What’s Next? The Importance of Stepping Down to a Lower Level of Care

We are delighted to share a post from Clinical Director, Intensive Outpatient Program, Dr. Kelli Malkasian regarding the importance of continuing with a lower level of care after comprehensive treatment. Dr. Kelli Malkasian is clinical psychologist with 10 years of experience working within the field of eating disorder treatment at a variety of centers and levels of care. Kelli began at the Oliver-Pyatt Centers three years ago as a post-doctoral resident and Primary Therapist in the comprehensive program and has since became Director of the Intensive Outpatient Program for approximately two years. Her passion and joy in work come from seeing clients shed their eating disorder identities and develop whole, sustainable, and meaningful identities which is why she loves working with the women in the IOP and TLP programs.

When residential, PHP, or as we call it comprehensive treatment is required to treat eating disorders and other co-occurring disorders it can be a long and tiresome process. So much physical and emotional work occurs during this process that often clients look forward to the “break” they imagine will happen after treatment. However, upon discharging and as reality is setting in, most clients also experience a sense of anxiety and fear about leaving the safety of the protective and caring environment that comprehensive treatment provides. Clients need this protective “bubble” and level of structure, monitoring, and support to initiate the process of recovery and to take the first huge leap towards a life without an eating disorder. However, some of the hardest work comes up after the comprehensive level of treatment, when the client is put to the task of generalizing what he or she has learned to his or her lives outside of treatment.

Enter intensive outpatient programming (IOP) and other step down programs such as the transitional living program (TLP), both of which are offered at OPC. Stepping down to a lower level of care is a very beneficial process in offering the structure and support needed to help with the challenging work of integrating recovery into one’s life, or for some going through a process of revamping their lives to better support recovery. Recovery is never a perfect process and the reality is that sometimes relapse happens. However, research and in my experience working at this level of care, we know that relapse is much less likely to occur if clients participate in step-down programs, such as IOP or TLP and follow the treatment team’s recommendations.

Providing clients with a feeling of safety, community, and an individualized level of structure allows them to develop confidence in their ability to recover, to enhance their identities outside of having an eating disorder or being a patient, and to navigate taking responsibility for their recoveries. These strengths can only come with exposure to opportunities that challenge them with the freedom to make pro-recovery choices. Additionally, with the support of the IOP and TLP treatment team, if slips or lapses do occur they can be easily caught and used as opportunities for learning and growth, further protecting the recoveries that many of these women have worked so hard to establish. At an outpatient level of care it can be much more difficult to catch and redirect slips or lapses and in the fragile time immediately following comprehensive treatment it is essential to have this additional support.

I have often used the following analogy to describe the necessity of IOP and TLP:  One would not spend months tirelessly creating a beautiful painting and then send it in its raw state out into the world before the paint dried. You would let it dry and seal it with a protective sealant first, right? IOP and TLP are that sealant over the dried paint. IOP and TLP help you to bring your work of art into the world which is full of things that could damage it, but because it is well set and protected, it is safer and better prepared.

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