Finding the right treatment for an eating disorder can be a daunting process. What kind of therapy will be most effective for my problem? How do I find an experienced provider? How on Earth will I pay for it?
As a therapist and admissions coordinator, I have spoken with individuals and loved ones struggling to find proper treatment amidst a variety of sometimes confusing options. In this post I will tell you about the different levels of treatment for eating disorders, the process of initiating treatment and how to zero-in on the right therapy and treatment setting for you.
A thorough evaluation with an eating disorder treatment specialist is the most important first step in the process of finding the right treatment. In this initial meeting, the provider will want to get a sense of your history and the path of your eating disorder to date: When did your struggles with food begin? What was going on in your life at that time that might have fueled these struggles? The provider will want to hear as much as you can comfortably share about the nature of your eating disorder symptoms including specifics about the behaviors along with their frequency and intensity. He/she will want a sense of your social and emotional development to date, your family life, and any major events that occurred previously that might impact how you feel today. It’s also helpful to get a basic record of your weight and diet history and any treatments you might have had in the past.
The initial intake is a time to be as open as possible about the eating disorder, as this information will guide your initial placement. It is natural to feel nervous if you’ve never spoken about your struggles before. Treatment professionals understand that there may be things that you leave out in this initial meeting… perhaps because you forget, or feel embarrassed or nervous (it’s not easy to share your deepest secrets with someone you just met for the first time!). This is understandable. There will always be opportunities in the future to share more when you’re ready.
Levels of care
Following the initial interview, a treatment recommendation for a specific level of care will be made. There are five standard levels of care in eating disorder treatment: general outpatient treatment, intensive outpatient (IOP), partial hospital, residential treatment, and inpatient hospitalization.
General outpatient care incorporates individual psychotherapy, nutrition counseling, family work and/or group therapy sessions taking place one to three times per week. Treatment at this level of care generally requires a moderate level of motivation. The individual absolutely must be medically stable in order to participate in outpatient treatment.
Intensive outpatient treatment - as in an Intensive Outpatient Program (IOP) – can be an ideal option for those with busy school or work schedules in need of increased support and some supported meals. IOP care is generally around 3 hours per day for several days per week. IOP includes individual therapy, nutrition counseling, supported meals, and group therapy. Medical stability is required at this level of care.
Partial hospitalization (PHP), also known as Day Treatment, provides a higher level of structure for medically stable patients with daily meals provided under supervision. Partial hospital programs generally consist of therapy in a group setting for 6 or more hours per day and up to seven days per week. Partial hospital is often the recommended next step when a patient discharges from a residential treatment since he/she will benefit from support in slowly transitioning home.
Residential treatment is indicated for medically stable patients needing full time structure, support and containment in order to completely disrupt eating disorder symptoms. Patients live at the facility full time. There are many factors that impact the length of stay at the residential level but in general, one might expect a stay of between 6 weeks and 3 months. Residential treatment incorporates group therapy, supported meals, nutrition, and medication assessment/management (when indicated).
Inpatient hospitalization is the most intensive level of care and generally of the shortest duration (1-3 weeks). Inpatient units, typically in or connected to hospitals, serve individuals with acute eating disorders in need of medical stabilization and monitoring. An inpatient setting may also be indicated for those with co-occurring psychiatric issues, at risk because they are suicidal or engaging in self injury.
What to ask?
It’s important to be proactive when inquiring about the training of prospective clinicians and about the treatment options that a facility may offer. The following questions may be useful in this regard:
Do you specialize in the treatment of eating disorders? How long have you been treating eating disorders?
If an outpatient provider: Do you work closely with other professionals (i.e. dieticians, psychiatrists, medical doctors) who specialize in the treatment of eating disorders? A “team” approach is essential for effective, comprehensive treatment. At minimum, there must be a medical doctor involved who knows that you have an eating disorder.
What kind of training have you received? Do you use research to guide your practice? What evidence-based treatments do you provide?
How do you know that what you do in treatment works?
Treatment for an eating disorder can be very expensive. Individual therapy can range from $50 up to $500 per session depending on factors like geographic location, the experience of the provider and the provider’s license (i.e. psychiatrists may fall in the higher range since they are Medical Doctors). If you have the resources to cover the cost of treatment without insurance, then you may have more options for treatment since not every provider or facility will accept insurance (this is an important question to ask first!). If you have a solid insurance plan with “out-of-network” benefits, then broader options may also be available since your insurance company may reimburse you for a percentage of the treatment costs you pay “out of pocket” (you will need to check with your individual carrier to confirm this benefit). If you have the kind of insurance that limits you to the carrier’s specific network of providers, then you will want to ask the carrier for a list of “in-network” therapists, centers or facilities where your treatment will be covered.
When choosing an appropriate level of care, your insurance company may assign a clinical care advocate who will need to clear you for participation in the recommended treatment. This is mainly for more intensive treatments like partial hospital or residential; general outpatient treatment rarely requires pre-authorization. Occasionally, your therapist may recommend a treatment that the insurance company will not support. You have the right to appeal decisions made by the payer that don’t seem appropriate.
For individuals who are under-insured or who carry no insurance at all (and therefore have no means with which to cover the cost of treatment), there are research studies at many major hospitals that offer free treatment in exchange for participation in the studies. This can be a way to get excellent treatment (outpatient or inpatient) with no cost. Sliduing scale scholarships
Training institutes often provide outpatient treatment at lower cost. You may be treated by a newer clinician operating under the supervision of a more seasoned advisor. Local institutes can be found through NEDA or by doing an internet search for “eating disorder training institute” in your area.
Hang in there!
While the process of finding the right treatment may be challenging, it’s important to remember that you are taking a tremendous step in caring for yourself by initiating the process. Eating disorders are treatable. You absolutely can get better and there are many skilled, passionate and caring professionals out there who can help you get there!
For more information on standards of care and treatment options, visit the National Eating Disorders Association resources on seeking and securing treatment.
Ashley Milco, LMSW, works full time at Columbus Park Collaborative, an eating disorder treatment center in New York City. As part of the Columbus Park team, Ashley provides individual and group psychotherapy, and also serves as intake coordinator. She earned her MSW from Columbia University. Prior to her graduate studies, Ms. Milco lived in the Middle East, working with refugees and survivors of trauma.