There are many options available for treating a teenager who has an eating disorder, including residential treatment. Obviously, this is a big decision for most fmilies, so we asked Zanita Zody of Clementine, a residential treatment program for adolescent girls aged 13-18, some questions about residential treatment for eating disorders.
We did not receive payment for this article, and it is not an endorsement of any facility. Each family should evaluate treatment options on an individual basis.
Q: What is the hardest part about residential treatment?
A: There are a few common challenges that adolescents may face when they enter residential treatment. Being away from the familiarity of home and their friends and families can certainly be difficult, especially since many of them have never spent any significant amount of time away from home.
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It isn’t unusual for the girls to call their parents the first few nights, begging and bargaining to be given one more chance at success in outpatient or a lower level of care. If this happens, the best thing you can do is to remain a united front, not only as parents or caregivers but also with the treatment team and the work that is being done in the program.
If your children see you waiver, it will make it harder for them to commit. With the best of intentions, one of the worst things you can do is tell them to give it a week or two, and then you will reevaluate. Of course this may be true, but if they have a finite period of time, their energy will be spent on getting to that date rather than doing the work.
Instead, keep any conversations about coming home that she wants to have brief and reiterate the need for treatment with loving conviction. That is no easy task for most parents so you should also call the treatment team to let them know what is happening so they can help redirect or address these conversations and make sure you are using your own support system (e.g., each other, therapists, friends) to get through the transition.
Q: What will you do if my child can’t adjust or seems to be getting worse?
A: You will be aware of any challenges your child is having in the adjustment along the way. The single largest barrier to adjustment is often perceived ambivalence or promises of a reevaluation of premature discharge from you.
For this reason, it is imperative that you are aligned with the treatment team and communicate this consistently to your child. If you have any concerns or questions, express that to your team, not her.
Remember that while the treatment team is the expert on the treatment of eating disorders, you are the expert on your child. If you all work together as a team, your collective wisdom becomes an extraordinary resource for recovery.
Q: What happens if my child is crying/inconsolable while staying there?
A: We will do everything we can to comfort and support her while also acknowledging that sometimes people are just sad, that the sadness won’t last forever, and that no matter how they feel the team will continue to show up and support them. We will also involve you to the extent that it is helpful for everyone involved and our shared goal of supporting your child’s process in treatment.
Q: What is your approach to food and eating?
A: We try to make the eating environment as similar to what a typical home environment might be like as we possibly can. This means that the kids do not choose their own meals or know what they will be eating days or even hours in advance.
After all, how many of you tell your kids on Monday what they will be eating for breakfast, lunch and dinner for the remainder of the week? Instead, the meal is announced shortly before mealtime and as the chef is finishing up preparations. Kids are allowed to choose their own snacks each morning for that day. Again, this is consistent with what a child might do at home.
We have a full-time chef that prepares most of our meals. Our menu is on a four-week rotation and all meals are eaten together as a group with staff at a single dining table.
Our menu consists of a variety of foods. While we absolutely agree that some foods are more nutritionally dense than others, we do not believe that there are any good or bad foods. Instead, we want your child to be able to make flexible choices around food.
For example, if she is out with friends and everyone is getting ice cream, we don’t want her eating disorder to choose whether or not she can have it too but instead, we want her to choose based on considerations such as her current hunger cues or her food preferences.
Q: How will you know that my child is getting better?
A: There are multiple indicators of recovery. Of course, there are quantitative measures like weights, vitals and lab values. But the less tangible indicators are often the most important signs that the deeper “core issues” are being addressed.
In general, one might use the umbrella of flexibility to consider these indicators. As a teenager with an eating disorder begins to heal and recover, we often see them demonstrating increased flexibility across multiple domains such as nutrition, relationships, unpredictability, and academic pursuits.
Q: What happens when my child leaves your treatment program?
A: The continuum of care is so important for success. We will start discharge planning from the time of admission and this includes supporting you in the identification of qualified and appropriate step down programs and outpatient providers wherever you live. We are a team and will be throughout the entire process!
Zanita Zody, Ph.D., LMFT is the Clinical Director of Clementine Portland. She has extensive experience in outreach, prevention and intervention efforts focusing on the full range of DSM-defined eating disorders, subclinical disordered eating, and associated comorbid conditions. In addition to being a licensed marriage and family therapist, she holds a Ph.D. in Child Development and Family Studies.