Unlike most treatment programs, Milestones addresses both the emotional issues and “dependency” elements characteristic of most eating disorders. We believe an eating disorder often results in a loss of control with one’s relationship with food and/or “dieting.” Whether resulting in a pattern of compulsive overeating, repeated episodes of binge eating followed by purging or periods of dieting – or attempts to compensate for over eating by any number of measures, we’ve come to describe this eating pattern as “food obsession or dependency.” Yet for others, the compulsion to restrict food intake and avoid weight gain to the point of jeopardizing one’s health is but another form of addiction, namely anorexia. One common thread among all eating disorders, regardless of form appears to be their similarity to other forms of dependency.
One must be able to diagnose and acknowledge an dependency in order to be able to get help. The American Psychiatric Association published its’ criteria [symptom list] to clarify primary characteristics of substance dependency. It’s worth noting, although not initially intended to describe an eating disorder per se, the list of criteria can easily be applied to an eating disorder. One need only meet three  of the suggested  to justify a diagnosis of dependency. In fact, when applied to process addictions – aka compulsive behaviors – these criteria appear to work equally well [compulsive overeating, bulimia, anorexia, compulsive gambling, sex compulsion, compulsive spending, and so on…]
The program offered at Milestones is comprised of two primary components, making the treatment experience unique among most programs. In addition to employing the most current evidence based therapies for treating an eating disorder, the primary mission of Milestones is to provide residents the ability to take home that which they practiced during their stay. Let’s take a look at what makes this possible.
The first is the setting – utilizing apartment-style residences affording residential participants to experience treatment in a “real world” environment. Participants grocery shop with our dietitian in the community, learn to prepare their own meals per the prescribed food/meal plan they have formulated along with the dietitian, attend a full schedule of groups and individual therapies at our clinical campus [near the residential complex], attend local community support groups in the evenings, and visit with our physicians and clinical staff regularly throughout their stay. A key element in providing the support necessary to begin recovery is remaining in the company of other participants during the initial phase of the treatment. This provides both a form of supervision and a deterrent from the behaviors often associated with eating disorders: namely eating in isolation or alone.
Secondly, Milestones approaches treatment from a more “holistic” perspective. Doing so is best described by the acronym “SMERF” – Spirituality, Meditation, Exercise, Rest and Food Plan.
Spirituality need not equate with any religious or spiritual beliefs imposed on or by anyone. In fact, spirituality at Milestones is simply left up to the individual to cultivate with his or her own working definition. For everyone, it is an individual journey and only requires an open mind.
Meditation when practiced consistently helps one to become more aware (conscious) of the mind being “hijacked” into a stream of thought when attempting to concentrate on one thing, such as breath. The discipline of meditation (or mindfulness) with practice will begin to infiltrate your life and you may begin to live more in the present and less in your thoughts.
Exercise is individualized and represents collaboration between the resident and clinical team. It is meant to be in the service of restoring and maintaining a healthy body rather than an “intensive” means of controlling body weight.
Rest is simply about finding the correct balance in recovery between work and play and narrowing the gap between an “all or none”, “feast or famine” approach to daily living. Many people who suffer with an eating disorder fall into the trap of “never enough” as well as perfectionism. That said, rest also becomes a metaphor for finding a middle ground, not only with regard to food and body image issues, but to our approach to day to day living.
The Food Plan suggested by Milestones is a blend of structured eating with a variety of healthy, whole foods that are bought and prepared by participants with the guidance and supervision of our dietitian and ancillary staff. In brief, residents select their own preferences within the “boundaries” of their individual food plans. The guidelines require participants to abstain from “junk foods” and eliminate most highly processed [sugar and flour laden] food products, as well as, weigh and measure portions per their food plan while in residence.
Residents are assigned a primary [individual] therapist whom they meet with on a regular basis during their stay, as well as, attend groups and experiential therapies per the schedule. In sum, the physical, emotional and spiritual aspects of food dependency are addressed within these formats. Additional members of our clinical staff include our psychiatrist [providing medication management and consulting services for depression and related mood disorders if needed], internal medicine [to monitor medical issues and provide treatment as needed], a registered dietitian [to monitor body weight, exercise, and food plan] and licensed therapists.