“Alyssa, we like you. And we hope we never see you again!”
It’s funny how these words can be music to a therapist’s ears, and yet; for me, they are. After working with a patient and family during hospitalization, I usually share the same sentiment – I feel an incredible connection with the patient and family, and I hope they never need to set foot through our doors again. Life is meant to be enjoyed outside of a hospital.
These very same patients and families often tell me that the day they discharge from the hospital is one of the scariest days of their whole experience. Anxiety builds as they imagine life after leaving the hospital, without the same structure provided by 24-hour care. And, it makes sense because the stakes are high – they don’t want to lose the gains they’ve made in treatment. This is where relapse prevention comes in.
Relapse prevention is a therapeutic process in which a patient works in conjunction with a treatment team to enhance and sustain motivation for recovery — describing situations that are likely to be triggering or high-risk in nature, problem-solving how to address these situations in advance, identifying and cultivating a support system, and preparing for how any lapses and relapses will be handled. Many patients choose to conduct relapse prevention planning by completing a written relapse prevention plan with their therapist, and most therapeutic approaches include some form of informal relapse prevention planning. Components of written relapse prevention plans can vary, however, common elements often include the following:
- Highlighting Motivation for Recovery. Many of my patients have found it is helpful to write out the pros and cons of engaging in eating disordered behaviors in comparison to the pros and cons of engaging in recovery-oriented behaviors as a way to strengthen their commitment to recovery. Some also find it helpful to outline their values and celebrate the positive changes they have made in treatment thus far.
- Building and Maintaining Structure. Because many people find it challenging to transition from a highly structured environment, like a hospital setting, to their home environment, it can be helpful to plan in advance how time will be structured and what goals they will be working toward prior to leaving the hospital. This can make the transition home less scary.
- Understanding Current and Potential Challenges. When patients leave the hospital, it is common to still experience some struggles, including body image concerns, low self-esteem and urges to engage in eating disordered behaviors. It is important to have an awareness of these current challenges and, more importantly, a plan for addressing them. Outlining warning signs that would suggest their condition is worsening is often a good idea. That way, the individual can intervene early with the help of a support system.
- Preparing for Triggers and High-Risk Situations. Although it would be wonderful if our patients’ environments were free of triggers, the reality is that many will return to environments that will be full of challenges. Planning how to skillfully cope ahead with these challenges is an important component of relapse prevention.
- Identifying a Support Network. The likelihood of achieving recovery is exponentially increased when a patient has a strong support network, including a comprehensive treatment team (e.g. therapist, dietitian, psychiatrist, and primary care physician), family members, and friends. Relapse prevention planning involves writing out details about this support network, including who they are, how they can be contacted, and what they can do to best support the patient.
- Planning for Lapses and Relapses. Every time I discharge a patient, I hope it is the last time they will need to be hospitalized. The reality of eating disorders is that they are illnesses that often involve lapses and relapses in behavior. Even though this is part of the nature of the disorder, a lapse or relapse does not necessarily mean a return to hospitalization. Anticipating lapses and relapses and outlining the steps that will be taken if these behaviors occur, will help the person get back on track and prevent a return to treatment at a higher level of care.
While relapse prevention can be an effortful process, it is one that I have seen give patients and families peace of mind as they embark on the next part of their recovery journey.