The last post explained the obstacles to good clinical care for all people with eating disorders. However, the conclusions are ideas for the future. What about the people looking for help now? What are the resources available? Considering financial limitations, what is essential for treatment? How does one find all of the options? Which ones are right for you?
The initial, most important step is to find a primary clinician. This is typically a therapist, psychiatrist or primary care doctor with a background in treating people with eating disorders. This person will help figure out what is essential to the treatment, give regular feedback about the available options and instill hope into the difficult process. It's worth spending time and energy to find a good fit. Searching the insurance company database is a place to start but is often fruitless. In New York City programs such as the Eating Disorder Resource Center or the Center for the Study of Anorexia and Bulimia can help find low-cost or in-network clinicians. Training programs like the William Alanson White Center or the Karen Horney Clinic offer sliding scale treatment by younger clinicians who, to enhance their learning, get regular support from their supervisors. The eating disorder program at Columbia University provides free care if the person is eligible to join one of their research studies. And some academic centers such as Mount Sinai have an eating disorder program with limited availability, low-cost therapy with psychiatry trainees. Even if these places do not have the right therapist, calling often opens up new leads in the search. It's better to spend more time finding a primary clinician and not just settle. The right connection increases the success of treatment significantly.
Nutrition counseling and support are critical for recovery yet also the least liked by any patient. Since people with an eating disorder often know so much about food, working with a nutritionist seems redundant. However, tracking food and assessing progress in eating is necessary. Without it, people can improve their lives in therapy but make no headway with food. Since nutrition counseling is frequently not covered by insurance, the cost can be prohibitively expensive and easily jettisoned from the team. There are creative ways to include nutrition help in an affordable way. One viable alternative, if the primary therapist agrees, is to use food journals more regularly in therapy. The obvious downside is sacrificing a large portion of therapy time to discuss food, but for many people, it's time well spent. For people with binging or overeating, Weight Watcher's can provide reasonably sound suggestions and weekly support, as long as the therapist de-emphasizes weight loss and instead focuses on using the program for nutrition guidelines and meal planning. Other diet programs don't seem to be oriented to recovery but rather just to rapid but temporary weight loss and are not very helpful. An extremely knowledgeable sponsor in a 12-step program such as Overeaters Anonymous may be able to step into this role as well. No patient can afford to ignore nutrition support, and creative ways to find it are available.
The final component of successful treatment is community. Because people with eating disorders are often so misunderstood by family, friends and clinicians, isolation is a huge hurdle to overcome in recovery. Adequate health insurance or financial backing provides opportunities for community support in inpatient or outpatient treatment programs or in group therapy. There are two programs in New York that accept most insurance (Columbia Eastside and Renfrew), but these resources are limited, and the programs aren't right for everyone. Many are left with little recourse to find the right community support. With guidance from a therapist, it's possible to find other helpful alternatives. Some patients benefit from the 12 step approach in Overeaters Anonymous specifically because of the 24 hour support network, the multiple daily meetings and the sponsor system which provides one-on-one help. Many meetings are even geared to people specifically with Anorexia or Bulimia. Agencies such as NEDA (National Eating Disorders Association) and ANAD (National Association of Anorexia Nervosa and Associated Disorders) and ROAED (Reaching out Against Eating Disorders) provide low-cost or free mentors or support groups for patients and families. An outreach-oriented network is a better fit for some people.
Typically, it takes patients a long time to seek help for an eating disorder. The limited options based on insurance coverage and cost can demoralize even a motivated patient. The time and energy needed to sift through dead ends and find the right treatment can slow down even the most determined. There is no central location to ask for help. The information is hard to find, confusing and often unreliable. When one treatment isn't successful, patients often give up without any obvious alternatives.
The goal of this post is to offer some new avenues to those who are frustrated and creative ways to integrate low-cost or free services as part of a recovery plan. Mostly, the idea is to instill hope that it's possible to find a treatment plan that works, and sticking with it can lead to true recovery. I have seen many patients work well with the choices available to them. Although it takes perseverance, I do believe the effort is worthwhile and really can lead to true recovery.