Outpatient Treatment Teams

Putting together a treatment team is the most important part of outpatient recovery.  There are too many components for one clinician to address: psychological health, medication management, meal plans, medical status, social interactions and family support.  The primary clinician needs to assess each patient and then assemble a cohesive group of people which can treat the patient AND work together.  However, this critical fact is not always evident to therapists.  Many assume individual therapy is enough. Residential treatment centers acknowledge the need for coordinated outpatient care but rarely follow through.  It can take a long time for even the most educated families to understand how critical a cohesive team is to recovery.  Sadly, the burden usually falls on the patient.  
In order to create a workable team, there are a few things to bear in mind: what are the benefits of having a team? What are the possible components of a team? What is each member's role? How do you find a team?  How do you monitor communication and assess progress?
Ideally, a treatment team is composed of clinicians who know each other, have a similar treatment philosophy and have worked together previously.  The team can constantly assess progress, quickly make any needed changes and express clear and consistent strategies for recovery.  Since each clinician is free to focus attention on one aspect of the patient's care, the team can address all of her needs in recovery.  Once the patient learns she can rely on her treatment providers, she can focus her energy on getting better, not questioning her treatment.
A team can involve a therapist, psychiatrist (to prescribe medications but who can also be the therapist), nutritionist (who hopefully specializes in treating eating disorders), primary medical doctor, group therapist and family therapist.  The therapist's role is to coordinate the team by communicating regularly with all of its members and to establish goals of recovery.  The nutritionist focuses primarily on meal plans and adequate nutrition but also plays a significant role in managing the anxiety and fear around eating.  If the nutritionist addresses these feelings, the therapist can focus on the psychological and emotional aspects of recovery.  Since these two members see the patient most often, they set the tone for communication.  Other members of the team play a more peripheral role but address key components of treatment.  The psychiatrist manages symptoms related to the eating disorder, mostly depression and anxiety, with medications; the primary care doctor treats medical conditions secondary to the eating disorder; the family therapist stabilizes the family unit struggling with the effects of the illness; and the group therapist teaches how to establish relationships without the eating disorder as a barrier.
Every patient does not need each component so the primary therapist should spell out what the treatment team should look like during an initial evaluation.  It is the therapist's job to have network of referrals who communicate regularly.  It can be such hard work to find a good fit with a therapist--someone trustworthy, knowledgeable and approachable--and team building is a way to appraise the therapeutic relationship.  It is a good idea to ask what each member would contribute to the team and what are the therapist's expectations of that team member.  Hopefully, these questions can lead to a dialogue, not an argument, and start the kind of collaboration needed for recovery.
The hardest and most important issue is monitoring communication and assessing progress.  The therapist and patient need to establish that reassessment is a regular part of treatment.  In fact, it is better to set aside time every few months to reflect on the current state of the treatment.  The more concrete the better: goals that have been met, goals that are being addressed, goals without an adequate treatment strategy and new goals to discuss.  Then the therapist needs to have a clear plan to communicate any changes to the team.  This process makes treatment more transparent to the patient and directly tests the team's integration.  If the communication is slow or unclear, the patient and therapist need to address these lapses immediately.  The next step might mean changing communication methods or even replacing a team member.  Unfortunately, a crisis often exposes a poorly functioning team.  At that point, the patient and therapist need to handle the crisis and then immediately make changes in the team.  Those critical moments often happen in recovery and either galvanize the team towards progress or mire the patient in ineffective treatment.
Now it is clear that successful recovery is not possible without a team of clinicians.  That team needs a leader: the therapist!  Which begs the question, how do you find a therapist?  Look out for the next post.