Therapeutic Meal Support in Outpatient Therapy

After many years of working in an inpatient/residential eating disorder program and then transitioning into an outpatient eating disorder clinic, it became clear to me that something was missing, something that was very important, and in my opinion, crucial to recovery. Day in and day out I saw patients during individual therapy that were battling eating disorder symptoms and behaviors, yet did not qualify (for a myriad of reasons) for the intensive outpatient program services (IOP) the clinic offered. Even when patients were in IOP (which ran 3/wk), it appeared that there were still some patients that needed more support, especially the ones that had just stepped down from a higher level of care. The missing link was experiential and exposure-based services that were directly linked and tied to, you guessed it, FOOD.

As we all know (or should know – yep, I’m “shoulding” on you) eating disorders are NOT about the food, but in order to facilitate healing and lasting recovery, it HAS to start with the food. I find that I do not fully know the extent of an eating disorder until I am able to visibly see my patient in the presence of food. As we all know, self-disclosure makes it difficult to assess the full extent of a patient’s struggle with food, and in-session guidance often does not extend its influence to the actual meal. So, with that said, how can we truly be effective as outpatient therapists if we are not introducing the very thing that induces fear and anxiety within the very patient we are treating?

Therapeutic meal support provides the benefit of supporting the patient in the moment by processing difficult thoughts and emotions that present during the meal. Recall does not always equate to the accurate intensity of the thoughts and emotions that a patient experiences and the ability to help them through those experiences in the precise moment of struggle provides a very powerful therapeutic experience that allows education and guidance on how to proceed through the struggle. There really is no other learning encounter that can match the power of being there with someone in their exact moment of struggle.

Imagine providing talk therapy with a patient on how to utilize coping skills when experiencing a panic attack, now imagine this very same patient, but showing them how to cope DURING a panic attack – which, would you say, has the therapeutic advantage? Now, of course, we cannot always plan to be there during a panic attack, but this is where eating disorder therapists have an advantage. We can promote an environment that is conducive to the creation of the anxiety through exposure, while in the midst of providing in-vivo behavioral therapy, utilization of coping skills, role modeling behavior, and values based motivations as a means to aide in decrease of eating disorder behaviors (real world practice conducted in a structured and supportive environment). As the work progresses, specific food related outings and challenges can be incorporated, and with this continued repetition and practice, it begins to extend to the patient’s outward individual environment, thus lessening the power of the eating disorder voice, symptoms, and behaviors.

Through my clinical experience, I have found that it is extremely rare for an outpatient therapist to include meal support within their realm of treatment practices. For me, I cannot imagine outpatient therapy services without it, and even further, I cannot imagine full and lasting recovery without the exposure to the very thing that is feared. If we are looking to help our patients gain freedom from their eating disorder and life lived in full recovery, therapeutic meal support has to be part of the equation.

For more information about our therapeutic meal support program please visit our services page.