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. A minimum 30 day commitment is required.

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.

Will insurance pay for any of the treatments?

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 the Business Manager, and they would be happy to assist you in discussing benefits with your insurance company

Does Castlewood accommodate vegetarianism, smoking, allow caffeine?

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.

How does the Castlewood staff work with frequent purging?

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.

What if I need hospitalization, intravenous feedings or tube feedings?

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. Our Medical Director would continue to work with you while you are at the hospital and would coordinate care with other physicians.

What information does the staff need prior to acceptance at Castlewood?

Before your arrival you need to provide by mail or fax:

1. 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.

2. Send a recent complete physical exam and medical history. This physical exam should include a morning weight in gown, height and postural vital signs.

3. 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 contact intake coordinator, Samantha at
636-386-6611 or 1-888-822-8938. .

Will adolescents be accepted for treatment?

We accept clients 16 and older. Under special circumstances, with family involvement, we can accept younger teenagers.

When Is Outpatient (IOP) Therapy Preferred For Treatment

For motivated and less injured clients, IOP may be the treatment of choice.

There are four types of groups offered in the program:

1. Skills group
2. General progress groups
3. Meal process groups
4. Experimental group

The skills group is a structured psycho-educational group that provides patients practical skills for coping with symptoms, and helps create alternatives to ED symptoms. Instead of bingeing and purging – self soothing, distraction and problem solving. Instead of restricting, patients examine unhealthy thought processes and body image distortion. Clients are taught to use their voice and communicate internal states, and obtain problem solving, communication and relationship skills.

The groups focus on body acceptance, behavior therapy, motivation, anxiety, nutrition, mindfulness, spirituality and self care.

The process group allows an opportunity to discuss emotions and underlying dynamics that maintain ED symptoms. Feedback from group members, particularly those further along or with similar experiences is useful.

In the meal process groups, individuals are helped to recognize hunger and fullness, and learn to prepare meals with variety, nutrition and proper portions. The therapists eat with the clients and clients are challenged at the table to confront their anxiety.

In experiential groups, clients deal with body, movement and strong emotions. This is typically the most useful and difficult therapy, according to our clients.

If clients weights are not moving in the necessary directions, or there is non-compliance, the client is moved to Partial Hospitalization, so treatment can intensify up to 6 days a week, with more individualized treatment for a period of time.

What Causes Eating Disorder?

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.

How Long Does Treatment Take?

Castlewood provides intense 7-day a week treatment and in our experience can facilitate the time involved in healing. 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 i.e. a message that an overwhelming emotion needs to be expressed, listened to, and dealt with effectively.

Why is a Continuum of Care Critical For Recovery?

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 room to “fall on their faces and learn.” This is useful. When Level III is attained they move to Stepdown and live with 7 women without supervision. 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.
What if Client Returns Home to a Stressful Dysfunctional Environment?
This almost always results in relapse. The clients 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.

What is Attachment Based Psychotherapy?

When a client has had early attachment deficits with their caretakers in the first few years of life due to sensory hyperreactivity or parental unavailability they will evidence attachment disorders later in life. They will become dismissive or preoccupied with securing love. So often, eating disorder results from a hunger for love, and the person is either too afraid to seek love (dismissive) or approaches partners with a purge mentality (preoccupied), or both (disorganized). Castlewood utilizes directive interventions to work with attachment difficulties.

How is Trauma Resolved?

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 remission.

What is Internal Family Systems Therapy?

Internal Family Systems (IFS) therapy is a therapy that is very applicable to clients who have complex traumatic stress disorders allows for a reworking of those experiences with one foot in the present, and one foot in the past (Schwartz, Galperin & Masters, 1993). IFS has in common with ego state therapies the idea that each individual has multiple selves or self-states. I.F.S., like Ego State Therapies, is predicated on the notion that to have self-states, (generally referred to as “parts”) is not (solely) a function of a dissociative process in need of therapeutic correction, but rather the normative state of all human beings.

“Parts”, in the I.F.S. model, are seen as having differentiated responses to all types of life experiences and as vital to the internal depth and scope of the individual. As a result of this important function, I.F.S., has no intent to irradiate parts or to impose fusion of parts on a client; rather, life experiences that are unassimilated, including but not limited to those which meet criteria for trauma, are viewed as creating circumstances whereby parts take on “burdens.”

“Burdens” in IFS are, in essence, unmetabolized residue. They might include overwhelming, polarized, or ego-dystonic emotions, beliefs or attributions – compartmentalized and stored such that subsequent alternative or reparative day-to-day life experience does not alter them. It is the burdens and their impact on the parts that are problematic. Burdens knock parts out of alignment, in a sense, shifting their trajectory and limiting access to their own aliveness and resiliency. Encumbered parts take on roles that are burden-driven as either “protector” or “protected,” and begin to function within a narrow range of response.

As the internal system takes on more burdens, as would be the case with complex trauma, the possibility of resolution of earlier trauma and novel response further erodes. Management of trauma-based affect becomes the ultimate priority. Burdened parts in circumscribed roles then repeat patterns of symptom management endlessly. In traditional nosology, diagnoses of personality disorders are given when these symptoms and patterns are used repeatedly. In I.F.S., as with other systems approaches, these symptoms and behavioral patterns are seen as the “system’s” perhaps failed, but nonetheless sincere, attempt at a solution. Unstuckness is the goal.

As with any system, extreme parts in one direction necessitate the existence of polarized parts, in the opposite direction in order to maintain homeostasis. For this reason, most beliefs are dialectical (Linehan) and individuals often believe two contradictory and polarized beliefs simultaneously, creating “black-white dichotomies” and an internal “civil-war’ often identified in individuals diagnosed with personality disorders, especially borderline personality. IFS posits that polarized parts cluster around each part that contains unreconciled psychic material resulting in triangular internal constellation that has been identified as basic to numerous theoretical orientations that proffer a map of the human psyche.

To elaborate minimally but meaningfully on the nomenclature and overlap of I.F.S. and familiar systems of psychological thought, both Freudian concepts of an “overdeveloped superego” and “identification with the aggressor” reflect what in I.F.S. theory would equate to zealous “protectors.” The former’s strategy would involve protecting through attempted perfectionism and fastidious conscientiousness, the latter, through reprise of tactics used by original perpetrators, typically domination and engendering fear, either directed internally (acting in), or externally (acting out). Indeed, in clinical populations of traumatized clients, behavioral reenactments have been noted that reflects seemingly disparate coping mechanisms. For example, the client attempts to be perfect, compliant, in control and then enters a pattern of dyscontrol by engaging in reckless, rebellious and destructive behaviors – in addiction, language, cycles of overcontrol alternating with those that are out-of-control (Schwartz, Galperin, 1993). Kernberg, noted these patterns in Borderline Personality Disorder. Watkins & Watkins (1998) posited that such contradictory behaviors in clients with a trauma history and/or diagnosed with borderline personality, in fact, represented the comings and goings of rapidly cycling ego states. Their ego state model including the understanding of parts (rather than unconscious processes of a broader or more drives-based origin) is the precursor of the I.F.S. perspective.

Internal Family Systems theory recognizes two levels of “protectors”: “managers” are those who are pre-emptive and attempt to ward off “dangerous feelings” (which might include: fear, shame, desire, hope, love, grief and others related to the contextual origins of burdens) and “firefighters”, those who are reactive, typically emerge when more extreme measures are. Some varieties of “managers” that often rule day-to-day life might include those that are: obsessive-compulsive: perfectionistic and striving: detached and/or antisocial parts: and compliant, conflict-avoidant pleaser. Should these manager protector parts fail, i.e., “dangerous” affect emerges for any number of reasons, for example, via connection, disappointment, set-backs, loss, unpredictability, effective therapy, relational depth, further trauma, second level protectors, the “firefighters” become activated. The flame they attempt to quell is that of the aforementioned affects carried within the unprocessed burdens of the ostensibly “protected parts” – those who have been injured, sustained compartmentalized burdens and been exiled with their dissident affects to an internal Siberia. When these exiled or disowned parts assume prominence, clients are often characterized as “regressed,” “needy,” dependent,” if assessed within conventional frameworks. When exiled parts emerge within unanticipated circumstances, including traumatic reenactments, they are often in a state of spontaneous reexperiencing or flashback, thus reinforcing the protectors’ need to suppress them since it is dangerous to allow them to emerge.

When “Firefighters” emerge, they typically sabotage therapeutic process through relapse or second level resistances that cause the client to shutdown. They might flee jobs, relationships or therapy. The I.F.S. stance regarding these firefighting efforts is a proactive one, geared to understanding the protective parts’ concerns – even when said concerns are stated with initial belligerence and/or condemnation and responding to them in a forthright manner. Achieving the required rapport involves disentangling the quickly emerging reactive polarized part(s) that inevitably come forward. In traditional therapies, when a part comes forward to argue for sanity with a seemingly extreme, destructive or persecutory part, it is often hailed as the client’s “healthy self” and welcomed. In I.F.S. the goal is activation of the Self that is beyond stances, positions and argument. Self’s hearing and compassionate understanding of the fears underlying parts’ intensity deescalates internal tension allowing for negotiation and similarities of ultimate goals to be felt across previously warring internal factions. When “Self” is present understanding is inevitable.

How Much “Freedom” is Allowed at Castlewood?

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 at Level II after refeeding or some control is established and maintained over eating disorder.

How do Men/Women, Anorexic, Bulimic, and Compulsive Overeating Clients Interact?

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.

How do We Deal With Exercise?

All clients have an exercise evaluation by our exercise physiologist 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.

What If You Have Medical Problems?

Unfortunately, many eating disorder clients have medical conditions. We have found specialists with knowledge of eating disorders in cardiology, gastro-intestional, internal medicine, orthopedics and so on. We have a full-time psychiatrist-neurologist and addictionologist.

What If You Are Alcoholic or Drug Dependent or Also Have Sex Addiction or Co-Dependency?

Specific therapists on our staff specialize in each of these co-addictions and groups are focused on each. Our psychiatrist, previously was Medical Director of a CD facility. Many of our staff are recovered. We arrange for clients to attend 12-step meetings in the evenings and weekends; if indicated.

Is Treatment of Men Different Than Women?

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. Often, men with eating disorders have had difficulties with masculinity and have weight-lifted or over-performed in sports, but now it is similar for women. Most have issues with gender identity and sexuality and issues with men in that area is quite different than for females.

Sexuality and Dating Issues.

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.

Confusion Regarding “Self” – Who Am I and “What Do I Want To Be When I Grow Up.”

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, closeness, by moving-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.

Body Image Difficulties.

coming soon!