a week.

EATING DISORDERS PROGRAM
• Helping males and females 10 to 19 years old
• Disorders treated:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating
- Other related complex disordered eating
• Weekly Family Involvement
• The Discovery Therapeutic Family Meal
• Four private therapy sessions per week
• Over 41 structured groups per week

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DUAL DIAGNOSIS PROGRAM
• Helping males and females 12 to 17 years old
• Disorders treated:
- Addictive Disorders
- Anxiety Disorders
- Depressive Disorders
- Childhood/Adolescent Disorders
• Weekly Family Involvement
• 12-Step Focus
• Four private therapy sessions per week
• Over 41 structured groups per week

Our mission at Center for Discovery is to combine the finest traditional inpatient approaches with creative, innovative and individualized interventions that position our therapeutic experience at the forefront of adolescent treatment.

For more information please call 800.760.3934 or visit us at www.centerfordiscovery.com 

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Oceanaire
At-A-Glance
Oceanaire is a spacious residential six-bed setting in a serene and confidential location on the Palos Verdes Peninsula for young adult women struggling with anorexia nervosa, bulimia nervosa, binge eating disorder or compulsive exercising. Nestled above one of the greens of the Los Verdes Country Club Golf Course, Oceanaire provides ocean vistas and Pacific Coast sunsets, creating a peaceful and healing environment for the mind and body. The home has a private interior courtyard swimming pool and lovely patio for outdoor relaxation and events. The space at Oceanaire provides a peaceful setting for healing where young adult women can safely and effectively address their issues and begin their path to recovery. Oceanaire provides an intensive treatment program with four private weekly therapy sessions, a strong family component including weekly family conjoint sessions, multi-educational groups including DBT (Dialectical Behavioral Therapy) groups, hands-on food exposure, restaurant outings, nutritional education, medical and psychiatric consultations, yoga, relaxation and stress management techniques and much more. Oceanaire is contracted with most major healthcare insurance providers and will assist families in verifying their insurance benefits. Our Intake Department is available for both professionals and families 24 hours a day, 7 days a week.

EATING DISORDERS PROGRAM
• Disorders treated:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating
- Other related complex disordered eating
• Weekly Family Involvement
• The Discovery Therapeutic Family Meal
• Four private therapy sessions per week
• Over 41 structured groups per week

For more information please call 866.406.1066 or visit us at www.oceanaireinc.com

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Upcoming Events

Networking
The OC Network – San Juan Capistrano , CA co-hosted by Reasons Eating Disorder Treatment at BHC Alhambra, Discovery Practice Management, and Hope by the Sea. Meetings are held on the third Friday of every month at Hope by the Sea from 11:30 – 1pm. Upcoming events: July 17 featuring Cindy Dupuie, CN; Friday, August 21 featuring Lori Hanson, "It All Started With Pop Tarts".  For more information, contact Alexia Mowry at 562-881-9886 or alexia.mowry@centerfordiscovery.com

IAEDP San Diego – San Diego, CA co-hosted by Discovery Practice Management and Harmony Grove. Next meeting is Friday, June 26 from 11:30 – 1:30pm at Aurora Behavioral Hospital featuring Jenni Schaefer, co-Author “Life Without Ed”, consultant Center for Change. For more information, contact IAEDP San Diego at iaedpsd@gmail.com.

Mending the Body: A One-Day Conference Exploring Innovative Approaches to Treatment – Valencia, CA co-hosted by IAEDP Los Angeles, Biofeedback Society of California, and the Santa Clarita Valley Psychotherapeutic Network. Saturday, June 27, 2009 from 11:30 – 1:30pm at Hyatt Valencia featuring Keynote by Stan Tatkin- Addiction to “Alone Time” – Avoidant Attachment, Narcissm, And A One-Person Psychology Within A Two-Person Psychological System, two concurrent tracks per each track: Psychotherapeutic (featuring presenters: Buck Runyan, MFT, LPC, CEDS; Michele Tamarkin, MFT; and William Randle, LCSW) and Biofeedback (featuring presenters: Cynthia Kerson, PhD; Margaret MacDonald, MD; Gary J. Schummer, PhD a Keynote Panel on Couples Therapy featuring, Terry Eagan, MD; Waverly Farrell LCSW and Steve Kassel, MFT, and a Networking Reception hosted by SCVPN, $60 per person (lunch included), 6 CE Hours PhD, PsyD, MFT, LCSW, CAADAC, RD, *Special Room Rates $119. Please RSVP to Christina Weiss by Friday, June 19 at 562.457.7373 or iaedpla@gmail.com. For more information please go to www.iaedpsocal.com Sponsors: Center for Discovery, Rosewood, Reasons Eating Disorder Center at BHC Alhambra Hospital, Insight, Clearview and Mirasol.

The SD Network – La Costa, CA co-hosted by Reasons Eating Disorder Treatment at BHC Alhambra, Discovery Practice Management, Hope by the Sea, and Miracle Recovery. Next meeting is Thursday, July 11 from 11:30 – 1pm at Miracle Recovery featuring John Lieberman, Visions Adolescent Treatment Centers “Substance Use, Abuse and Addiction”. For more information, contact Alexia Mowry at 562.881.9886 or alexia.mowry@centerfordiscovery.com

Adolescent Resource Network – Pasadena, CA co-hosted by Discovery Practice Management, Clearview, and Insight Treatment Centers. Next meeting is Friday, July 17 from 8:30 – 10am at Casa de las Amigas featuring Lisa Hoffort, PsyD, Clinical Director of Reasons Eating Disorder Center of BHC Alhambra Hospital, “Metaphor Therapy for Insight into Countertransference”. For more information, contact Christina Weiss at 562-457-7373 or christina.weiss@centerfordiscovery.com

Adolescent Resource Network – Pasadena, CA co-hosted by Discovery Practice Management, Insight Treatment Centers, Clearview Treatment Center, and The Matrix Institute. Next meeting is on Friday, April 10 from 8:30 – 10am held at Casa de Las Amigas featuring Dr. Melissa Johnson “Therapeutic Essentials for Healing Adolescent Girls”. For more information, contact Christina Weiss at 562-457-7373 or christina.weiss@centerfordiscovery.com

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CEU Events

Understanding Substance Abuse and Eating Disorders: A Psychiatric Perspective
Featuring: Brian Holt, MPH, MD

Friday, July 24, 2009
8:30 – 4:00pm

$60 per person (lunch included)
6 CEU’s: MFT, LCSW, RD, CAADAC, PhD (pending), PsyD (pending)

Double Tree Doheny Beach
34402 Pacific Coast Highway
Dana Point , CA 92629
949-661-1100

Please RSVP to Alexia Mowry by Friday, July 17, 2009
562.881.9886 or alexia.mowry@centerfordiscovery.com

Upcoming Conferences
Stop by Discovery’s booth!

41^st Annual Southwestern School for Behavioral Health Studies 
Continuing the Journey: Staying Relevant in the 21^st Century
Featuring: Buck Runyan, MFT, LPC, CEDS
August 23-29, 2009
Loews Ventana Canyon Resort
Tucson, AZ

NEDA
September 10 - 12, 2009
Reshaping our Future: A Vision for Recovery, Research, Attitude and Action
Minneapolis, MN

Westwind Roundtable
September 11 – 12, 2009
Manitoba, Canada

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