At Castlewood, we understand that eating disorder symptoms are accompanied by an underlying problem. Sometimes the client doesn’t know exactly what the problem is, but there is an underlying problem such as Depression, Anxiety, Obsessive-Compulsive Disorder, Social Anxiety or just feeling overwhelmed by the perceived need for perfectionism and the need to not disappoint others. Some clients have unfinished business with their families that make separation difficult, while others have unresolved grief or trauma.
Each of these underlying disorders require a different form of specialized treatment. Castlewood offers a team of specialists, each with different skills, including therapists who have sub-specialties in each of these disciplines. Most importantly, we have dietitians who listen to the client and work with each individual’s unique metabolic requirements. Castlewood has therapists that specialize in Cognitive Behavioral Therapy, Attachment Based Psychotherapy, Exposure and Response Prevention, Dialectical Behavioral Therapy, EMDR, Internal Family Systems Therapy, Schema Therapy, Expressive Therapies, Art Therapy, Dance/Movement Therapy, and Psychodrama. Our mission is not merely to churn out weight-restored clients who look healthy to others, but whose internal wounds, if un-addressed, will readily result in relapse. Experience has taught us that the full measure of health rests on more than a temporary absence of symptoms. We are entirely focused on ensuring a complete and enduring state of wholeness, following whatever path is most appropriate for you.
At Castlewood, our registered dietitians do more than just prescribe meal plans and supplements. It is our goal to provide education, support, and nurturing guidance as our patients let go of their eating disorder behaviors and distorted thoughts regarding food and weight. Our menus are based on the average nutritional needs of our clientele. Patients are plated at 50%, 75%, or 100% of their daily needs at each meal. Upon admission, our clients tend to be very disconnected from their bodies and have little information about their internal cues of hunger, satiety, or even thirst. By practicing mindful eating, many of our clients are able to begin recognizing these intuitive cues again. The weight restoration process needs to be completed before beginning to practice this new method of eating.
Castlewood believes in treating the individual and our nutritional philosophy is no different. While AN, BN, BED, and EDNOS all have similarities, there are also many differences. The treatment team and dietitian develop challenges specific to each independent struggle. Castlewood incorporates a number of exposures including, but not limited to: eating with peers on Castlewood grounds, eating independently, group restaurant meal or snacks, individual meals or snacks, grocery shopping, cooking groups, and individual cooking, binge exposures, leaving some food behind or eating a full plate of food, and meal planning. Meals are prepared in house by our chefs who pay special attention to the unique needs of eating disorder patients. Only the freshest ingredients are used and meals are not only nutritious, but delicious and appealing.
Eating disorders are maintained by various factors that include shame, self-hate, difficulty regulating or tolerating emotions, lack of or inadequate self-care, and anxiety. These factors are maintained by unhealthy internal schemas which are saturated with afflicting core beliefs, cognitive distortions, and difficulty being connected to the present moment.
At Castlewood, clients receive daily individual and group evidence-based cognitive and behavioral therapies (i.e. CBT, ERP, ACT, DBT, etc), which have been shown to be effective in decreasing cognitive distortions and core beliefs that fuel eating disorders, and that negatively impact quality of life.
Our approach is to not simply teach CBT/DBT skills, but rather to help our clients put these skills into practice through experiential groups and exposure opportunities. Several times a week, our clients participate in groups that address emotional identification and regulation, as well as cultivation of mindfulness. Other groups offered at Castlewood teach and promote behavioral and cognitive flexibility, where clients face some of the fears they encounter in social situations, which often lead to isolation. Furthermore, mindfulness based therapies are also incorporated to promote connectedness with the present moment and facilitation of management of emotions. This way our clients gradually learn to tolerate negative affect instead of reverting back to maladaptive emotional coping behaviors.
Castlewood utilizes exposure and response prevention therapy, a specific type of cognitive-behavioral therapy, to treat anxiety disorders. Clients are asked to identify anxiety-provoking situations that they typically avoid altogether or have difficulty tolerating without using ritual or harmful behaviors. We then gradually and repetitively expose clients to these situations, while requesting that they not engage in ritual behaviors to cope with the anxiety or fear that they experience. With this consistent exposure to feared situations, clients allow themselves to see that what they fear will happen in a given situation will not actually occur, and as a result their anxiety about a previously feared situation reduces naturally.
In conjunction with exposure and response prevention therapy, Castlewood also utilizes other cognitive and behavioral therapies in the treatment of anxiety disorders that allows us to challenge belief systems that maintain fears and ritual behaviors, as well as to provide clients with alternative skills to help them in managing their anxiety.
Castlewood incorporates various expressive therapies and creative arts therapies into our treatment program. Many of our therapists are trained in expressive therapies or creative arts therapies including psychodrama, drama therapy, art therapy, music therapy, and dance/movement therapy. Expressive groups provide a time for participants to tell their stories, set goals and solve problems, express feelings, examine past experiences or current relationships as well as practice being present in their bodies, often for the first time.
Clients who have suffered for years from anxiety or distressing memories, nightmares, insomnia, abuse or other traumatic incidents can often gain relief from a revolutionary therapy called EMDR (Eye Movement Desensitization Reprocessing). Research shows that EMDR is safe and effective for trauma resolution. EMDR does not involve the use of drugs or hypnosis. It is a simple, non-invasive patient-therapist collaboration that can be highly effective for a wide range of disorders, including chronic pain, depression, panic attacks, and other issues.
The constant availability of a caretaker in infancy and childhood to provide safety, a healthy exploration of the environment, and help to learn to regulate emotions effectively results in secure attachment. The result of secure attachment is a person’s sense of security, a sense that the world is a safe place that one can rely on others for protection and support, and one can feel effective in exploring and operating in their environment. The result is a sense of both self-identity and esteem. Very few eating disorder clients have secure attachment or a solid sense of identity and feel confident in establishing adult relationships. Castlewood has developed a unique program involving group and individual therapy to increase secure attachments, which is critical for long-term symptom remission. Our attachment expressive groups provide a unique way to look at complex attachment concepts and understand them in an embodied way, which provides an opportunity of mastery and moving towards an earned secure attachment. We work with clients to help them develop a cohesive coherent collaborative narrative and life timeline to assist in the development of an earned secure attachment.
Internal Family Systems (IFS) therapy is a powerful tool in working with eating disorder clients. Its founder, Richard Schwartz, Ph.D., is a staff consultant for Castlewood, has trained our staff and works with our clients. The cornerstone of IFS is to facilitate self-leadership and integration of “parts of self” that may become fragmented, split off and polarized within an individual. One part of a person may both want to give up the eating disorder and another part may want to not give it up; or in another instance, one part may feel fat, while another part knows the person is starving. IFS allows for working with such parts of self to facilitate integration.
Many eating disorder clients have found that through using the tools of Internal Family Systems Therapy (IFS), they are able to relate to the eating disorder as being separate from the client’s self. This allows for a better understanding of factors maintaining and perpetuating the symptoms. In this process, clients often learn that the eating disorder actually protects them from re-experiencing or thinking about difficult things from their pasts, which is why they are ambivalent about giving up their symptoms.
Through IFS therapy clients begin to approach their eating disorder with curiosity and compassion. IFS therapy provides techniques to help the client heal the pain, shame, or fear from their pasts that the eating disorder protects them from experiencing. When these injured parts are healed, eating disorder symptoms begin to remit. The eating disorder part is no longer forced into such an extreme role and it can begin to take on other healthy ways of helping the client cope.