Thoughts about the Transition from Residential to Outpatient Treatment

One of the rockiest parts of eating disorder recovery is the transition from residential treatment back into real life. Navigating that step plays a large role in the benefit the inpatient experience can give. 

Although treatment programs provide many necessary and valuable opportunities to help people challenge the eating disorder thoughts, certain parts of the illness lay dormant.

Ultimately, all food decisions are made by the program, so the internal struggle between restricting food and eating a sufficient meal is moot. Regular nourishment and improved health both substantially decrease the eating disorder thoughts, but the insidious urges to follow a trail back into illness remain. 

Treatment programs attempt to inculcate patients to sign on fully to recovery, to believe in their desire to be well, as a hedge against the inevitable return of these thoughts after discharge. This dynamic sets up a confusing and somewhat unrealistic situation upon re-entry into the world. 

The crux of a sufficient discharge plan lies not with the perfect arrangement of treatment providers. A well designed plan with gradual step down from more to less intensive outpatient programs combined with an experienced, caring and communicative team does not guarantee full recovery. The likely success of the transition rests instead with a plan to face the ambivalence, confusion and daily struggle to contain the eating disorder thoughts, a very individual and personal effort. 

Two aspects of treatment at this stage are critical. 

The first is the openness and honesty of the patient in treatment. The track record of anyone who entered residential treatment shows that battling the thoughts alone will lead to a likely relapse. Any way to be open about that daily struggle with any part of the treatment team means the person is not facing recovery alone. In and of itself, this openness changes the dynamic of daily life. 

The second is transforming ambivalence of recovery from another shameful or guilt-inducing part of this illness--a mental state likely to encourage relapse--into a natural part of the process. The idea of leaving behind something that has been a central coping mechanism and a source of individuality, despite the obvious negative effects as well, is very difficult. It's natural to experience mixed feelings when going through a deep, emotional and personal change. 

The transition from residential to outpatient treatment remains complex and challenging. Openness and acceptance of the ambivalence will help make this step even more successful for patients.