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In-Home Coaching: An Alternative to Residential Eating Disorder Treatment

Many times, when an individual is struggling with an eating disorder such as anorexia or bulimia nervosa, residential treatment is determined to be the best option to treat severe symptoms. 

Residential treatment centers claim to be the optimal opportunity to truly interrupt problematic behaviors such as restricting calories, bingeing, purging, over-exercising, and laxative abuse. Patients in this setting are placed into an artificial environment which imposes rigid structure, and rules that do in fact interrupt behaviors. However, this setting is far removed from everyday life and often patients comply while in treatment only to avoid negative consequences. Upon returning home, more often than not, they fall back into their previous patterns and routines. 

There is a very high rate of relapse when it comes to eating disorders, and many individuals fall into a “revolving door” pattern of treatment and relapse that can go on for years while long term recovery remains elusive. These individuals can be labeled as “chronic relapsers,” and practitioners often convey the message that these patients will not actually achieve recovery. They are told that they are treatment-resistant, non-compliant, and will never be free of their disorder. Some may lose hope and stop reaching for recovery all together. But what if there is another way? What if the patient is not failing treatment, but in fact residential treatment is failing the patient?

That alternative looks like in-home coaching. This is an approach and set-up that can be put in place to interrupt eating disorder behaviors in a completely different way. Instead of a client travelling to a treatment center, a skilled and trained professional recovery coach travels to the client. They are able to stay in the client’s home 24/7 to provide one-on-one intensive support. 

There are many advantages to this treatment model over a traditional residential setting. Here are a few to consider: 

Real world experience:

The coach meets the client at home in their own environment. Together, they navigate everyday stressors such as school, work, family dynamics, and juggling daily responsibilities. All the while, they are practicing recovery-focused behaviors. The client has an experience of navigating their day-to-day life without their eating disorder behaviors. They may practice following their meal plan at work, grocery shopping for the week, or ordering a pizza on a Friday night without having it turn into a binge. This can be empowering to a client who has never experienced coping with daily struggles without reverting to behaviors like restricting, bingeing, or purging.

Individualized treatment plans: 

Instead of a cookie-cutter approach that is taken at most residential treatment centers, in-home coaching can truly customize the treatment plan to fit the client’s needs. For example, exercise is frequently banned in treatment centers. However, a coach can assist a client in exploring a balanced and healthy relationship with exercise. This may mean the coach accompanies the client to the gym or helps them find a yoga class. This is much more sustainable and beneficial for the client’s long-term health.

Customized meal plans:

Residential treatment often imposes strict and rigid meal plans on patients. They offer limited options, rationalizing that they are encouraging flexibility in food choices. In reality, individuals in treatment may be forced to choke down foods they legitimately dislike due to the threats of a feeding tube being placed for noncompliance at mealtime. Eating becomes a fearful and unpleasant experience in this case. With coaching, client and coach collaborate to plan, shop, prepare meals, and eat together. The coach can ensure the client eats the appropriate amount while also encouraging exploration and enjoyment around food. Clients may venture into the kitchen and cook homemade meals from scratch for the first time in years. Or they may experience going out to a restaurant with friends and family, forming a new, positive relationship with food. Instead of eating only out of fear, they can learn to enjoy food in a new way.

Lower rate of relapse:

Instead of leaving a residential treatment center and jumping into the stress of everyday life, a client with an in-home coach will have already practiced and conquered life without their old behaviors. Many times, patients in a residential setting comply during their admission only to return to triggers and stressors at home that send them back to square one. A client and coach can formulate a step-down plan that often includes virtual coaching for a period of time. In this case, a coach and client may check in several times a day and even eat meals together via Facetime or Zoom. This progressive step-down allows a client to gain independence while maintaining new, recovery focused behaviors. Also, many times treatment centers are a breeding ground for “copy-cat behaviors”. This happens when patients see new eating disorder behaviors (i.e. purging) from peers in treatment and begin to do these behaviors themselves. In contrast, a recovery coach is a mentor and role model of recovery, and clients are able to copy positive behaviors rather than problematic ones.

What are you recovering TO?:

Coach and client will be able to explore not only what a client is recovering FROM (i.e. bingeing and purging) but also what they are recovering TO (i.e. a new job, new friendships, or new hobbies). They can explore hobbies together, attend 12-step meetings, search for employment opportunities, and discover a new purpose and meaning. This is invaluable in maintaining a lasting recovery and avoiding relapse.

There are a myriad of benefits that in-home coaching offers. However, there is a drawback. The financial piece. Insurance companies typically do not cover coaching, so clients do have to cover costs / fees out-of-pocket. That being said, residential treatment often comes with a high price tag, even if part is covered by insurance. And repeat admissions add up if relapse as so often the result. Coaching may be more of a “one and done” strategy that could in fact save money in the long run. Simply reallocating financial resources and investing in a more effective treatment modality may be a wise financial choice in the end.

If you or someone you love is struggling with any variety of eating disorder behavior, exploring the option of in-home coaching may be a life-changing decision. It has the ability to end cycles of repeated relapse, and can offer new hope of long-term recovery.

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