Wednesday, July 6, 2011

Let's talk about Tx Baby, Let's talk about FBT.

Yeah, so clearly Salt 'N' Pepa was a part of my childhood enough for me to really remember their possibly most famous song and parody it for the title of this post - although I don't know how since my parents DEFINITELY streamlined gospel and country music...

Anyways, recently a lovely group of ladies and lads I know had a pretty heated (but not angry) discussion regarding treatment. Types of treatment. They were mainly discussing FBT (family based treatment) and the two sides were quite passionate.

Discussion regarding treatment is important. For providers, for researchers, for those seeking it, for families (if applicable), for activists, etc. 

With eating disorders, treatment can be confusing... FBT (or sometimes also known as the Maudsley approach), CBT (cognitive behavioral therapy), DBT (dialectical behavioral therapy), compassion focused, acceptance and commitment therapy, pharmacological, psychotherapy... and on and on. There are different types of places to seek treatment from residential to inpatient to intensive outpatient to day-hospital/php to outpatient to telephone based outpatient and I'm sure I'm forgetting some.

There's also research out there suggesting yoga is highly effective as a part of a treatment program... there's also research that concludes that experiential art and photo therapy can play huge roles in recovery as well. Additionally there's evidence showing that emphasizing mindful eating should be further examined for its merits

We have ALL of this information available to us and as is human nature people tend to gravitate towards ONE or TWO options to advocate. However, I think it's crucial to remember that just as one size does NOT fit all for people, one treatment option does not fit everyone. I think that's important for ALL to remember so providers can find the best options for their patients... and so patients can know that if one type of treatment does not work for them it does not mean they're a hopeless case, but rather they may just not have found the right treatment fit yet.

MissMaryMax and I were at Kaldi's (a local coffee shop that makes the most delicious grilled cheddar and goat cheese) munching on some nom nom noms and a certain local treatment center came up in our discussion. We both had had friends go there and both of our friends had starkingly different views of the facility, proving that what works for one does not work for everyone.

I'm not a professional, so take this with a grain of salt (or two!), but I believe care should be taken when matching up treatment with a person - I know it's hard due to insurance, but I do believe that when it's possible, care should be taken - by ALL involved in the process including the patient.

I say the latter as I believe mindset is a huge part of the equation.

That's one of the reasons I'm super leary of all those eating disorder treatment review sites that are cropping up. SO much goes into whether or not a certain treatment center, treatment provider, or just plain treatment is a good fit.  I think sometimes being put in the wrong environment can do more harm than good.

To rate a facility, search the site to find the specific facility you would like to rate. Locate the box, like the one to the left, just above the facilities contact information. For each of the five categories, click the star that represents your opinion on a five point scale.
The star scale is represented as follows:
Five Stars: Excellent
Four Stars: Good
Three Stars: Average
Two Stars: Fair
One Star: Poor
Rating a treatment center with just a star rating does not make sense to me. I think more in depth information is needed. How the program is set up (some people need more structure, some do better with a little bit of flexibility, some need a place where everyone is treated the same, etc), what treatment philosophies are incorporated (religious based, CBT, DBT, combination, etc)... a rating in and of itself doesn't say much... and I sometimes wonder how that rating would change if the person had went at a different point in their recovery process. I have a friend that went to Rogers TWICE - hated it the first time and thought it saved her life the second time... why? She said it was because her own mindset had changed and her attitude towards recovery had as well... I don't think 100% of any rating is a reflection on the facility itself. It's also WHO is rating the facility... who knows and has access to the site? Did they even GO to that treatment facility?

I think instead of the inclination to give just personal information or opinion, facts should also be given, information about how a program is operated, etc. I'm a huge proponent of personalized care -- or as close to that as possible, by trying to find a program that fits the needs.

I think in order for this to happen we truly do need to talk about treatment and ALL the options, not just our personal favorites also, which options are best for which type of individuals, acknowledging once again that treatment is not "one size fits all" and that we need to have open minds. If  you notice I said "we" earlier -- as I think this applies to patients too. Speaking as someone with an eating disorder I can assure that we discuss treatment past, present, and future amongst ourselves... and I think if we start a wider discussion then we can eliminate some of the uneasiness and increase the understanding that just because our friend (or someone's patient) thrived, regressed, or stayed stagnant doing a certain type of treatment (or with a certain provider) it does not mean someone else or ourselves will have that same outcome

p.s. in case you read my post here... I wanted to let you know I found a new home to move into. A cute little house on a hill. While, I still absolutely LOVE my current neighborhood and am sure to come and visit the park, I'm finding myself mega paranoid and really anxious when I see anyone that fits my roomie's description of the guys that robbed her :(


  1. An excellent post. I've noticed the same phenomenon of people having way different experiences...and I definitely think mindset is a huge part of it, too. I actually have been thinking about mindset for the last few days and am going to do a post on it tomorrow...there's an excellent researcher named Carol Dweck that talks about mindset that I'll reference so it'll probably be a good followup post to consider in tandem with what you've written here.

    Thanks, as always, for your insightful thoughts.

  2. Oh, and I meant to add...I actually had a friend who tended to hold some unconventional views in general. When I told him I went to a treatment center, he said..."what?!" We had a conversation about addiction and eating disorder and the like afterwards...and I must say I'd never considered that getting better on my own could have been an option, too.

    I'll add a caveat to that, though. It seems that for a lot of people, that recovering w/o any sort of outside treatment loses its possibility at some point when nutrition becomes compromised. Of course, compromised nutrition means that decision making is affected at some point, but I always do keep in mind that I have a choice to prevent a return to that state in which people typically become mentally compromised.

    Cheers to volition,


  3. First - congrats on the new house on a hill! Second - I agree totally about treatment. For me personally CBT combined with ERP was literally a lifesaver. The Maudsley approach was a very mad fit for me for reasons I won't go into and actually made me worse. I just had a conversation similar to the one you described about treatment centers near here and you're right, it's so individual. I'm glad there are so many more options now though!


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