By Meghan Vivo

Staying Flexible in the Face of Rigidity

Perfectionism and rigidity are two hallmarks of eating disorders like anorexia and bulimia. Although individuals with eating disorders may approach treatment with a rigid mindset, the most effective eating disorder treatment programs will respond with a strategic blend of structure and flexibility.

“Eating disorders are rigid and rule-governed diseases,” says Leah Leonard, Ph.D., the clinical director at Center for Hope of the Sierras, a renowned eating disorder treatment program in Nevada for women ages 16 and up. “But you can’t treat rigidity with rigidity – the disorder will simply adapt to the new rules. Individuals with eating disorders need structure, but there also has to be some element of the unknown or unexpected.”

An Individualized Approach to Treatment

Many eating disorder treatment programs emphasize the need for the recovering individual to develop a sense of self by identifying personal interests and talents and connecting with her emotions. In order to do so, treatment must be highly individualized and adaptable to the specific needs of the individual with an eating disorder.

At Center for Hope, the staff of eating disorder specialists has created an eating disorder program that provides structured support and boundaries balanced with the flexibility required for individualized care. For example, one rule of treatment is that patients must be near 90 percent of their ideal body weight in order to go on outings, or “passes,” with family. However, if it is deemed in the patient’s best interests therapeutically to connect with family before that threshold has been reached, the staff may make exceptions as appropriate. In a small, specialized treatment center like Center for Hope, this rare level of personalization and flexibility is highly beneficial to both patients and their families.

Effective eating disorder treatment also requires a balance of group, family, and individual interventions. Although group therapy sessions help individuals with eating disorders feel understood and supported, individual therapy can be just as, if not more, essential to address the individual’s unique circumstances and life experiences.

Center for Hope offers its patients three individual sessions each week with their primary therapist, as well as a great deal of individualized attention from the program’s psychiatrist, medical doctor, and registered dietician. Based on the individual and group therapy sessions, each patient receives five to seven goals for the week. The individual’s treatment team then meets once a week with the patient to discuss any concerns, requests, or goals and to ensure treatment is progressing.

By personalizing every treatment plan, every patient is sure to participate in the therapies that work best for her. Patients who benefit most from structured talk therapy will receive plenty of group and one-on-one therapy from therapists trained in cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), psychodynamics, and other therapeutic approaches. Patients who would benefit from non-verbal approaches may participate in writing projects, art therapy, equine programs, meditation, yoga, massage, horticulture, or a variety of recreational and service-oriented activities.

Modeling Flexible Thinking

The concept of flexibility, which is modeled in the program structure and by staff at Center for Hope, has a real-world application, particularly for individuals with eating disorders who naturally resort to rigid, black-or-white thinking. The women learn to cope with uncertainty and difficult feelings with a level of flexibility often required in daily life. Because these feelings are evoked and managed in a safe, structured, gentle treatment setting, the patients are able to confront and work through them effectively.

In addition to a structured schedule, Center for Hope offers unstructured therapeutic time, during which patients work on their individual goals or a pastime of their choice.

“Many eating disorder patients resist the idea of downtime,” explains Leonard. “This is usually a time when perfectionistic thinking makes patients feel anxious or worried about a lack of productivity or feelings of boredom. But these feelings are a healthy part of normal life that patients need to practice coping with in the safe confines of treatment.”

More than a treatment philosophy, the treatment environment at Center for Hope is also flexible – in part to help bring up the feelings that arise in the real world, and in part to facilitate a smooth transition back to everyday life at home. The facility feels more like a comfortable home than a treatment center – the chef cooks openly in the kitchen, patients plan and prepare their own lunch one day a week, and groups of patients venture off campus each week for restaurant, grocery store, and recreational outings.

“All activities are geared toward real life, to provide each patient with the particular lessons she needs to cope with everyday experiences,” says Leonard.

The flexibility and support offered at Center for Hope continue after the patient leaves formal treatment. The treatment team stays in close contact with the patient’s treatment team at home, if she already has one in place, and will put in place resources in the patient’s home community if needed. This way, even after formal treatment ends, the patient has a support network of professionals who understand her specific needs, challenges, and goals.

Center for Hope of the Sierras offers residential treatment and Partial Hospital Program (PHP) levels of care for the treatment of anorexia nervosa, bulimia nervosa, binge eating, and related disorders. In two large, yet cozy Victorian-Country style neighboring homes, patients receive highly individualized care from a team of licensed clinicians, registered nurses, a dietician, chef, psychiatrist, and physician who specialize in treating individuals with eating disorders with compassion, dignity, and a commitment to each person’s unique healing process. For more information about eating disorder treatment at Center for Hope, visit www.centerforhopeofthesierras.com or call (866) 690-7242.