What kinds of professionals are included in a treatment team?
The most effective treatment team will be comprised of professionals from a variety of disciplines working together to comprehensively address the various aspects of recovery. The type and quantity of professionals included in the team will depend on factors such as severity of patient symptoms, level of care indicated, cost, location, and availability. Take care to select professionals with whom you are comfortable. In addition, you may need to go outside your local area for assistance if there are insufficient resources available in your region. Depending on the level of care needed, you may choose to start with one or two outpatient healthcare providers (i.e., a physician and therapist) and ask them to assist you in identifying other care providers in your area to add to your team. Do not feel like you need to go it alone in the recruitment and decision process. Treatment centres for patients who require a greater level of care usually have a “built-in” team of staff already in place.
A comprehensive treatment team may include the following essential or non-essential individuals:
Essential:
• A physician who monitors and treats physical complications associated with anorexia.
• A mental health professional who provides emotional support helps to alleviate emotional distress, works to increase coping skills, assists with problem-solving, and addresses various issues that contributed to the onset of the eating disorder and/or serve to maintain eating disorder symptoms.
• A registered dietitian who provides nutritional counselling and/or nutrition education.
Beneficial, when appropriate:
• A physical therapist or exercise therapist who helps determine appropriate levels of physical activity, and designs and supervises a balanced approach to physical activity and exercise.
• A social worker to help develop life skills necessary for independent living, such as cooking and food preparation, social skills, transportation, and housing.
• Other medical professionals, such as a dentist who can evaluate any adverse effects on oral health brought about by purging and a gynecologist or endocrinologist who can evaluate and treat hormonal imbalances that may have resulted from an eating disorder.
Optional but desirable:
• Psychopharmacologist when necessary, to evaluate medications that may assist with recovery (may or may not be the chosen physician). State provisions vary, but prescribing providers may include physicians, clinical nurse practitioners, and psychologists.
• An experiential therapist who can incorporate various adjunct therapies when appropriate and desired, such as art therapy, music therapy, yoga, massage therapy, drama therapy, and equine therapy.
• Coaches, teachers, and friends who can provide needed support and encouragement.
• Paraprofessional or peer support group facilitators who can provide a forum for shared experiences, assertiveness and social skills training, and social support.
Mental Health Providers
Mental Health Professional is a broad term that includes therapists from a variety of professional disciplines. License and credentialing requirements vary from state to state within the U.S., so check with your state’s Consumer Affairs Department for more information. Education and training also vary among the different categories of therapists. For purposes of clarity, here is a description of the most popular categories of mental health professionals:
• Psychologists hold a doctorate degree in psychology (either a PhD, a PsyD, or an EdD). Four to seven years of training combines education in research, human behaviour, assessment and diagnosis of mental illness, and a broad range of psychotherapeutic techniques. In the United States, psychologists are currently permitted to prescribe medication in a limited number of states.
• Psychiatrists are medical doctors with additional speciality training in mental health. Psychiatrists are able to prescribe medication.
• Social workers typically have a master’s degree in social work (MSW or LCSW), which typically entails 2-4 years of education and training. Social workers may perform psychotherapy and may also offer skills training and assist with job placement or housing concerns.
• Other therapists may come from a variety of training backgrounds. Some hold a master’s degree in a counselling related field, such as marriage and family therapy, or psychiatric nursing. Others may not hold a master’s degree but may have specialized training in particular areas, such as substance abuse. Each type of therapist or professional counsellor has unique requirements for certification or licensure. Some of the letters you may see after the name of a master’s level therapist or other counsellor are LMFT, LMHC, LPC, and LPN.
What is meant by “level of care,” and how does it affect my treatment options?
Level of care refers to the intensity of treatment determined for a patient, given their symptoms and risk for complications. Five basic levels of care are utilized in eating disorders treatment. Additional factors such as medical risk, body weight, comorbid conditions, and motivation for recovery are considered when determining the most appropriate level of patient care.
The five basic levels of care for eating disorders treatment are as follows:
1. Outpatient care: A patient meets with one or more treatment providers one to three times per week in an office setting. Sessions typically last 45 minutes to an hour. Outpatient care is generally provided by collaboration between a physician, psychotherapist, and registered dietitian.
2. Intensive outpatient care (IOP): A patient attends a treatment program several days each week, full or half days. This option allows for increased structure, support, education, and monitoring. Additional therapeutic activities and some meals are provided. The patient sleeps at home at night.
3. Partial hospitalization care (also known as full-day treatment): Similar to an IOP program, but a patient generally attends 5 full days per week, 4–8 hours per day. All daytime meals are provided. Nutritional and medical needs are closely monitored. This method provides greater structure and patient accountability. The patient sleeps at home at night.
4. Residential treatment facility (RTF) care: A patient lives at a facility that offers extended care (usually no longer than 6 months), including group and individual psychotherapy, medical and nutritional monitoring, patient education, and alternative therapies. Residential treatment facilities are intended to be a home-like setting where patients can practice the coping skills they learn in therapy sessions while they are in a structured, supervised program. Residential treatment is not intended for patients who have acute medical or psychiatric symptoms. Length of stay and cost vary.
5. Inpatient hospitalization (also known as medically managed, or intensive treatment): A patient is treated in a hospital setting because they require 24-hour medical monitoring due to medical risk or complications, or another immediate risk. Length of stay can vary from a few hours to a week or more.
Summary of Guidelines for Determining the Appropriate Level of Patient Care
Inpatient Hospitalization Medically unstable:
- • Acute health risk
- • Weight <85% of normal range
- • Acute weight decline with food refusal
Psychiatrically unstable:
• Rapidly worsening symptoms
• Moderate to high risk for suicide
• A co-occurring psychiatric disorder that may require hospitalization
• Needs supervision during and after all meals or needs special feeding
Residential Treatment
Medically stable:
• No intensive medical intervention needed
• Weight generally <85% of normal range
Psychiatric impairment:
• Needs supervision to gain weight and to prevent excessive exercise
• Inadequate social support
• May show moderate risk for suicide
Partial Hospitalization
Medically stable:
• No immediate risk
Psychiatrically stable, however:
• Needs some structure to assist with weight gain and to prevent excessive exercise
Intensive Outpatient or Outpatient
Medically stable, psychiatrically stable, and:
• Has sufficient social and/or familial support
• Adequate skills for self-sufficiency
SOURCE: American Psychiatric Association.. Practice guideline for the treatment of patients with eating disorders, 3rd ed. Washington, DC: Author.
