Our Clinical Philosophy for Eating Disorder Therapy
Castlewood offers a team of specialists, each with different skills, including therapists who have sub-specialties both in eating disorder therapy, but also in specialized adjunctive treatments. Most importantly, we have dietitians who listen to the client, and work with each individual’s unique metabolic requirements.
Our mission at Castlewood is not to churn out weight-restored clients who merely look healthy to others. The mission of therapy for eating disorders at Castlewood is to identify and address the internal wounds of our clients. 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.
The Castlewood Clinical Philosophy
For each individual, the eating disorder is the outcome of a complex developmental track. While the eating disorder is a distinct disorder, it is also a symptom of the person’s attempt to cope with other struggles. The eating disorder has served and does serve different functions in the person’s life. Treatment starts with a comprehensive conceptualization of how the eating disorder developed, as well as other related issues/conflicts that lead the individual to rely on the eating disorder. While each client is an individual with a unique developmental track, there are developmental patterns of eating disorders that can be organized into different subtypes. Each subtype requires a different treatment strategy or map to effectively help heal the whole person. Castlewood will work with you to create a treatment plan tailored to your specific constellation of behaviors and co-occurring disorders.
Therapy for Eating Disorders
Castlewood has therapists on staff that specialize in:
- Cognitive Behavioral Therapy (CBT)
- Attachment-Based Psychotherapy
- Exposure and Response Prevention (ERP)
- Dialectical Behavioral Therapy (DBT)
- Eye Movement Desensitization Reprocessing (EMDR)
- Internal Family Systems Therapy (IFST)
- Schema Therapy
- Expressive Therapies
- Art Therapy
- Drama Therapy
- Dance/Movement Therapy
In addition, our registered dietitians play an expanded role in the health and wellness of our clients. At Castlewood, our skilled dietitians do more than just prescribe meal plans and supplements. The overall goal of nutrition therapy for eating disorders at Castlewood is to provide education, support, and nurturing guidance as our clients 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 anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and EDNOS (eating disorder not otherwise specified) 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 eating disorder therapy 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
- 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.
Understanding Eating Disorder Therapy
Our skilled eating disorder therapy team collaborates closely to provide the best combinations of treatment for each client. At Castlewood we believe in evidenced-based treatment, supplemented with expressive therapies. Understanding therapy for eating disorders can be difficult. To help clarify, we present the following information about some of the highly regarded approaches that we use at Castlewood.
A Professional Treatment Team
The Castlewood Treatment Team is made up of caring and compassionate professionals that all work together to see that each client's needs are met. Our licensed health care team is made up of nurses, dietitians, psychiatrists, and therapists. We also enlist the help of family and loved ones during the recovery process.
Our nurses stay with clients every step of the way, providing medical support and treatment, and monitoring individuals' progress. The registered dietitians work closely with clients to educate, support, and provide guidance in their journey to a healthy life.
The psychiatrists at Castlewood provide medical management when necessary and work with the rest of the team to ensure the mental health needs of clients are addressed. Castlewood's therapists help carry out the treatment plan, working in connection with psychiatrists and other staff to encourage complete wellness.
Finally, the family and loved ones of our clients are part of our treatment plan. Individuals who enter our program with the support of a loving family behind them are more likely to succeed in recovery. We provide many opportunities for families to interact with one another and we provide family education and counseling to help loved ones become a positive source of support for the individual.
Exposure and Response Prevention
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.
Cognitive and Behavioral Approaches in Eating Disorder Therapy
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.
Expressive Therapies / Creative Arts Therapies
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.
Eye Movement Desensitization Reprocessing
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, or 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 Therapy
Internal Family Systems (IFS) therapy is a powerful tool in working with eating disorder 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, 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.
Not all clients receive each of these modalities in their individualized plan of therapy for eating disorders. Depending on the client’s particular history and unique constellation of issues, a personalized set of effective approaches will be utilized by the Castlewood treatment team.