- What is the average length of stay?
- Why provide so much individual therapy, especially when patients are less likely to respond when at such a low weight?
- Will insurance pay for any of the treatments?
- Does Castlewood accommodate vegetarianism, smoking, allow caffeine?
- How does the Castlewood staff work with frequent purging?
- What if I need hospitalization, intravenous feedings or tube feedings?
- What information does the staff need prior to acceptance at Castlewood?
- Will adolescents be accepted for treatment?
- When Is Outpatient (IOP) Therapy Preferred For Treatment ?
- What Causes Eating Disorder?
- How Long Does Treatment Take?
- Why is a Continuum of Care Critical For Recovery?
- What if Client Returns Home to a Stressful Dysfunctional Environment?
- What is Attachment Based Psychotherapy?
- How is Trauma Resolved?
- How Much “Freedom” is Allowed at Castlewood?
- How do Men/Women, Anorexic, Bulimic, and Compulsive Overeating Clients Interact?
- How do We Deal With Exercise?
- What If You Have Medical Problems?
- What If You Are Alcoholic or Drug Dependent or Also Have Sex Addiction or Co-Dependency?
- Is Treatment of Men Different Than Women?
- How does Castlewood Approach Sexuality and Dating Issues?
- Confusion Regarding “Self” – Who Am I and “What Do I Want To Be When I Grow Up?”
We expect most patients will stay 2 to 4 months. Our program however can accommodate much longer stays with gradual step down to increasing independence.
Why provide so much individual therapy, especially when patients are less likely to respond when at such a low weight?
Castlewood provides frequent individual therapy for all patients even when they are very underweight. Most programs do not provide individual therapy during the stabilization and/or weight gain portion of treatment. We realize that most therapies have been found to be most successful when patients are at a normal weight. True change and growth may not occur until adequate nutrition is restored.
On the other hand, we know that without supportive trusting relationships it is difficult to achieve the behavioral changes that would allow weight restoration. Therapy at this stage can nurture fragile motivation, provide hope, and facilitate appropriate goal setting and expectations. It is the best way for the team to understand the rituals associated with eating, the value of the symptoms to the individual, assess motivation, illuminate fears and identify beliefs which maintain the symptoms.
Therapy begins the process of helping our residents understand how their experience makes sense, how their feelings may be understood in a new more adaptive context and how to imagine an alternative way of coping. It facilitates a better use of the group treatments. Patients who stay beyond the weight restoration phase may find the individual therapy translates more obviously into long term behavioral and emotional change.
In our experience, insurance companies will often pay for some or even most of the treatment. However, sometimes it is not easy to accurately determine benefits. We encourage you to contact your insurance company and inquire what the benefits are for: “Residential, mental health, non-substance abuse.” Also ask for the same benefit information for “partial hospital” and “intensive outpatient”. Additionally we would be happy to contact your insurance provider to obtain this information for you.
Castlewood, is licensed as a “Residential” facility, so it is important to obtain the residential benefit and not simply the “inpatient” benefit, as they might be different. It is also important to note that many states have “parity” laws, which means that the eating disorder could potentially be covered on par with medical benefits. It is important that the insurance provider know that you are seeking help for an eating disorder.
Castlewood will submit insurance claims on your behalf, at no charge, and will work closely with you and the insurance provider to obtain the maximum allowed reimbursement. Contact our Intake Department and they would be happy to assist you in discussing benefits with your insurance company.
We try to be flexible so that you are comfortable during your recovery. If you smoke we expect you to smoke moderately in designated areas. We accommodate vegetarianism but not vegan diets. If you drink caffeine we will expect you to drink moderately.
The small number of residents allows lots of support and one-on-one supervision during the hours after eating. We take into account metabolism changes associated with purging so that weight gain is gradual and safe.
We avoid hospitalization, IV’s and tube feedings unless absolutely necessary. If necessary, the staff would transport you to a nearby hospital until you were stable to return to Castlewood or Castlewood will help you transfer to an Inpatient Eating Disorder Program until you are medically stable to return to Castlewood. Our Medical Director would continue to work with you while you are at the hospital and would coordinate care with other physicians.
Before your arrival you need to provide by mail or fax:
- Blood work from within 7 days of beginning treatment including CBC, Electrolytes, Renal function tests, Liver panel, Magnesium, Phosphorus, Calcium, Protein, TB test, Hepatitis A shot, Hepatitis B screening, EKG, Pregnancy Test and Albumin. Download our Lab Work Check List
- Send a recent complete physical exam and medical history. This physical exam should include a morning weight in gown, height and postural vital signs. Download our H&P Form
- You also need to complete an intake interview which will review your past treatments, goals and psychiatric history. This interview will also give you an opportunity to decide if Castlewood fits your needs. Please contact our intake department at 1-888-822-8938.
We accept clients 16 and older. Under special circumstances, with family involvement, we can accept younger teenagers.
For motivated and less injured clients, or as a step down from higher levels of care, IOP may be the treatment of choice. Castlewood’s IOP program is called the Eating Disorder Center of Missouri.
EDCMO’s Intensive Outpatient Program offers services for individuals needing more structured treatment than can be received in outpatient therapy alone but who do not necessarily need residential treatment. The program consists of group and individual therapy four nights a week and one afternoon per week. A supervised meal is included in programming 4 days a week. Friday’s meal is optional and client’s are encouraged to coordinate with their peers for meal support. For more information visit the EDCMO website.
Eating Disorder is a symptom of many different syndromes (see list A) with many developmental pathways. For some clients, they are afraid of growing up and assuming adult responsibilities, often because of neglect during childhood or being overbonded with a parent. For others, they appear great on the outside but inside they are confused, distressed and need a symptom to yell help. They become trapped in the role of pleasing others, perfectionism, and being the “good child.” For some clients, there was a major loss during childhood, such as a mother with postpartum depression or other experiences of separation from a loved one.
Others have had great pain in their social interactions in school or with peers. Often, families that are disengaged without sufficient emotional connections, shame-based with many intergenerational secrets, experience trauma or are enmeshed without proper boundaries result in overindulged children who get stuff rather than parenting. Some clients have perfect families in appearance and feel overwhelmed because they cannot live up to the parents perceived achievements or expectations. If one doesn’t identify these “root-causes” and resolve them, Castlewood’s experience has been that symptoms quickly remit.
Research suggests that in difficult cases, most clients do get better but it can take 7 years or greater from the time they initially seek treatment. Castlewood’s experience is that intense treatment can greatly speed the time to recovery for many clients. We have a long-term follow-up research study, and most clients leave with symptoms in remission, and if they get to Level 3 in treatment, they have a high probability of succeeding. Parents and family need to be educated that no one is “cured” and lapse of symptoms is part of recovery and an opportunity to learn that an overwhelming emotion needs to be expressed, listened to, and dealt with effectively.
Almost all our clients become motivated, regain weight, stop bingeing, purging and compulsively exercising. When control is attained, they move to Level II and get much more autonomy. When Level III is attained they move to Stepdown. Almost all clients “slip” during this phase and when they do we have staff closely monitoring them and we offer “tools” for relapse prevention and dealing with the real world. So, often the client doesn’t know what they don’t know – social skills, perfectionism, emotional numbness, obsessive thinking, overwhelming anxiety and depression and so on can “come back.” We offer tools in context, for dealing with families, school, work and relationship conflict.
This almost always results in relapse. The client needs to be educated that returning to a full load at medical school, or a spouse that refused to change, or a highly pressured job as an attorney, or abusive families almost always results in relapse. They need to be taught to take care of themselves and put their recovery at priority for 6 months to a year. We work with the spouse, family or others to help them change, sometimes intensively, but in brief therapy we are not likely to facilitate major changes without outpatient follow-up.
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 feeling of confidence in establishing adult relationships and feeling confident and competent. Castlewood has developed a unique program to increase secure attachments, which is critical for long-term symptom remission.
The client needs to return to the root of “what happened” with one foot in the present and one foot in the past. The client needs to re-examine the memories, re-associate the emotions, and change the trauma-based or childhood attributions used to make meaning of the experience to an adult perspective of clarity, wisdom, and compassion. Tools such as EMDR, or Internal Family Systems can be utilized to facilitate and speed up these changes in a safe, loving context. Unresolved experiences of child sexual abuse or rape, will, for example, almost always result in symptom recurrence.
As a residential treatment center, there is much greater freedom than hospitals typically allow. We permit cell phones, computers – we have TV’s in each bedroom, and we have some single bedrooms for privacy. We take clients to restaurants and have weekly outings and allow passes with Stepdown clients who have cars. Of course, these “outing” privileges are allowed only for those clients at Level II after re-feeding or some control is established and maintained over eating disorder.
We believe that diversity actually is optimal since it forces clients to confront the real world issues that confront them daily. Still it takes some skill on our part to optimally facilitate the community issues for all clients to learn and none to be revictimized. We work with these community issues to establish a “therapeutic community” and allow for clients to help one another.
All clients have an exercise evaluation by their dietitian and like nutrition, exercise planning is a critical component of effective treatment. Obviously, while refeeding, exercise is minimal but eventually all clients need to learn how to best consider exercise into their overall treatment.
Unfortunately, many eating disorder clients have medical conditions. We have found specialists with knowledge of eating disorders in cardiology, gastrointestinal, internal medicine, orthopedics and so on. We have a full-time psychiatrist. Our nursing staff will make appointments to these specialists and arrange for our clients to obtain comprehensive medical care during their stay at Castlewood.
Specific therapists on our staff specialize in each of these co-addictions and groups are focused on each. We arrange for clients to attend 12-step meetings in the evenings and weekends; if indicated.
Yes and no, some men have very similar developmental pathways or “causes” to their eating disorder as women, and treatment is remarkably similar. In other cases, these issues can be very different. Most clients have issues with gender identity and sexuality and issues with men in that area is quite different than for females.
Almost all eating disorder clients have issues with sexuality and relationships, even if they have never had a partner. Integrating focus of intimacy and skills related to dating and partner choices is critical to recovery. Castlewood focuses on relationship issues in individual and group therapy.
Eating disorder is a disorder of self. Most clients have an identity in which they are obsessed with pleasing or not disappointing others. Castlewood specifically, attempts to “seed” the development of an authentic Self by removing blocks to compassion, caring and closeness. We encourage clients to move beyond numbness, narcissism, and fears of adult responsibilities, by providing social and life skills, and helping the client look into their mirror without body dysmorphic symptoms. The process of identity begins with neutralizing forms of self-hatred and thereby facilitating a relationship with one’s self and others. This is part of every group and therapy session.