Author: Kaely McDougall
Published: Monday, March 11, 2013
I have had the opportunity to spend the past three weeks at Castlewood Treatment Center, a residential eating disorder treatment facility. Coming into this rotation, I had very limited experience in with eating disorders and what residential treatment entailed. During my time there, I learned so much about therapy strategies, counseling techniques, and the role the RD plays within the treatment team. At the start of this rotation I questioned whether or not I could handle the emotional fatigue that comes with the territory, but as the weeks went on I gained a better understanding of the positive aspects of this setting and could definitely see myself working at a place like this.
At Castlewood, the residential clients participate in group therapy sessions each day, and have weekly individual sessions with therapists, dietitians, and psychiatrists. Each member of the treatment team is an expert in their respective field – but through daily meetings and communication, they are able to coordinate an effective, individualized plan that addresses all aspects of each client’s eating disorder. Even though nutrition is the area of expertise for RDs, it is extremely important that all of the dietitians at Castlewood are familiar with the different therapy modalities used for the clients. Here a few therapies Castlewood implements:
Cognitive Behavioral Therapy is a combination of both cognitive and behavioral therapy techniques. This type of therapy involves a strong, trusting relationship between client and therapist and addresses how a persons thoughts and beliefs impact their actions. CBT also teaches skills to handle negative thoughts and beliefs to prevent maladaptive behaviors. This is especially useful in the treatment of EDs because the therapist and client work together to identify and correct distorted beliefs, relate to others in more positive ways, and change behaviors accordingly.
Expressive therapies are a unique style of counseling and psychotherapy that encourage self-exploration and expression through art, drama, music, writing, and movement. Expressive therapies allow clients to connect to their bodies and their emotions and expose feelings and thoughts that they were previously unaware of or avoiding. During these sessions, the clients are able to process the emotions that come up and create a better understanding. ED clients are often very disconnected from their bodies and their emotions and expressive therapies help them become more comfortable, trusting, and in-tune with themselves.
The Internal Family Systems model is a unique psychotherapy approach that suggests that the mind contains individual “parts” each with its own function and viewpoint. There are three types of parts: managers, exiles, and firefighters. The exiles are the parts of self that hold intense memories and feelings and are very difficult to connect to. The firefighters suppress the emotions of the exiles to prevent the self from feeling them. The managers control the internal environment and are protective. The ED is viewed as a part of the self and serves the function of protecting the individual from painful traumas, memories or feelings. IFS treatment allows the clients to dialogue with the parts of self and understand the function of their eating disorder so they can work towards unburdening and healing the exiles so that there is no longer a need for their ED. Richard Schwartz, Ph.D, who has trained the staff at Castlewood and still works with clients there, developed this treatment model.
Where does the RD come in?
The dietitians are in charge of setting and advancing the meal plans for each client, as well as the placement or removal of any restrictions (i.e. movement, fluid, outings). Unfortunately, these responsibilities often cause the eating disorder to fear that changes the dietitian brings. This is why it is extremely important to build a trusting, open relationship with each client from the start.
Through attending group therapy sessions and daily treatment team meetings, the RD gains a deep understanding of each client, their past, and the function of their eating disorder. This knowledge helps to create an individualized and effective meal plan and progression for each client. In this setting, it is crucial that RDs utilize counseling strategies – at Castlewood, they are all trained in various counseling techniques. This setting provides a very challenging but rewarding role for dietitians and allows for development of skills in both nutrition and psychology.