Exposure Therapy at CastlewoodRecovery from an eating disorder is a journey, with different phases and stages along the way. While not everyone has the exact same journey, it’s certainly not uncommon for our clients to begin in an intensive, residential program before transitioning into a partial hospitalization program (PHP). Ultimately, as clients make these transitions, our treatment approach encompasses more and more exposure therapy, wherein clients are asked to identify some situations that cause them anxiety—situations that they might normally either avoid or have trouble tolerating without ritualizing or doing harm to themselves. We gradually and repetitively place clients into these situations, offering guidance and support to prevent them from engaging in rituals or in self-harm. Through this repetition, clients learn that their fears about these situations are ill-founded, and they become more comfortable and more independent in dealing with them head-on, without ritual or harm.
A Typical Day in PHPIn a sense, the transition from the initial inpatient care level to PHP is one of increased independence: While Castlewood staff members are very much available to support all our clients, those who are in PHP are encouraged to make more decisions for themselves, to implement the skills they’ve learned, and to address challenges without as much direct engagement from the Castlewood staff. This is what exposure therapy is centered on. As the client moves into PHP, he or she will be placed into stressful situations that call for the practical application of learned skills, which at first is daunting but in time becomes more comforting, even empowering. There are several examples of how exposure therapy can work:
- While we will initially portion meals for most Castlewood clients, in accordance with a dietitian’s guidance, those who are in PHP may be encouraged to portion their own meals, and to use what they’ve learned to put their own plates together.
- Accountability is another big part of exposure therapy. While clients in residential care may have Castlewood staff members checking to ensure they are eating rich, varied diets, those in PHP are often expected to maintain those standards without someone looking over their shoulders.
- Some of our exposure therapies may involve off-site activities. Going to the grocery store to pick out food, or even dining out with other Castlewood clients, are important ways for our clients to develop normalized approaches to food preparation and eating.
- Speaking of food preparation, client creations is another key exposure therapy—essentially, evenings set aside for advanced PHP clients to work together to make a community meal, drawing on what they’ve learned from their therapists and nutritionists.