Reclaim You- Navigating Higher Levels of Care in Eating Disorder Recovery
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In this episode, hosts Sarah and Abby are joined by Nick, a registered dietitian specializing in eating disorders at Reclaim Nutrition.
This week we explore the challenges of transitioning to and from higher levels of care in eating disorder treatment. The discussion emphasizes personalized decision-making, effective communication during transitions, recognizing challenges, and maintaining momentum after treatment. It's a must-listen for anyone in eating disorder recovery seeking valuable insights and guidance.
To learn more about Nick and his work, head to https://reclaimnutritionpa.com/meet-the-team/nick/
To learn more about Reclaim Therapy and how to work with a therapist on the team, head to www.reclaimtherapy.org.
Be sure to comment, like and subscribe here, or on YouTube and come follow along on Instagram!
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[00:01] Sarah: Hi there.
[00:01] Sarah: Welcome to Reclaim You, a podcast published by the Reclaim Therapy team. Join us as we share stories, tools, and insights on how to reclaim you in the wake of trauma disordered eating and body shame. Grab your coffee, tea, or your favorite snack and get cozy because we're about to dive in.
[00:19] Sarah: Welcome back to reclaim you Today we have a really special episode. We are chatting with Abby and Nick, and Nick is one of the dietitians at Reclaim Nutrition. We're really excited to have him here to talk about some higher level of care stuff with eating disorders. So welcome, Nick. It's good to have you.
[00:40] Nick: Yes, thank you for having me. I'm really excited to be here just to give you a little information about myself at Reclaimed Nutrition. I'm one of the dietitians there, and I really love working with people who really are in their know they're starting or maybe they're a little bit later in it if they've been at a higher level of care before and are stepping down and looking to work in an outpatient setting with someone. I really do well with teens and people that are younger adults really just starting out really in their lives. I love working with the LGBTQ plus community as well and help them navigate existing in a society that sometimes is a little harsh on our community and helping them navigate that in their recovery, for sure. And definitely just with anybody who's working to improve their relationship with their food and their you. If you're looking for that, definitely reach out to me, and I would love to help you in that journey.
[01:25] Sarah: Amazing. Thanks, Nick. And it's really cool to have Abby and Nick here today because they've both worked in a higher level of care for eating disorder treatment. And I thought it would be really cool to just have a podcast that exists on the internet somewhere that talks about higher levels of care, what to expect, maybe when you might need one. So that if you're looking for that or you're considering that maybe your treatment team has talked about it, that there's a resource that might support you in deciding if that's going to be a fit for you or what you might be needing and maybe just some nuances that people aren't talking about otherwise. So I'm excited that both of you are going to have this conversation.
[02:06] Abby: Yeah, I'm excited to have this conversation. I think it'll be really helpful for folks who are considering, is this something that would be beneficial or something that I need? Because, yeah, there's a lot of information out there, but not necessarily consolidated in one place. So, yeah, I'm excited to talk about this a bit more.
[02:23] Sarah: And just a quick note of in our practice, and I'll include Reclaimed Nutrition in this as well. We're not practices that give ultimatums and.
[02:32] Abby: Say, you have to do something.
[02:34] Sarah: We really trust that our clients know what's right for them and stepping up to a higher level of care where we hopefully are super supportive in helping people decide when that's needed, how that's needed, how we can support them in doing that. So hopefully this will just be like a soft, gentle conversation. I think it will be, knowing Nick and Abby around, what all of that could look like. So maybe to start, guys, we'll go from, like, a nutrition and a therapy perspective for some of these questions. I think that would be really cool to see the overlap and the differences, maybe. But what are some of the signs that maybe a higher level of care is needed when someone's struggling with an eating disorder?
[03:13] Nick: I can start from the nutrition perspective.
[03:15] Abby: Cool.
[03:15] Nick: I think one of the telltale signs is if you are really struggling with adequately nourishing your body consistently, right? And you're working with your team and you're addressing barriers, and when you're addressing the barriers, we're still really struggling. And so that may be an indication that more support is needed. Maybe a different environment in a high level of care can be more supportive to help you do that. I think if we think about how work impacts us, how school impacts us, how maybe even family life can impact us, maybe changing that environment and putting more the ability to be focused on it. Because when you go to a higher level of care, you have often more space to be able to put direct focus on, okay, how am I going to nourish my body? How am I going to challenge my any sort of thoughts and urges and process through them and be able to still, even when things get hard, still eat and still nourish my body? And so I think that's very indicative of if you're really struggling with that and you're honest with your team, you're working with your team, and you're trying to address those barriers and it's still not really clicking at that point, then maybe that is a sign that more support is needed and can be helpful for you.
[04:19] Abby: Yeah. On a similar note, I was kind of thinking about how just asking ourselves the question, to what extent is my eating disorder impacting my daily? And like, of course eating disorders impact daily functioning regardless. But it's sort of like, to what extent am I able or less able to kind of engage in the things that I want to engage in? And I think, Nick, you touched upon this too, kind of the question of how much energy and focus am I able to direct towards recovery with all the other things that I have going on in my life? So if work is really taking a toll or school is really taking a toll and it's making focus on recovery really challenging, then that may indicate a need for increased support. It may indicate a need for, like, okay, maybe I need to take a pause on work stuff, school stuff, things that are really pulling my attention from this so that I can, in a more concentrated way, direct all of my energy and time to recovery. Because for some, it really is it can be really hard to juggle all the things at once. And that's what I think higher levels of care do really well at. Just sort of creating a lot of space and time for recovery focused things. And that's not to say that in certain levels of care you can't continue to engage with school or work that is still possible and can be sort of worked out, but it's sort of how much time and energy do you need to spend on your recovery as an indication of what level of support you need? And I'll also say, too, that if you're starting to notice, okay, I have an outpatient team. Maybe I'm working with a therapist, a dietitian, maybe a psychiatrist, maybe other supports. And it's still not feeling like enough. I still feel like, oh, I'm waiting for that next session, and I feel like I can't really quite do this without touching base with them more often. Perhaps that's an indication of like, okay, how can we increase the support from my outpatient treatment team? And or does this mean that I might want to start to consider or think about higher levels of care? So those are some of the things that popped into my mind.
[06:44] Sarah: Yeah. What do you guys feel like? Are some of the important conversations to have with an outpatient team? Say the client is really struggling and maybe it's having a hard time bringing that into sessions of, like, I'm counting down the hours, the days until my next session to get the support that I need to kind of stay afloat. What conversations feel important and maybe necessary in trying to negotiate what's next in their treatment?
[07:12] Nick: I think being trying to make the space as safe and welcoming as possible, to be honest. Right. Especially if you are building that rapport together with your provider and you're feeling really safe to share. Like, okay, this is what's going on for me, I think that allows for the space to ask the question of, like, okay, what support do I need? Can we shift something right now as we work together in the outpatient setting to see if that's more supportive? Or are we finding that it's really difficult and challenging right now? And maybe we need maybe it may make more sense for what we're doing in recovery to look into a high level of care and see if that may be a right fit and more supportive at this time in your recovery journey. And so I think just being as honest as you can and we're not here to judge you. We're here to support you. And so whatever's going on, we're here to say, okay, what can we do to help you as you continue on your recovery journey. And so I think that's really one of the most important things is to bring up what's going on. If you're struggling, what is making that challenging for you and to share, if you are having the question yourself of maybe I do need a higher level of care, bring that up. Bring and say, maybe I do feel like this might be more supportive, and they can help you navigate that and deciding what is the next step as well.
[08:30] Abby: Yeah, I think too, if someone were to come to me and ask, based on your experience or your opinion or whatever, do you think I need more support?
[08:39] Sarah: I don't know.
[08:39] Abby: And you both can kind of chime in on what you may say or how you may engage with that question. But I feel like my inclination with that question would be to really sort of collaborate on, sort of let's kind of lay out what all the options are and engage in sort of like a pros and cons activity, if you will, or exploration to get closer to what it is that you may need. So I think yeah, just like you were saying, Nick. If it feels safe and comfortable to do so. To say, like, I'm really struggling right now, and maybe it's the case, like, I'm terrified of having to know, engage in a different type of treatment that really scares me, or I'm really not sure what options exist out there, knowing that bringing that question in won't necessarily lead to sort of a therapist or a dietitian, especially in our practice, in saying, like, oh, well, if you're struggling like this, you need to go. No. From what I understand about all of us, we would definitely sort of engage in a deeper exploration around what it could look like, what are the multitude of options, because there's many and based on your own recovery, based on your own personal life, what feels like it would be most supportive at this time? And that may not just be one session conversation that might take place over many sessions to kind of determine an appropriate course of action. So I think that's another thing to kind of keep in mind. If you do come to a provider and say, I'm really struggling. I don't know if this is working or if I need to do something different, know that that will be something that we can sort of explore together in a collaborative way. There's no sort of consequences, if you will.
[10:24] Nick: Yeah, I think that's really important, the exploration, the idea of, like, we're not making a decision just because we brought it up, right. We're saying, okay, what makes sense? And taking in the factors that affect that decision. Right. In terms of the ability to get off work, how schools impact childcare, there's many factors. Go into being able to explore that with your team and say, okay, what is most supportive and what really makes sense with all the factors in my life right now and how those can be impacted by what you decide to do.
[10:55] Sarah: I think that's so important because I think a lot of people do struggle with saying like, gosh, I really am struggling much more deeply than maybe I've let you know, or brought you in on or reported or whatever it is. And it just feels so important that the struggle is so welcome in our spaces, in our virtual spaces, in our offices. We're here for it, we're here for all of the parts of you. And we hope that we can build these relationships with folks that are super inviting and safe and can invite some of the struggle in so that we can know really what's going to be most helpful in navigating your recovery. Thank you both for speaking to that. It feels so important.
[11:41] Abby: Yeah, and on the topic of struggle too, I often think about how struggle isn't a good or a bad thing, right or wrong, it's just all information. And that can be such helpful information in determining how to get the most appropriate support that you need and that could look so many different ways. So, yeah, I think that's just really important to name that. We very much invite the struggle because it's really good, helpful information.
[12:07] Sarah: Yeah. And speaking about the different options, I think that for today's purposes, we'll talk about IOP and PHP, so intensive outpatient and partial hospitalization programs in the kind of like step up from outpatient therapy and eating disorder recovery. So, because you both have worked in those settings, what do you feel like are some of the most important questions for clients to ask the programs about their programs before kind of jumping in.
[12:39] Nick: Moving forward from the nutrition side of things? Often I think it's figuring out what do the meals look like there, what's the snack situation look like, what is the dining protocols, how does that go on during the day while you're in the program? Especially if you're at a PHP or an IAP, those can look different in terms of how many meals you're getting support with in the program. Also thinking about are there accommodations for religious, cultural, ethical reasons that you have? Right? If you're somebody who is kosher, is their ability to have kosher food right? If you're somebody who is a vegetarian or a vegan for ethical reasons, can you explore that in the program as well? Thinking about textural issues or sensory stuff that comes up, if you're someone who struggles with Arfit, is there the ability to have accommodations for the meals there too, so that they can be meals that feel more supportive and nourishing your body while you work on exploring more of the textural stuff? And I think often people ask, okay, how often are they meeting with a dietitian, what does the support look like in that way? And I think a really important question is to ask what is the nutrition philosophy of the program? What do they believe in? What do they focus on? Are they focused on numbers of things or are they focused on more of looking holistically, of like, how do emotions impact my eating right and how I'm feeling that day? How trauma being trauma informed? How does trauma history potentially impact that? And are you able to work with me on that or are you going to look from a very much numbers based perspective? So I think those are questions to ask, depending on what you are looking for to get really a sense of like, okay, is this program going to be potentially a really good fit for me and what I'm looking for?
[14:18] Abby: Yeah, I love that point around sort of what's the nutrition philosophy? And I think similarly, it could be important to ask sort of like, what does the treatment program focus on from the therapy standpoint? Are there certain therapeutic modalities that the therapists and the staff use are trained in that may be really important to know? And even if you don't know the nuances and the details of the different types of therapeutic modalities, it could be interesting to ask, yeah, what sort of lens do therapists view this work from and what does that actually look like? So maybe don't give me jargon and lingo, but instead, what does that mean for then my treatment? So if I'm in an individual session, what might be some sort of techniques or strategies that I learn? How do the groups feel in that same way? And on the topic of groups, I think it would be important to ask what does the sort of typical week look like? If you're kind of thinking about a five day IOP or a five day partial hospitalization program, could you give me sort of an overview of the schedule? What are the different types of groups? So there may be groups that focus on relationships, there may be groups that focus on trauma. If you have a trauma history and you really want to dive into the connection between trauma and your eating disorder, are there groups for that? Things like substance use. If I'm struggling with substance use, is there a space for me to connect with others who are experiencing the same thing? I think too, it's really important to kind of get a sense of what does a typical Milieu look like? And by milieu I mean sort of what's the patient makeup in the sense of demographically speaking, what's the age range in a given month or so? Many different parts of our identities? Are there people of color?
[16:08] Sarah: Perhaps?
[16:08] Abby: Also another question would be just like, how affirming is that space for someone who holds blank identity? Whichever identity you're really feeling is important to ask about. So is this space trans affirming? And if so, what does that actually look like? What does that mean similarly with the staff, what's the makeup of the staff? If there are identities that are really salient and important to you, I think that's really important to bring in, to get a sense of what will this community feel like. And maybe too, what are the ways in which the staff and the community, what are the ways in which people come together to really develop a solid community? And if there are challenges within the community, whether it's with staff or with other community members, how do we typically go about resolving those? Because in higher levels of care, you're doing a lot of group work. And so I think it is important to kind of get a sense of what that would feel like for you in a group space.
[17:05] Sarah: Yeah, I'm thinking along with that, too, is like the general philosophy of the treatment center, especially when you're coming from maybe an outpatient practice that is really firmly rooted in fat, positivity and health at every size. Really kind of shift towards intuitive eating, asking those questions to treatment centers to just get a gut feeling of, yeah, these folks really get it, and they can support me in deepening into those different paradigms that diet culture has stolen over the years. So that just feels like another question to maybe ask and intake departments may or may not be able to answer those questions and I'm not totally sure, but it feels like something that could be important to people as they're calling around and getting a feel for what's out there. So what does IOP and PHP look like? What could people expect from your experience working in those programs, both of you, with so much individual work, so much group work, what are some challenges that people maybe commonly experience in those settings?
[18:02] Nick: From the nutrition side of things? I mean, individually. Typically, in my experience in the PHP level of care, you meet with your dietitian once a week individually for sessions to check in on how we're doing with any behaviors coming up, like behaviors, how we're doing with challenging those and trying to if we're working to reduce them, how to talking more about how we're doing with nourishing our body? Are we doing it consistently? Are we noticing anything different with hunger and fullness now and navigating something uncomfortable? Feelings that come up sometimes, especially if we haven't felt that in a while, especially in this lens. Typically in the dietitian, you talk a lot with your therapist about the emotions and impact, but that definitely impacts your eating. So that does come up in the space with individual work too. And so you'll be kind of thinking and building more awareness and understanding of what happens, what comes up and how maybe your eating disorder has been used to avoid maybe emotions that you're feeling sometimes really a lot of work with that. And then nutrition education about the nutrients our body needs, how they help our body how it helps us do things we enjoy, being able to be nourished adequately and working to consistently do that. And so that's a lot of the work you end up doing. You could even do challenges together with fear foods or foods you haven't had in so long. So working to reincorporate some of those foods maybe you used to love, but then over time they became really scary and you didn't like them anymore. And so really also figuring out your preferences, because sometimes our preferences can be skewed a little bit by our eating disorder. Now, those foods we used to like are really scary, whether we get information from diet culture says they're bad foods, right, so we shouldn't have them. And so being able to kind of challenge those thoughts, explore those core beliefs that we have and those values and kind of see if there's a disconnect, what we can work towards. So that's stuff that really happens individually and then in the group setting, typically you'll have a nutrition group once a week at least, and some programs do even more than one. And that's a space where you'll get more nutrition education about all the nutrients our body needs, maybe even learning more about digestion and how our body uses as nutrients. And even exploring your relationship with physical activity and movement and how to find and if you find that your relationship is very much like compensatory in nature, maybe define how to get to the point where you are feeling like it actually feels good to do it, not that you have to do it, right? And exploring those beliefs. And so a lot of beliefs get explored, even in the nutrition sense too, of what are our core beliefs and values, where have we learned some of this stuff? How does diet culture and social media impact how we feel about our body impact, how we eat, feel about certain foods, how we eat? And so those things get explored in a group setting. And what's helpful about that is a lot of the people there have similar experiences. So you can really learn from each other. And in a group setting, you may be with people that have been in a little bit later stage in their recovery process, right? And so they often can give that support and validation of like, I've been there. If you're just starting out, I know exactly how you feel. And now looking on the work I've done, I feel different now. So that can be very helpful in terms of feeling like, okay, you know what? I can too, I can do this, even though it's really hard. And so I think that's really what you notice in terms of the group work too. And speaking of challenges, transition, this is a transition when you start in any program. And transitions are notoriously difficult and challenging because they feel unsafe, because it's different, it's something you're not used to. And so when you take those steps, as important as a step it is for what you want and what you're working towards in recovery, it can be very scary and challenging. And so that's something I think that a lot of people bring into the space. And sometimes the group setting can be so helpful in people being able to say like, I felt the exact same way and I've been able to feel more comfortable and safe here as well. And so it can be a very supportive environment. But I think transition often is a very challenging aspect of when you start at a PHP or an IOP.
[22:02] Abby: Yeah, I love how you kind of highlighted just like the benefits of the groups, just sort of being around other people who are experiencing similar struggles, challenges and also being able to share in the wins. I think there's a really cool opportunity there that folks in group settings can. If you feel comfortable sharing sort of what you're working on and what goals you're sort of working towards, it could be really a cool space to kind of offer encouragement and support and celebrate when you feel that sense of yeah. In addition to what you had shared. Nick around, what does IOP and PHP look like? I think it could look a variety of different ways depending on the treatment facility and also if there are ways in which you can sort of customize your experience. So I know IOP intensive outpatient, at least where we've worked, it's often like sort of maybe two groups plus a meal and maybe a snack and then of course meeting with the dietitian, meeting with the therapist. PHP partial hospitalization tends to be sort of all day long and often over the course of the week. And then there's similarly like a number of groups continuing to work with your dietitian therapist, maybe a psychiatrist. Yeah. So it could sort of look a variety of ways. I know that some places offer like night IOP for those who do want to work or go to school during the day, so sort of starting maybe at like 435 or something like that. So I think what's important to know is that there may be ways you can talk to intake coordinators to different programs to see what are the different scheduling options. And then I guess I will say too, there is a component of IOP and PHP that there's sort of vitals when you check in, you might get your vitals and weight taken. So I think that's just an important component.
[23:51] Nick: Yeah, I mean, to speak on that, yes, I think that's something actually I think is important to know that you may get your vitals checked, you may get your weight checked either more frequently or differently than you would an outpatient setting. I think that's the nature of being a high level of care. Often I think it's a space and we'll talk about maybe that later, but it's also a space where maybe you can talk to your providers about, okay, how do you feel in terms of getting your weight checked? How can we try to make this a little bit more less anxiety provoking, if we can, to make it do what the program maybe needs in terms of often, like insurance aspects of it. Insurance, to be honest about, is that they do look systemic. Yeah. They're not catching up with everybody yet. So you have to work within the system, even if it's not helpful. And so it's one thing, I think, just to be honest and rule with people, but as you go, as you spend time in high level of care and you work with your providers, I think just sharing how you're feeling about it and working with them. If they can be flexible in how that monitoring of your vitals and your weight is done to make it really more yeah.
[24:55] Sarah: That feels so important. And I'm so glad you said that. It's a systemic issue which is still so epically problematic and harmful. And we appreciate all of that. And the treatment centers, because they accept insurance, they have to kind of play that game, I guess, if you will, which we share a lot of feelings.
[25:19] Nick: Yeah.
[25:20] Sarah: Something that stood out to me, Nick, when you were talking about was that transition piece and how it's so threatening. And as you were saying that, I was just thinking of how on the therapy side of things, we often view the eating disorder as a part or the eating disorder as many parts of a person. And how the very act of transitioning to a higher level of care can actually threaten the energy like the livelihood of that part or those parts. And so I think you're so right. There can be so much tension and so much challenge internally when someone transitions to a higher level of care that it can kind of pour out externally too, in building new relationships and settling in and all of those things. So I'm curious if you guys have any tips about how folks can talk with their new providers and settle in, maybe with a bit more ease when everyone's just kind of, like, realigning their energies and meeting each other and learning new philosophies and people are being seriously challenged all of the time. How to communicate needs, how to settle into these new relationships feels really difficult.
[26:28] Nick: Yeah, it can be definitely challenging, especially when we're trying to work with a new provider and we're not sure fully how safe it is yet. Right. We have to kind of get to know the person a little bit first so that we can feel a little more comfortable being able to share what we're really feeling, what's really going on. And when we're struggling with the transition and it's hard, it can be hard to communicate that with a provider. And so I think, as you can. Maybe even ask questions about how maybe their experience with people in transitions, like, get information of like, okay, well, if other people dealt with some of this stuff, maybe that can feel a little bit more supportive and safe to share. Like, okay, this is what I'm dealing with right now. This is so challenging. And just being able to be more honest and open and upfront of like, this is really hard work that I'm doing here. Right. But I am motivated or I do want to work towards this, right? And so being able to share that stuff I even worked in one setting where people wrote notes to the providers. They were like, oh, I just want to make sure you know this so we can bring this up in our next session and talk about it a little bit more. I think that can be a really supportive way to especially if you're feeling a little bit nervous to share that in the moment, then you can be like, okay, here, this is what's coming up for me right now. Can we explore and talk about this so that if it's something that within the program space, it's feeling like, okay, I don't know if this is working for me, this might be more supportive. Is there a possibility for us to be able to do this? I think that really allows to be able to communicate, okay, these are my needs while I'm here to really help you get the most out of what I'm working towards in recovery.
[28:01] Abby: Yeah, I think it could be really helpful and important to if you are transitioning to a higher level of care. And let's say you have an outpatient team, and even without an outpatient team, if you're just sort of working with other types of supports, whether that be family, friends. You could even sort of do this little, I guess, activity yourself or exploration yourself. Kind of thinking about, okay, looking back at my sort of past experience in transitions, what do I know to be true about my needs? What do I know to be true about what I mostly struggle with as it relates to transitions and how can I use that information to communicate to my new providers what this might look like for me? And if I do struggle in these ways during this transition, what could be helpful from them? So, like, I know I have a tendency to shut down when I'm being challenged. And so if that were to happen in this space, whether it's a group or individual session or at a meal, this is what I find to be really helpful. You also might not know that or might not have a sense of what's challenging or what might be challenging. So I think there's value in letting your new providers, your new treatment team know, okay, I don't really know yet how this is going to feel for me if I do struggle in a specific type of way? What's the sort of game plan we can come up with that I can lean on in a sense of like, okay, I'm really struggling right now. How can I communicate that to my treatment team? What are some things I can ask for? What are some things I can do for myself to feel a little bit safer in this transition, knowing that that sort of game plan, if you will, can shift and can be adjusted as you get to know yourself more, get to know your treatment team more. Yeah. So I think it can be really nice to use that first session with providers to explore what the possible challenges might be, and then those providers might also be able to name some that they've experienced so that you can get a sense of, okay, if this occurs for me, here's what might be helpful from you.
[30:04] Sarah: Yeah, and then what about red flags that the higher level of care isn't a good fit, which I feel like can be very challenging because for maybe some folks, their eating disorder is like, no, I'm out, this is too much, see you. And for other folks, it's like, no, this actually isn't a great fit for me. So just curious about any thoughts you guys have on that.
[30:25] Nick: Yeah, I mean, I think it definitely can be challenging to determine, okay, what is the driving factor with it? Right. Is my eating disorder trying to kind of get me to leave? And because, like we said, with the transition, it can threaten the eating disorder. So is it trying to pull back or are we finding that, okay, this program is just not meeting the needs I have, and it's not feeling as supportive. I think first and foremost, when you realize things are not really feeling that supportive, I think trying to share that with your providers and your team to see like, okay, this is what's happening. This is how I'm feeling. And see if there is the ability to change things a little bit, to see if there's a different way to approach it, to make it feel more supportive. I think a red flag would probably be like if you did that and you didn't really feel hurt or you felt like invalid, I think that might be a sign that this may not be really meeting your needs. In terms of support, definitely encourage people to try to bring that into their sessions if things aren't feel like they're working or feeling like they're supportive, because there could be changes that be made. A different change in approach might be something that may feel very supportive. I think these high level cares. There is the space often to be able to be more individualized. Yes, it's a group setting, and yes, there's some things they follow in terms like what's the schedule looking like during the day, but I think there is the space. If you ask for it to be able to be more individualized. Because we know that people's eating disorders affect people differently. It's not one size fit all type of concept. We have to be able to look at the person as well and not just the eating disorder and saying, well, this would work for everybody across the board. So I think being able to share that with your team and seeing if you're heard and feel validated and feel like you're supported in that they may be able to determine if this is a good environment for you, a supportive environment, or if maybe this is not the right place.
[32:15] Abby: I was thinking the exact same thing. Like if I have concerns, if I'm feeling unsupported, how safe do I feel bringing this up to someone? And even if it's just one treatment team staff member, or is there someone in this space that I feel like I can go to and express my concerns and have those concerns be heard? And knowing that I often go back to this, my hope is that sort of any treatment programs aim to strike, which is like the balance between challenge and support. So like, yes, this is going to be challenging because we're challenging the eating disorder which really does not want to be challenged. And so appropriate level of challenge with an appropriate level of support. Because if we lean too sort of hard into the challenge, it's not going to be sustainable. It could be harmful. Additionally, with leaning too hard into sort of support, without challenge, then maybe there's no movement. And so I keep thinking about like but ultimately is this person hearing me? Is this person recognizing that I'm having concerns? Are we then taking those concerns and working with them to make this space and my treatment feel more safe, sustainable, et cetera, et cetera. And if that's not the case, then that might be a red flag. So I think that's just important to note because like you said Sarah, it can get confusing of like is this a red flag or is this because my eating disorder is being challenged? And then we kind of get in our head of in sort of like a gaslighting way of am I not seeing things in the right way? But I don't know, I think there's a world in which we can kind of approach self advocacy with this, knowing that, okay, I will be challenged, but I also need to be heard and seen and validated and supported and that my concerns will be worked with. And I guess I say that because sometimes I think there are certain things that we may express a concern and let's say a treatment team is not able to sort of meet that concern in the way that we need. Because perhaps there's structural barriers in place and maybe it's the case that a treatment team really wants to meet those needs, but those barriers exist. Talking back to that systemic stuff that we were talking about earlier with like, and so that's really hard to navigate, I will say, even with those barriers and even with sort of constraints, what is the treatment team doing to make sure that your needs are being met with that balance of challenge and support?
[34:42] Sarah: What about staying in contact with your outpatient team?
[34:45] Nick: So at the PHP and IOP level care, I mean at IOP for the dietitian perspective, we meet with the client in IOP every other week. So it was encouraged if you had an outpatient dietitian you're working with to continue working with them on the weeks you're not meeting. And part of that reason is another insurance type of thing is some insurance companies do not allow you to see two providers in the same week for nutrition services. And so that is part of the reason. And that may be in PHP, like you may not be able to necessarily meet if you're using insurance with your outpatient dietitian. However, though you can still, I think, keep that open communication and your providers can too. So if you allow your treatment, PHP or IOP dietitian to speak with your outpatient dietitian, then they can give updates on what you're working on together and how you're doing. And that's really helpful, especially for as you get closer to discharging from the program to help with another transition of going back out into regular life again and trying to navigate that. So that can be very helpful to either communicate yourself with your dietitian or your outpatient team or allow that collaboration to occur as well between your treatment team.
[35:54] Abby: Yeah, I echo all of that. I think it's really helpful, especially at the end of treatment, to have call with outpatient team current team to sort of bridge the gap around sort of here's what we've been working on. Here's what would be helpful to continue working on to kind of maintain that momentum. So yeah, I think it could be helpful on both ends, like the transition into a higher level of care and out to have sort of that joint meeting.
[36:23] Sarah: And then speaking of momentum, how can folks maintain momentum as they transition out of higher levels of care to outpatient treatment? What are some tips that you guys have?
[36:35] Nick: Yeah, definitely that collaboration can help with that transition and keep that momentum up. I would also say continuing to be honest with your team, with what's going on. Be honest with supports. If you have supports that are also helping you in your recovery and I think don't get stuck in things going perfect, right? And being like, oh, I went to high level of care. If I'm not doing everything right at this point, then that was a waste, right? And so I think thinking of progress, not perfection, because as we know, recovery is often, if not ever linear for people. You're going to have days that are easier than others. And there's going to be challenges that come up. And I think giving yourself the grace and the self compassion to say, okay, today was really challenging for me. Tomorrow may be different, so let's not get stuck in the all or nothing, black or white. Thinking of today didn't go well. So now recovery is impossible for me. And I think that's important to continue when you're with momentum of giving yourself the grace and compassion of today was a really hard day and things aren't going to go perfectly and that's okay. I've learned maybe new skills. I'm working with my team to be able to continue to challenge my eating disorder and the thoughts that come up and try to reframe those thoughts, maybe, or work in a way that is continuing to be supportive of. Your goal that you're working towards in recovery and other nutrition things that can be helpful with momentum sometimes is again utilizing supports if you have any in terms of eating meals with people sometimes if you feel like that would be supportive in a transition or eating snacks even doing it over like a FaceTime call with a support often. Maybe even a flexible type of structure for meals because we think about that's often. A challenging part of transition is the less structure you're about to have, right? And so if we can try to mimic that structure as much as we can in our own life as we discharge from a program and keep that flexible, that's the key word because we do not want to end up becoming rigid with the timing of stuff. But it gives us something that helps us stay more accountable and feel a little bit more like we're not really jumping to the deep end in terms of flexibility. That gradual transition of stuff can be so helpful and even planning meals ahead can be another way to stay accountable. And this is stuff that, again, can be just initial stuff. With the transition, you can work with your team on what that looks like moving forward. But sometimes that structure can be so helpful for keeping up momentum initially, afterwards, and then maybe over time, you'll see you don't need as much structure to be able to continue to work towards the goals you're doing in terms of adequately nourishing your body consistently and anything else in recovery. So that is often a very helpful piece with the transition after.
[39:10] Abby: Yeah, I'm thinking of something like I often say is just sort of take what serves and leave what doesn't. So like leaving a treatment program, there may be things that really worked for you, there may be things that really didn't, and there's still value in all of it. And so kind of maybe with your treatment team, maybe by yourself identifying what were the parts of that experience that were really helpful that I want to continue in my day to day life with my outpatient team. So even if it's just like, oh my gosh, I started to do art again in those art groups and I hadn't done that in so long. Can I find ways in my week to continue to do some art, to give myself some of that space? Or if there were journal prompts that really resonated with you, are there ways that you can kind of continue a journaling practice? So in addition to all of what you said, Nick, to kind of maintain that structure, like pulling the pieces that really served you well, and finding ways to maybe incorporate that in your day to day.
[40:08] Sarah: Any parting thoughts that either of you have?
[40:12] Abby: Yeah, I think not all programs are created equal. So, just like doing your research with trusted supports and providers and again, creating space for yourself, if you are considering again, if you are considering a higher level of care, creating the space to just explore what are the multiple options that I have and what might be most supportive to me at this time. And whatever decision you do or do not make, finding support, regardless, with your treatment team or family friends will be helpful.
[40:45] Nick: Yeah. And going along, that just remembering that you really know yourself and your body the and so, you know, you can work with your team to decide what's the best decision for you, but know you know that and you can look at your options. Like Abby said, look at the options. Try know, pick what may fit and feel most, you know, listen to yourself, trust yourself.
[41:07] Sarah: Well, I'm feeling so grateful for both of you for chatting about this. I think it's going to be so helpful for folks who are considering higher level of care to understand a little bit more of the nuance behind it. So what I'll do is I will link to Nick's Work With Me page in our show notes. If you're interested in getting nutrition support, head to www.reclaimnnutritionpa.com. And of course, the therapy team, Reclaim Therapy. We're at www.reclaimtherapy.org and our team is really passionate about working with folks who are struggling with disordered eating. So feel free to reach out. And again, thank you guys so much for being willing to have this conversation.
[41:50] Abby: Yeah, thank you.
[41:51] Nick: Thank you for having me.
[41:52] Sarah: All right, everybody, we'll talk to you next week.
[41:55] Sarah: Thank you so much for joining us on this episode of Reclaim You. Be sure to like, comment and subscribe and check us out on YouTube at reclaim you. If you're looking to start therapy for trauma disordered eating or body image concerns, head over to our website@www.reclaimtherapy.org to learn more about us and our work. We'll be back next week with another episode. Until then, take good care of yourself.
Reclaim therapy provides therapy in Pennsylvania for eating disorders, body image and trauma.
We are a group of therapists who provide psychotherapy and EMDR for eating disorders, EMDR for binge eating and EMDR for trauma treatment in Pennsylvania. We are passionate about helping people recover from eating disorders, trauma and body image concerns.
If you’re looking for support in your recovery from trauma or disordered eating, we’re so glad you found us.