Eating Disorder Treatment Programs

Group Process Program

The Group Process Program is a multi-disciplinary approach to the treatment of eating disorders and is the core element to the recovery process. Treatment is provided through group therapy that focuses on skill building, self-esteem, body image, cognitive behavior, and nutrition, as well as discovering the relationship between food, fat, and feelings. All therapeutic groups are facilitated by a rotation of therapists/counselors, and supervised by the Clinical Director.

The keystone to the Group Process Program is the Primary Group, which is held up to five times a week. In this interactive and supportive group, the women explore self-reflection with their peers. When a client begins to realize that she is not alone, she can then begin to trust others and begin to trust herself. In a group setting a bonding happens between the women that can help to heal lifelong patterns of behavior that are simply not working any longer. Women with disordered eating have learned to stuff their feelings down with food, or attempt to control their life and relationships by restricting food or ritualizing how they eat. Life revolves around food and weight, which are not the real issues, but coping skills and patterns developed to manage life at an earlier time. The power of group is that in the safety of a trusting group bond, a woman can begin to explore previously terrifying feelings or events. The group can help a woman to develop new ways of managing these feelings and can help to support her through this process, as well as give caring and supportive feedback about how she and her actions are perceived by members of the group. The power of this feedback and support can propel a woman into more satisfying relationships with herself, with her body, with others, and with food.

In conjunction with the Primary Group, there are a series of Expressive therapeutic groups. Expressive therapies help patients express feelings, repressed emotions, distorted thoughts and sensitive information through nonverbal means. Expressive therapies also provide patients with opportunities for insight, reflection and discovery of their individual uniqueness. Residents become aware of the universality of experience, appreciate others and their contributions, and understand the effect of self on others and relationships. Expressive therapies are also designed to provide recreation and enjoyment, giving residents awareness of the support and balance that leisure activities can provide. The expressive therapies offered include: Equine Therapy, Art Therapy, Body Image and Movement Therapy, Recreation Therapy, Challenge Course, Water Therapy and Acupuncture.

Rounding out the Group Process Program are several focus groups designed to target key growth areas, essential for recovery. These groups include: Cognitive Behavior Group, Food and Feelings Group, Body Image Group, Relapse Prevention Group, Cultural Awareness Group, Assertiveness Training Group, Self-care Group, and Multi-family/Relationship Group.

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Nutrition Counseling

Each client at Nova Luna will participate in nutrition counseling in two ways: individual & group process.

Clients will begin with a thorough evaluation by a Registered Dietician to develop a balanced weight management plan using proper nutrition and fitness. Under the supervision of the RD, Nutritional Counselors will meet with clients at least 3 times individually each week to discuss their food and feelings journal, assess any issues revolving around specific food items and ensure clients are working towards establishing a set point that can be maintained in a healthy, balanced manner.

The Registered Dietician and the Nutritional counselors will also head the Nutrition Group. Tasks will be given throughout the program to assess the growth in participants' knowledge. Trips to the supermarket will be arranged to demonstrate appropriate shopping. Cooking suggestions and demonstrations will also take place to teach more healthy ways to prepare foods. Creative menus will also be provided to accommodate the families' ethnic and cultural food preferences.

It is important to appreciate each individual's food preferences. Our motto for nutrition is "healthy and balanced." And this too, is a major goal of the nutritional interaction.

Nutrition Services Initial Interview with the resident to assess the following:

• History of eating Disorder
• History of weight gain/loss
• Degree of damage to gastrointestinal track as a direct result of the eating disorder
• Other medical problems with nutritional components
• Food allergies/food intolerance
• Food fears developed from the eating disorder
• Family history of eating disorders
• Extent of laxative/diuretic/diet/pill/caffeine/alcohol/other drug use
• Nature/type of purges, method used to purge
• Exercise history
• Menstrual cycle function
• Degree of food restriction
• Nature/type of food binges
• Body composition (body fat, muscle mass, hydration status)
• Ideal weight
• Goal calorie level

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Equine Therapy

Following approval by a doctor for physical activity, Nova Luna Center clients will be admitted into The Equine Assisted Psychotherapy Program and will receive up to two equine therapy sessions per month.

All EAP sessions are provided by a team consisting of a licensed therapist and a trained EAP/horse professional, which are certified through the international Equine Association, EAGALA. This team will design sessions to fit the group's needs as well as each individual client's needs, and one or more horses will be chosen specifically for each session to complete the team. EAP activities are all conducted on the ground, so there is no need for clients to have prior riding or horsemanship experience.

Following each equine therapy session there is a follow-up group process time period to explore issues that came up while working with the horses. Individual appointments can also be made with the equine therapy team, to provide clients with more time to address their personal issues and goals.

Equine Assisted Psychotherapy is one of the most effective forms of experiential therapies. EAP uses interactive activities in place of traditional sessions where you ‘talk' and a therapist ‘listens.' People are able to get better results in a shorter amount of time than with traditional services.

Not only does EAP work, it has become the industry standard as an adjunctive for treatment of patients with eating disorders. EAP is much more enjoyable than typical talk therapy. With EAP, sessions are designed to meet each client's unique needs. The activities in each session require the client(s) and the horse(s) to accomplish a specific goal. The clients' reactions to the horse, and the horse's reactions to the clients, help the clients gain insight into their nonverbal communication and behavior patterns, and provide a platform for learning how to better communicate and interact with others to accomplish personal goals. With EAP clients discover new, more effective solutions for the challenges in life.

EAP can be useful in solving a wide variety of issues that affect eating disorder clients: behavior issues, thought disorders, abuse issues, depression, anxiety, relationship issues, communication problems, as well as substance abuse and grief issues. Through specifically designed EAP sessions, clients will learn valuable skills such as: non-verbal communication, assertiveness, creative thinking, problem solving, leadership, responsibility, teamwork, relationship building, confidence & self-esteem, as well as positive attitude.

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Fitness and Rehabilitation

The licensed fitness trainer will meet with a patient during the first week for an initial fitness assessment. The primary role of the fitness trainer is to impart to the patient information about how the body works: specifically, (how food is converted into energy and utilized by the body.) Educating our clientele in this area is critical in recovery because many individuals may be using exercise in an inappropriate manner to purge the body of excess calories. In an intellectually and developmentally appropriate way, the fitness trainer will accomplish the following goals:

• Establish the biological basis for fitness. Educate the patient on normal levels of body fat, caloric intake, and exercise.

• Analyze daily activities to reduce any excessive burning of calories. The fitness trainer will analyze the day of the patient in an attempt to look for opportunities to reduce dangerous fitness behavior.

• Develop individualized positive strategies with each patient, in particular to develop a positive body image.

• Access for exercise resistance and develop a plan to overcome it. The plan will also work to promote healthy, balanced movement in the patient’s daily lifestyle.

By the end of their treatment with the fitness trainer, the patients will have built a repertoire of positive body image building exercises into their daily activity, have a greater awareness of the biology of weight, and have identified dangerous fitness behaviors to refrain from.

Approved clients will participate in an exciting array of different modes of fitness including but not limited to: guided nature and beach walks, meditation walks, yoga, creative movement, water therapy and meditation.

Among the many mind and body "exercises" we also encourage fitness activities that promote positive body image. These rehabilitative exercises may include movement and dance therapy with the use of music.

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Family Therapy

Family support is another key element in the success of the program. Parents, siblings and others in the household must become aware of what the patient is experiencing and learn the same core healthy and balanced eating principles as the patient. Changes in lifestyle cannot be accomplished without ongoing support.

In the initial evaluation the family will also be interviewed, as they play a critical role supporting the patient through the program. One of the many treatment modalities used with the family is Equine Therapy. If necessary, patient's family will be seen separately from, and together with, the patient in order to construct a comprehensive psychological history and profile. Understanding the family's cultural background and ethnic health beliefs is critical in tailoring a behavioral modification plan for any individual patient. The behavioral therapist will be fully versed in the different cultures that the Center serves.

Accordingly, family members are brought to the center for formal sessions half-way through the patients program. Brochures, pamphlets and other materials will be available for family access. Sessions on positive supportive behavior will be offered.

The Center will work hand-in-hand with the families of each patient to create and encourage adherence to the dietary and behavioral programs at home. The patients' referring physician will be advised of all medical diagnosis and will be kept informed of treatment programs and progress.

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Medical Treatment
(Intensive Inpatient only)

Each patient who is admitted into the Intensive Inpatient Program receives:

1. an assessment of the patients current medical condition requiring immediate intervention, areas of high risk mandating individualized treatment planning, and physical limitations requiring modification of the program
2. management of mineral and electrolyte imbalance, anemia, gastrointestinal disturbance, re-feeding edema, and other medical problems
3. physician supervision of the patients re-feeding program and medication management
4. psychiatric evaluation performed by the staff psychiatrist with psychotropic medications reviewed at admission and adjusted accordingly. Medications are administered and monitored by registered nurses

Discharge Planning -

The primary challenge facing patients is to shift habits developed over years. Nova Luna's Intensive residential program employs a full time specialist whose function is to provide consultation to residents to support a successful discharge plan and to provide post-discharge contact. Potential impairment to recovery are assessed by the treatment team and assessed at the development of the individuals Master Treatment Plan.

Discharge and Aftercare Planning include:

1. an initial interview by the case manger shortly after the resident's admission
2. contact with the referring professional by the the case manager
3. one to one sessions as needed with the case manager to identify resources essential to recovery (therapy, medical treatment treatment, pharmacy, changes in living, support groups, etc.)
4. a contact with the referring professional prior to discharge by a member of the clinical team establishing priorities for continuing care
5. identification of triggering events that might stimulate old eating disorder behavior and alternative responses
6. examination of areas of neglect and corrective changes in a variety of physical, nutritional, mental, emotional, spiritual and relational ideas
7. goal setting for education, social, relationship building, and family issues
8. specific focus on accountability and support systems
9. identification of relapse warning signs to allow the patient to engage relapse prevention tools and support systems early and minimize the potential for any significant relapse
   

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