A Day in the Life: Adult Patients in PHP at Eating Recovery Center
Each day begins with a core belief among the treatment team. “Recovery is possible,” says Chloe VandeVoort, RD, a clinical dietitian in the Partial Hospitalization Program (PHP) at Eating Recovery Center (ERC) in Wisconsin. “I want to see patients succeed, get back to their lives and have that future they want.”
She and Primary Therapist Brittni Marshall, LPC, NCC, at ERC Wisconsin, are two of the first people patients meet when they admit. “Many people come to us at the lowest point in their lives, and it’s very fulfilling to see and be a part of their journey of recovery,” Marshall says. “The nice thing about working with adults is that it’s all their choice. We're a voluntary program so I enjoy working with people that know it's really up to them; it's their decision to be here.”
Both VandeVoort and Marshall provided insight into what a day in the life of adult PHP patients looks like.
But first, what is PHP and when is it necessary?
“A Partial Hospitalization Program is recommended when the patient continues to act on disordered behaviors at a lower level of care,” explains Steven Crawford, MD, Medical Director at ERC Baltimore. ERC offers PHP 10 hours a day, seven days a week in an outpatient setting. Patients spend nights at their home or in nearby accommodations, allowing them to practice their skills in a non-treatment setting. They receive daily meals, snacks and group therapy, as well as regular meetings with a therapist, dietitian and psychiatrist.
Therapy is a Team Effort
Treatment is a collaborative process. Each patient sees a psychiatrist three times a week, including during a meeting with the entire treatment team. Additionally, patients spend time in individual, group and family therapy.
The primary focus of individual therapy is to stabilize current symptoms. and identify and manage stressors that may trigger acting on eating disorder behaviors.
“We always want to establish goals and make sure that we're working towards whatever the patient’s needs are -- and that they're meeting their life goals,” says Marshall, who facilitates individual sessions. “A lot of our conversations revolve around that and things that come up in the day-to-day that they need to talk about, such as their interactions with family and friends that they bring in. It all helps them work towards their eventual goals.”
Individual therapists work with patients to challenge rituals that are part of the eating disorder and combat fears associated with certain behaviors, such as trying on clothes, grocery shopping or looking in a mirror.
Group therapy is a principal mode of treatment in PHP. As an extension of individual treatment, these sessions explore thought patterns, emotions and behaviors that may contribute to eating disorder behaviors. Program therapists lead group therapy, following an evidence-based curriculum to guide lessons and conversations and collaborate with the treatment team.
“I think group therapy is really important because it brings connection,” says Marshall. “It helps people know that they're not alone; they have people that are going through the same or very similar things.”
When families or other support systems are part of the process, a patient’s ability to take steps toward healing dramatically improves. Partial hospitalization offers an opportunity for patients to practice utilizing their families, friends or other support persons within the context of their recovery. In turn, it allows families to practice providing that support.
“We have a family session once a week, and sometimes more as needed,” says Marshall. “In the adult program, while it doesn't always have to be their parents, it often is. Sometimes when we get older patients, it might be a spouse or their children that join a session.”
Family therapy is designed to enlist support in the treatment process, and build a strong network that will assist in sustainable recovery outside of treatment.
Treatment Team Meetings
The entire treatment team meets with each patient weekly to review progress, develop treatment strategies and make treatment decisions. Patients are encouraged to bring questions or concerns regarding their care to this meeting, a process that allows patients to have an active role in developing their treatment plan.
How Are Nutrition Goals Addressed?
Dietitians work closely with patients throughout treatment, beginning with a nutritional assessment that serves a critical function in planning. Dietitians support patients in developing individualized meal plans and help them adjust those plans throughout treatment, meeting regularly with patients.
“I see where they're at, what they need nutritionally and then build on that,” says VandeVoort. Because patients in PHP leave each evening, the meal plan covers the time spent offsite and a way to record those meals. In the beginning, VandeVoort says patients may experience setbacks as they adjust, but she works to alleviate any anxiety around that. “I create open discussions to make sure that they're willing to share when those things happen. It’s not my job to reprimand, but to support them. I want them to be able to be honest and then determine together how we can we address this and create a different scenario going forward that works.”
The goal is for patients to be intimately involved in learning and applying the meal plan so that at the time of discharge, they are more comfortable with continuing to follow it. The program provides nutrition groups to help them learn the importance of various nutrients in their meal plan, understand the meal plan and assist them in challenging some of the distorted beliefs they may have around food.
While family meals are part of the standard treatment plan for all minors, they can also be valuable for adult patients and their families. During this meal, a therapist is present to serve as a coach to the family or support person, assisting them in developing supportive skills that help patients stay on track.
What Happens After PHP?
Because the patient’s journey in PHP begins with the endpoint in mind, planning for discharge and aftercare begins on the day of admission. Treatment in PHP typically lasts six weeks, and almost always includes a recommendation to step down into ERC’s onsite or Virtual Intensive Outpatient Program (VIOP). This continuum of care model helps ensure that there is a smooth transition back into the home environment, with ample opportunity to practice learned coping skills in daily life with the same treatment philosophies.
Each day spent in PHP is a step toward long-lasting recovery, which is exactly what VandeVoort likes about her job. “I want them to do well. I really enjoy seeing patients progress in treatment and surprise themselves with how far they’ve come.”
Marshall agrees. “I love seeing people begin to have hope, improve their relationships and start pursuing their passions again.”