Considering Residential Treatment
by Cherie’ Monarch
Your loved one may have been struggling with an eating disorder for several months or for many years. You may have tried feeding and intervention at home. Everybody says FBT (family based treatment) works. It is evidence-based. You rationalize…I must be doing something wrong. I will try harder. I will increase calories. I will sit with them longer after meals. That will stop the behaviors. I’m not giving them the support they need to conquer the eating disorder. I am failing. Why aren’t they recovering?
Or maybe your loved one has recently been diagnosed. You’re trying to wrap your head around what’s happening. Everything about eating disorders is counterintuitive. The things that seem logical to say and do are actually resulting in decompensation. You are desperately trying to figure out what the answer is… What direction to go. What you do know is that your loved one is decompensating fast and nothing you do in an attempt to stop the snowball seems to be working. They are spiraling. Declining. Quickly.
Or maybe it appears like your loved one is making progress. They’re attending all of their appointments, they appear to be improving, they seem to be eating more… You think they are not using behaviors that often – it’s only once a day. You might see a glimpse of what looks like improvement, so again you rationalize that with time things will get better, I will just add more therapy appointments. That will make a difference. You think they are better than they were, they’re not that bad. You rationalize there has been forward progress.
Or maybe your loved one hasn’t lost any weight. In fact, maybe they have gained weight or are overweight. But it is clear they are falling apart. You are scared. You know they fast all day, but binge at night. They are failing their classes. They are socially isolating and unable to participate in life. They are avoiding the family, they will not discuss their struggles, they are unable to nourish themselves in a proper manner. You know they need help.
It’s likely one of these scenarios describe your current situation…
But the doctor, your loved ones treatment team, or your gut is telling you they need a higher level of care.… They need residential treatment.
Residential treatment?! Maybe you’ve known they needed it but just didn’t have the courage or ability to say those words. Maybe you’ve just thought if we try harder, go to more appointments, feed them more food, they will recover. Maybe you’re shocked at hearing those words, because you didn’t think they were that sick. You haven’t even considered that before.
As difficult as it is to entertain this thought you start considering it…residential treatment. As hard as it is to recognize and admit that that your baby, your loved one, whether child, adolescent, or adult, may need a residential level of care you start making the phone calls.
Just embarking on the task of calling residential treatment programs, determining what questions you need to ask, identifying which ones are the most appropriate care for your loved one, and how to select an appropriate program is a daunting and overwhelming task. That in itself can be paralyzing. So many questions. You may not even recognize that there are large differences between residential treatment programs. You may think they are one-size-fits-all. Then you have the realization that they’re actually very different. One may be housed in a hospital environment, another may be in a home. One may have individual therapy twice a week while another has individual therapy five days a week. One may use exchanges, while the other uses mindful/ intuitive eating. One program may do supplements, one may not. One may allow your loved one to maintain their vegetarian diet, another program is adamant that that won’t be allowed. The list goes on and on. The more you investigate, the more questions you have, and the more you struggle with entertaining the thought of residential treatment. How could your baby need residential treatment? How did we get here?
You start discussing with your spouse and your family the possibility of residential treatment for your loved one. The treatment team may be telling you you must go. There must be an intervention. Sometimes as a family you struggle to recognize or realize how truly sick your loved one is. You start feeling like a failure. Why wasn’t I able to accomplish this at home. I should’ve tried harder. I should’ve done more. Why wasn’t I able to be stronger? How did I miss this?
You get the courage to mention those words “residential treatment” to your loved one… Honey, I am concerned, maybe it’s time for residential treatment. There is the rare possibility that they may react and say I think I do need more support. Do you think it’s possible? The likelihood is they will react with fury, anger, and stating adamantly that you are crazy, you’ve lost your mind, and I don’t need residential treatment. I will show you. I can eat whenever and whatever I want to. I can stop purging whenever I want. I just haven’t wanted to. They tell you I will show you I can stop.
You think… my child is promising that they will work harder. I will give them more time. They will gain weight or they will stop the behaviors. I must believe in them. What kind of mom or dad am I if I don’t believe in them? Why wouldn’t I give them a chance? Even though you have been battling for 6 months, one year, two years, three years, or maybe five – you still wrestle with those thoughts. My loved one can turn it around. They don’t want to leave school, leave their friends, leave home. I don’t want them to leave school, leave their friends, leave their family, or leave home. I need to give them a chance.
Over the next few days, or even the next couple of weeks it will seem as if they’re eating a little more, they don’t seem to be purging as much. You are witnessing fewer behaviors. You swear they’re getting better, that they’re improving. They may have even gain two or three pounds. Maybe five. You rationalize, well they can get better when they want to. They don’t need a residential treatment. We will just work harder. We will try longer.
But the thing you have to know is this is the game. This is the game called “eating disorder”. This is the M.O., modus operandi, of the eating disorder. The minute there is discussion of a higher level of care, or changes in the treatment equation, or possibly residential treatment, they will suddenly beg for more time. They will promise they can do it.. So often when you mention the words residential treatment, they miraculously appear better. They are hell-bent on proving that they don’t need treatment. Nothing like a glimmer of hope to get the family to dismiss the idea of a higher level of care. You start questioning the thought yourself… What was I thinking? There appears to be forward progress, until the words residential treatment or higher levels of care are no longer spoken.
The manipulation, the deceit, the promises are so predictable. It is the game of the eating disorder. Families pass on open beds in treatment programs and spots in PHP’s because they’re convinced their loved one is improving. The charade continues just long enough to convince us to dismiss the idea of residential treatment or a higher level of care. When we see them engaging in behaviors again we rationalize there are going to be good and bad days. It’s not a straightforward path.
As parents, you’ve got your eyes focused on hope, on light, so you don’t even notice when things start decompensating again. It might be a week or two, maybe a month, or maybe six months before you realize that you’re right back to where you were before, only now it’s worse. The eating disorder is more entrenched. The miraculous improvement and forward progress was deception by the eating disorder. One intended to throw you off the path – to extinguish the thought of residential treatment and allow the eating disorder to thrive unchallenged in your loved one.
I encourage you to do it now! Seek a higher level of care. If you have not seen complete remission and a huge step in to recovery, do it now. The longer the eating disorder is allowed to reside in your loved one the more they will disappear. Literally and figuratively. The harder it will be to extract the eating disorder from your loved one. The longer it resides, the more welcome the eating disorder feels.
Please know that there is no judgment in this journey. Many of us have been standing where you are. Many of us have been fooled. I’m writing this to encourage you to take more aggressive action. To know that your loved one is not exceptional when it comes to an eating disorder. It is important for you to understand that they are not smarter, wiser, stronger than everyone else’s loved one with an eating disorder. They are all exceptional individuals. But they are not an exception for the eating disorder. They must walk the journey like everyone else. I know it’s hard. Grant yourself permission to do the hardest thing ever. You are worried they will hate you. In fact they will probably tell you they do. But in the end, someday, they will tell you thank you. Thank you for having the courage to stand strong and save their life.