Treating Eating Disorders: A Christian Counselor Explains 5 Care Levels

For anyone new to the world of eating disorder treatment, understanding the many different levels of care available to people seeking recovery can be quite a feat, not to mention deciding which level is the best fit for you or your loved one. My hope is that this article will provide a reference to help you make sense of the options that are out there as you consider where to begin. As always, the best treatment for any individual is treatment that is tailored to that person’s unique needs.

Treating Eating Disorders: Deciphering the Code

If you have begun the process of looking into options for eating disorder treatment, you may have come across acronyms such as PHP, IOP, IDP … add in the acronyms for the different types of therapy (DBT, CBT, ACT) and pretty soon you will have had your fill of alphabet soup. So first things first, here is a breakdown of the most common levels of care, beginning with the most intensive and moving down to least intensive.

1)    Hospitalization

The use of hospitalization in the treatment of eating disorders is generally limited to brief, intensive stays for the sake of rapid weight restoration and the monitoring of medical complications. Hospitalization is used in severe cases for clients at high medical risk. This is not a stand-alone treatment and is focused primarily on physical or medical needs, rather than on psychological needs. Hospitalization is almost always followed by another form of treatment that involves psychological and nutritional care, as well as ongoing (though less intensive) medical monitoring. 

2)    Residential Programs

Residential programs involve 24/7 care and often take place in a homey setting, sometimes in actual neighborhood homes, with constantly accessible staff members on rotating shifts. Depending on the program and the client’s needs, the length of stay at a residential treatment center may range from a few weeks to many months. It is common for these programs to include frequent individual, group, and family therapy sessions, supervision of meals and exercise, consultations with medical doctors and dietitians, and organized outings to grocery stores, restaurants, and other activities. These programs often offer options for students to continuing their schooling. Apart from hospitalization, Residential programs will provide the highest level of structure, consistency, accountability, and monitoring.

3)    Partial Hospitalization Program (PHP) or Intensive Day Program (IDP)

This level of care is where you will begin to see more variation from treatment center to treatment center. Generally PHP or IDP programs are a step down from Residential and a step up from Intensive Outpatient Programs (see below). They tend to vary from five to seven days per week and last most of the day so that clients are only home during the evenings and overnight and sometimes for the weekend. These programs often offer options for students to continue with their schoolwork in some fashion. The services offered in a PHP program are much the same as in Residential programs, with the main difference being that clients return to their homes for brief periods of time.

4)    Intensive Outpatient Program (IOP)

Much like PHP programs, Intensive Outpatient Programs also vary from treatment center to treatment center. These programs generally run for three to five days a week and for shorter hours than the PHP program. Whereas PHP programs often run during the day and send you home in the evening, IOP programs often run during the evening hours, allowing you to attend work or school during the day. These programs often include group counseling and skill-building activities, a monitored meal, and work with an individual counselor and dietitian. Treatment centers that offer PHP programs often also offer IOP programs so that clients can step down from PHP to IOP and still stay with the same treatment team and in the same facility.

5)    Outpatient Treatment

Outpatient treatment is considered the least intensive treatment option for eating disorders and will vary depending on the client’s needs and the style of the therapist they see. “Outpatient” simply means that a client is seeking care from private practitioners outside of a treatment center, usually a mental health therapist and a dietitian. When clients come to see me for eating disorder treatment they may be “stepping down” from an IOP or PHP, or seeking counseling as their first step toward recovery. I work in partnership with dietitians who also specialize in eating disorder treatment, and also consult with my client’s medical doctors (and occasionally schools) in order to form a holistic treatment team. In some areas clients also have opportunities to attend outpatient support groups.

What Next in Treating an Eating Disorder?

Now that you have a brief outline of the different treatment options that are available, where on earth do you start? There are two main options and both will involve an assessment of your needs. You can either do an assessment with an outpatient therapist or an intake assessment with a treatment center. Whichever direction you choose, it will be important to do some research on the treatment centers and outpatient therapists in your area. Some basic questions to keep in mind include what level of care the provider offers, the ages of the clients they serve, if and how they involve family members in treatment, what you can expect from your time with them, what their level of experience is, and how they work with insurance.

Christian Counseling and Eating Disorders

Here at Seattle Christian Counseling we offer what is called a “risk-free” initial session. That means that, while there is a fee for the first session, if you choose not to reschedule with that particular therapist the fee will be waived. In other words, you only pay for the first session if you decide to continue working with that therapist. So, if you or a loved one is struggling with an eating disorder and you need help determining what level of care will be best and what it even means to step into the recovery process, consider scheduling a risk-free first session. If we decide that your needs are best met in outpatient therapy and you choose to continue working with me, that’s great. However, if we decide that your needs are best met in a treatment center, I will also gladly be a resource for you in getting started with that process.