I'm interested in working with disordered eating/ED populations after graduation and I'm curious to know what are the most well respected programs and/or inpatient centers for ED treatment on the east coast?
Best training/centers for eating disorder treatment?
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I'm not an ED person but my program had a lot of them. The biggest ED expert I know did their internship at Western Psychiatric. I also know ED people who did internships or fellowships at West Virginia University Medical Center. I want to say Mount Sinai, Yale, and Harvard/McLean are also known for ED training. If you are okay with the south, University of North Carolina has a center of excellence for eating disorders, and University of Mississippi Medical Center has a good reputation as well.
This isn't east coast, but UCSD is really great for eating disorders.
This isn't east coast, but UCSD is really great for eating disorders.
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Seconding UCSD, especially for family-based treatment (which is really the gold standard for evidence-based adolescent/young adult ED treatment).
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They have a strong DBT component too, one of the supervisors worked with Linehan and is now a trainer with Behavioral Tech.
I can't speak to reputation, but Monte Nido, The Renfrew Center, Sheppard Pratt, Walden Behavioral Care, John Hopkins, Columbia, and Princeton all have inpatient programs along the east coast. In addition to the programs mentioned above Drexel, UPenn, and Mass General also have strong training programs in outpatient ED treatment if you are interested in that setting.
Thanks so much for this!
Good to know! I actually recently was asking someone if there was a standardized modality that's most commonly used for inpatient ED treatment. Sounds like FBT is a big one for younger populations! What are your thoughts in regards to anyone older than a young adult? Say mid-20s and up? Do you think there's a place for psychodynamic work with ED populations?
Thank you!
I am psychoanalytic and did my postdoc in an eating disorder clinic in the East Coast. Treatment was based on behaviorism and focused on symptom management using punishment/rewards with little interest in patient's states of mind, internal world, subjective experiences, etc. Pts, their families, or clinicians were blamed when pts didn't eat. Of course I left as soon as I could. I found DBT was useful for pts when it was used properly and integrated into the group's current anxieties. I am not aware of any place that uses psychodynamic understanding of EDs.
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Ooh, pick me! I’m an ED specialist and have worked in the field for the past 6 years 🙂 Any particular questions? Are you a masters level therapist or a psychologist in training? Where are you geographically located? (New England vs. South Atlantic is very different, for example). Is there a level of care you prefer to work in? All will affect your options.
For the record, I am psychodynamic and use psychodynamic intervention in my work. Most facility-based treatment will center on CBT, DBT, ACT, ERP, but therapists can incorporate their own theoretical leanings in individual sessions for sure.
For the record, I am psychodynamic and use psychodynamic intervention in my work. Most facility-based treatment will center on CBT, DBT, ACT, ERP, but therapists can incorporate their own theoretical leanings in individual sessions for sure.
Oh wow yes I have so many questions! I'm a masters level graduate student. I'm on the east coast right now but also might move back to California after graduation. Depends on what kind of jobs are available to me. I'm not entirely sure what level of care I'm interested in working in to be honest...Longterm I know I want to be in private practice so perhaps having the experience of working inpatient after I graduate would be important for me? Personally I am psychodynamically oriented but know it's pretty rare to see EDs approached psychodynamically in institutional/facility settings. Do you find a psychodynamic orientation to be more effective or just different? Do you incorporate any behavioral models into your approach?
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I would highly recommend you try out all the levels of care. ED tx in particular requires a lot of collaboration of care between the LOCs and as an outpatient provider, oftentimes you will be making the recommendation for your patients to go to HLOC and need to know the difference in model between, say, an RTC and an IOP.
Plus, you will get your associate hours SO FAST in HLOC because it's nonstop direct patient care. I was done with my hours within a year and just had to wait for the minimum time to hit haha. RTC in particular makes the hours go by super fast.
Off the top of my head (it's also been a while since I've checked - new facilities are opening up literally every month):
East Coast treatment centers of note: McLean Klarman, Princeton, Robert Wood Johnson, UNC, Drexel, Veritas, Emily Program, Mirasol, Carolina House, BALANCE, Body Image Center
West Coast: Alsana, Denver ACUTE, Stanford, UCSD, UCLA, Center for Change, Meadows, Lotus Collaborative, Cielo House, Sierra Tucson, Reasons, Opal, Montecatini, Central Coast, Los Gatos, Healthy Teen Project
Nation-wide companies with TONS of facilities everywhere: Eating Recovery Center, Center for Discovery, Monte Nido & Affiliates (includes Monte Nido, Clementine, Rosewood, Walden, Oliver-Pyatt), Renfrew
At risk of doxxing myself, I've worked all levels of care at the big companies (ERC, CFD, MN) and some of the smaller ones I've also mentioned above. Feel free to PM me if you want more specific details.
Psychodynamic is effective once they are stable enough to mentally engage. At the IP/RTC LOCs it is primarily behavioral/CBT/DBT. They are not well nourished enough to engage in deep work. PHP is when I start really bringing in some of my psychodynamic interventions. That said, your theory is your theory regardless of what techniques you use - I psychodynamically conceptualize my patients in IP just as I would my patients in OP.
Are you in your internship year yet?
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A thousand years ago I trained and worked w. EDs, and they are some of the most resistant cases you'll find clinically. I was most interested in the cognitive impact of EDs on the brain and in regard to decision-making, though conceptualizing cases and treatment of cases were some of the most interesting I've had as a clinician. @chicandtoughness and others have provided some great info already, so I'll just talk about some of the less obvious aspects related to clinical care of EDs.
EDs are *very* treatment resistant and often it takes multiple/numerous attempts for treatment to stick....and even then relapse is somewhat common. I generally conceptualize it as a life-long consideration (read: battle) because for most, it's something that often pops up throughout life, depending on life circumstances, stressors, etc. In an ideal scenario, you'll be able to get to train/work at a couple of different levels bc in-pt / refeeding is *very* different than out-pt. Residential, in-pt, and intensive out-pt are the in between levels, each with their pros/cons.
ED work can be tough, but it also can be very rewarding. Anorexia Nervosa has one of the highest mortality rates of any psychiatric condition, and co-occurring mood disorders and substance abuse are quite common. Trauma (all forms) is commonly present, but not always. My personal pet peeve is over-diagnosing, which can happen easily in ED cases, especially when they start in hospitals and/or in-pt psych. Having a quality prescriber to consult with is also really helpful because these cases can often have numerous medical complications as a result of the ED. There can be an over-medicalization of psych stuff, but that's something that you just need to get experience navigating.
Psychodynamic conceptualizations were all the rage back in the day, thanks largely to folks like Hilde Bruch, MD. Bruch (as you likely know) was a german psychiatrist who wrote a seminal book "The Golden Cage". A lot has occurred in the research since '78 when she first published it, but some of those ideas are still very applicable in modern treatment. The challenge is that certain settings fit better w. certain treatments: hospitalized--> behavioral, residential--> behavioral / CBT / family based treatment, out-pt--> psychodynamic, Beh, CBT, other, which is as much about what insurance will cover, as it is about effectiveness. I've been away from it long enough, I can't really comment on coverage and treatment lengths, so I'll defer those areas to others.
Depending on the medical status of the patient, particularly those w. anorexia, that can severely limit the patient's ability to fully engage. Education-based and behavioral interventions tend to be the early on stuff. It can be pretty rough for most patients, especially their first time through, but that's where good supervision and mentorship really come into play. ED work is one of the few areas where I think psychodynamic conceptualization can be pretty helpful, though I still worked primarily from a behavioral and CBT framework for interventions. It's pretty common to see patients pop back up, across most settings, so make sure not to base your success or failure on who relapses or doesn't.
It's likely best to be open to a variety of frameworks because if you work in the area regularly, you'll run into most of them. It's generally a pretty small world, so many clinicians have trained together and/or referred to each other when patients relocate. The various conferences can be really interesting too. Once you get out of training you'll see that there are a wide range of programs....and personalities. There are some toxic places and providers, just like in every niche area, and they are generally known because it tends to be a small world.
EDs are *very* treatment resistant and often it takes multiple/numerous attempts for treatment to stick....and even then relapse is somewhat common. I generally conceptualize it as a life-long consideration (read: battle) because for most, it's something that often pops up throughout life, depending on life circumstances, stressors, etc. In an ideal scenario, you'll be able to get to train/work at a couple of different levels bc in-pt / refeeding is *very* different than out-pt. Residential, in-pt, and intensive out-pt are the in between levels, each with their pros/cons.
ED work can be tough, but it also can be very rewarding. Anorexia Nervosa has one of the highest mortality rates of any psychiatric condition, and co-occurring mood disorders and substance abuse are quite common. Trauma (all forms) is commonly present, but not always. My personal pet peeve is over-diagnosing, which can happen easily in ED cases, especially when they start in hospitals and/or in-pt psych. Having a quality prescriber to consult with is also really helpful because these cases can often have numerous medical complications as a result of the ED. There can be an over-medicalization of psych stuff, but that's something that you just need to get experience navigating.
Psychodynamic conceptualizations were all the rage back in the day, thanks largely to folks like Hilde Bruch, MD. Bruch (as you likely know) was a german psychiatrist who wrote a seminal book "The Golden Cage". A lot has occurred in the research since '78 when she first published it, but some of those ideas are still very applicable in modern treatment. The challenge is that certain settings fit better w. certain treatments: hospitalized--> behavioral, residential--> behavioral / CBT / family based treatment, out-pt--> psychodynamic, Beh, CBT, other, which is as much about what insurance will cover, as it is about effectiveness. I've been away from it long enough, I can't really comment on coverage and treatment lengths, so I'll defer those areas to others.
Depending on the medical status of the patient, particularly those w. anorexia, that can severely limit the patient's ability to fully engage. Education-based and behavioral interventions tend to be the early on stuff. It can be pretty rough for most patients, especially their first time through, but that's where good supervision and mentorship really come into play. ED work is one of the few areas where I think psychodynamic conceptualization can be pretty helpful, though I still worked primarily from a behavioral and CBT framework for interventions. It's pretty common to see patients pop back up, across most settings, so make sure not to base your success or failure on who relapses or doesn't.
It's likely best to be open to a variety of frameworks because if you work in the area regularly, you'll run into most of them. It's generally a pretty small world, so many clinicians have trained together and/or referred to each other when patients relocate. The various conferences can be really interesting too. Once you get out of training you'll see that there are a wide range of programs....and personalities. There are some toxic places and providers, just like in every niche area, and they are generally known because it tends to be a small world.
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Just a note, but it's a little misleading to say that Princeton has an inpatient eating disorder unit. It's not affiliated with Princeton University. It used to be called University Medical Center of Princeton at Plainsboro (it used to be in the town of Princeton then the hospital moved to Plainsboro). It's now called something like Princeton Health Penn Medicine and I believe is part of the UPenn system.
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My apologies, I didn't mean to imply that Princeton University had an affiliated unit! I was referring to Princeton Medical Center's inpatient ED unit (which is, as you said, part of Penn Medicine now). It's just called "Princeton" amongst the ED circle so I didn't even think about how that might come across to the layperson. Thanks for clarifying!
Also, +1 to everything Therapist4Change said. I also want to reiterate the statement that the ED treatment world is very small. Like, very small. As a personal anecdote, I lived in Texas and met a particular therapist there. I moved to Massachusetts 3 years later and ended up working at the same ED tx center that her sister worked at. I've seen the same patients pop up at various levels of care in three different treatment companies. I've run into clinicians five states over and after comparing case consult notes, realize we worked with the same patient. You'll meet the same people over and over again at conferences, and the professional organizations are both full of enriching experiences and cliquey relationships. iaedp in particular has a love-hate vote from me. It's absolutely wacky.
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Oh- to add. If you want psychoanalytic training in EDs, the William Alanson White Institute runs a training series every year on eating disorders that might be of interest!
Eating Disorders, Compulsions & Addictions
The William Alanson White Institute of Psychiatry, Psychoanalysis & Psychology has distinguished itself as one of the world's most prominent and respected psychoanalytic training and treatment centers for more than sixty-five years. Our faculty and nearly three hundred active graduates continue...
www.wawhite.org
Thank you!! I’m actually doing a grad school internship here there this year starting in the fall!! Very excited.
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