By Mary K. Stein, Managing Editor
Reprinted from Eating Disorders Review
May/June 2007 Volume 18, Number 3
©2007 Gürze Books
Preparing to Leave the Program
Even with all the preplanning and a careful structure to prepare the patient for leaving, it is never easy for a patient to move from treatment to home, said Dr. Kenneth Weiner, Director of the Eating Disorder Center of Denver (EDC-D). This is true even though patients in the partial hospitalization program go home each night, and even though they have continually worked on transitioning back to their lives from the moment they entered the EDC-D program.
Making the transition home is often even more difficult for patients from far away, out of the greater Denver area, who cannot stay connected to the program via the Center’s outpatient program. According to Dr. Weiner, the EDC-D outpatient program allows a full continuum of care as long as it is needed.
To help patients from outside the Denver area with transition, the staff is in touch with their referring clinician, and parents are encouraged to visit the program and to participate in programs in person.
Working with the Transition Team
Whether the person is from nearby or elsewhere in the country, when the time to return home is drawing near, they are enrolled in a transition group. The goals are to help the individual patient successfully leave the program and to go back to real life. This also involves examining all of the patient’s challenges and critical areas for growth, says EDC-D Clinical Director Tamara Pryor, PhD.
Dr. Pryor adds that the transition team also helps patients evaluate how they are going to take the new skills they have developed during treatment home, and how they are going to maintain their new motivation and commitment to staying well. Patients are very involved in the process, and are encouraged to work on goal-setting and analyzing their progress, she adds.
Patients can work on transition skills in a group setting and also have individual time with the transition therapist. They can thus apply what they are learning. For example, they may want to set a specific goal, such as going grocery shopping. During their individual session, they can work on what this will be like when they go home. To do so, they may plan a visit to a local grocery store. They can work on any type of area that will be challenging for them once they are back home, says Dr. Pryor. Using a transitions coaching sheet, patients list what they have accomplished during the week, for example, what they have set out to do and didn’t do, how they have worked on interpersonal and intrapersonal relationships during the week, skills they have practiced or acquired during the week, and how they have practiced acceptance in recovery. Patients also work on time management, healthy movement and exercise, cooking for themselves, and developing new social support systems.
Dr. Pryor notes that just as there are different stages one goes through on the way to recovery, there are distinct stages patients go through while moving through transition.
First, anticipation and fear of failure. The first stage involves lots of anticipation and excitement, and focusing on the “what ifs,” and the fears of failure. At this stage the transition therapist and patient work on realistic goal setting and reviewing the skills she will take home. Program participants also work on practicing food preparation. For example, one young mother with two young children had never cooked for the family. The transition therapist helped her work on preparing meals so she could do this when she was back home.
Then, disillusionment and obstacles. The next stage involves some disillusionment when patients run into difficulties; for example, they may berate themselves when they don’t do a task ‘perfectly,” and they may fear they won’t have support once they are back home. After this, they show increased confidence and are proud of what they are learning. Their morale is high again.
Uncertainty again. In the next stage, the patient may be nervous about moving back into her former life. Even though the therapist feels the patient is ready, the patient may say, “I’m just not sure I am ready.” Patients also may compare themselves with others in the program, saying, “Life is hard for me, but not for her,” and need reassurance that recovery is hard for everyone. The therapist shows them what they themselves can do, and applauds this. It might be working with healthy movement, clothes shopping, or trying a new skill.
Reassurance. In the last stage, the therapist continues to stress what the individual can do rather than what she cannot do, and applauds the successes. There is also reassurance that the patient can stay in touch with the treatment team and contact them whenever she wishes.
Keeping in Touch After Discharge
Once the patient returns home, Dr. Weiner said the outpatient therapist can call in and talk to any of the staff members and get a “curbside consultation” about the patient and treatment. In addition, patients know that the staff believes they can take the new skills and succeed, but they also know that if they need help, they can always return to the program. One consideration is that their insurance may not allow a return. However, the emphasis for these patients is stressing what they accomplished the first time, and reminding them of that success. And, if needed, they can return for another episode of care at any time.