Thinking about eating disorder treatment and aftercare support is a lot like doing a puzzle where the pieces don’t interlock perfectly. Sometimes, a piece or two may even be missing, making it particularly challenging to see the full picture. Aftercare should be considered from the earliest moments of the treatment decision — before treatment begins when possible or, at the latest, on day one of treatment.
Understanding the Treatment Process
To best understand the complexity of treatment planning and aftercare support, you have to first understand the treatment process. Eating disorder treatment is one of the most complicated fields in the mental health industry because there are so many components to the treatment and co-occurring struggles for patients. It’s important that both treatment and aftercare address not only the symptoms of the eating disorder but also the medical and psychological ramifications of the disease. The treatment team must also work with the patient’s loved ones, who play a major role in recovery. It’s important to remember that eating disorders do not happen in a void, and they are often related to family dysfunctions and struggles.
Furthermore, there is the identity component. Clients who have struggled with eating disorders, especially for extended periods of time, only see themselves within the context of their bodies and their disorders. Additionally, those who have had extended treatment histories often struggle to see themselves outside of their role as a patient or person in recovery. In order to sustain and see the benefits of treatment and recovery, they must work to reconnect and form relationships to themselves and others as well as to their place in this world and a higher power.
As if that’s not enough, they then must be prepared to take all of those physical, psychological, emotional, family, identify, and spiritual changes into a world that values thinness, tolerates and encourages eating disorder behaviors, promotes disconnection from their body, and reinforces the belief that a person’s worth and value is tied to how they look on the outside rather than who they are on the inside — which leads us to the importance of aftercare support.
The Importance of Aftercare Support
To start, the treatment team and family members must support the patient’s efforts and progress thus far and reinforce the idea that aftercare — thanks to more freedom and less monitoring — will be difficult. It’s always better to err on the side of caution, encouraging a patient to step down to more structure than they need rather than have to find a way to add additional treatment or structure back in.
Here’s a metaphor I like to use to explain this transition: In treatment, they work hard to create a beautiful painting filled with new awareness, motivation, skills, and direction. In the real world, there are a lot of “elements” that could influence their new mindset, so they must give that paint time to dry and then seal it with a clear coat of “gloss” (aftercare support) to protect it.
As I previously mentioned, it’s important to have a preliminary discussion about what a client’s needs and plans are for aftercare early on. Collaboration between the treatment center, outpatient team, loved ones, and client is imperative. This approach helps to guide treatment to incorporate interventions, encouraging participation at lower levels of care and preparing the client for a gradual step down. Once we understand what difficulties a client may face, we can begin to create an adequate structure for aftercare support.
Next month, we’ll dive deeper into the components of aftercare, which include advocacy, fun and self-care, family support, school and work, support groups, meal support, socialization, treatment team, spiritual, and co-occurring support.
If you or a loved one is struggling with an eating disorder, reach out to Dr. Kelli Malkasian, PsyD, CEDS at Coral Reef Counseling, and schedule a free consultation or telehealth appointment today.