Wellspring's treatment of severe eating disorder (ED) combines close monitoring and management of symptomatic behavior with nutritional planning and medical supervision. This provides a secure base from which to address the cognitive, emotional and relational issues underlying the illness. Our experience has shown that only this integrated approach with severe disorders will produce positive long-term results.

Treatment planning is individualized to work on symptoms, trauma, individual dynamics and relationships. Specific modalities for the treatment of ED are integrated with modalities from the general program to address different aspects of the disorder. We collaborate with hospitals for short-term crisis intervention, where medically necessary, to support the longer term process of a multi-dimensional treatment.

For the eating disordered person, an obsessive focus on food, eating, weight, body size, starving, compulsive exercise, bingeing, and/or purging usually functions as a mechanism for relief from painful feelings. It also serves as a way to avoid facing uncomfortable life problems and relationships. Often, the eating disorder is a way to meet or cope with previously unmet needs, which the person has not been able to gratify in healthy ways (i.e., needs for closeness, specialness, attention, feelings of self-worth, etc.).

For severe anorectics, treatment will be concentrated initially on an active refeeding program. Our goal is for the person to at least reach and maintain at 85-90% of optimal body weight; otherwise, capability to engage in and effectively use the emotional and relational dimensions of the treatment remains limited. Thinking is unclear and the compulsive nature of symptoms at lower body weights makes little else matter.

Once this basic body weight is attained, continued weight gain to an arbitrarily optimal level should not be viewed as a measure that assures long-term success. Anorectics are often capable of accepting refeeding and gaining weight in order to be "successfully" discharged. Although the most apparent symptoms may be temporarily diminished, the hold of the illness as a way of coping with feelings about self and relationships remains strong. Without progress in other aspects of ED, continued hospitalizations usually occur.

Our approach to eating disorder combines symptom management, Cognitive Behavioral Therapy (CBT) and a psychodynamic understanding of the individual in relationship as basic components of the treatment.

Symptom Management

Although weight gain by the numbers is not our primary goal, we provide close monitoring of symptomatic behaviors to prevent the person from encapsulating in the eating disorder. We attempt to create a partnership with the client, using structures specifically designed to enable them to become honest about their ED - the particular complex of attitudes and actions that make up the emotional and behavioral patterns of their disorder.

Close monitoring of symptomatic outlets and defenses causes underlying feelings and issues to become more accessible for psychotherapeutic intervention. When a person with an ED is non-compliant with control structures, we can examine and confront how the person uses symptoms to avoid relationships and emotional problems. When the person complies with the structures, she/he is giving up a usual crutch for emotional coping and is, therefore, in a better position to face difficult feelings and process them with others. This paves the way for learning healthier ways of coping. When there is too much focus on control and power struggles around compliance, this becomes fertile ground for addressing what purpose the ED serves in the person's life.

The treatment typically proceeds in the following stages:

1. Acknowledgment of the ED.
2. Commitment to reveal when they are "in" the ED, and if this is not yet possible, to turn themselves in after they have resorted to symptomatic behaviors.
3. Constant examination of the choices involved in their ED (e.g., choosing the eating disorder over and against relationships, willing to move toward self-destruction or self-protection / self-affirmation, etc.).
4. Recording the daily practice of struggling with making these choices.
5. Understanding the ED as a symptom, leading to active consideration of the underlying dynamics.
6. Reconciliation of self to body and self to others.

Cognitive Behavioral Therapy

Coupled with insight process-oriented therapy, cognitive behavioral interventions concentrate on exposing and changing the thought structures and conscious or unconscious beliefs the person has about food, eating and body. These thought structures tend to generate feelings of anxiety and depression, which symptoms may temporarily relieve. The development of more healthy thought structures and beliefs is a necessary step to deal with emotional responses, improve coping skills and develop healthy alternatives to symptoms.

Psychodynamic Insight Oriented Therapy

A psychodynamic understanding of the individual and family relationships is another important component of the treatment to achieve stable long-term results. By understanding how the person is trying to meet or cope with emotional needs through the ED, the different treatment modalities at Wellspring (individual, group, family, emotional-expressive, creative-expressive, etc.) can be planfully designed to address key issues in a concerted way. Treatment can be approached in a comprehensive manner from emotional, cognitive, relational and physical perspectives as an integrated whole. The daily life of relationships, activities and experiences within the small treatment community, becomes the context for living and learning new ways of relating to body, self and others, giving depth and immediacy to the treatment process.