Clinical Treatment  FAQ

We know there is a lot to consider when entering a treatment program.  In order to help you make an informed decision regarding if this is the right process for you, our staff have compiled a list of answers to the most of frequently asked questions about BANA`s Clincial Treatment.

Because individuals need to be assessed in order to determine the suitability for each tract of Eating Disorder Treatment, specifics to CBT-E and CBT-T are password protected on the BANA website. In order to learn more about the treatment-tract you have been approved for, please contact the BANA intake department for information on accessing the CBT-E or CBT-T specific FAQs as this information will only be provided to clients approved for treatment.

For general inquiries on our clinical treatment, click on the tabs below for more information.

Clinical Treatment FAQ

The time of year, the number of available clinicians, and the complexity or readiness of clients already engaged in treatment often impact the length of wait before starting treatment. It is difficult to state a definite timeframe in terms of wait times, as they are constantly shifting.

On average, BANA’s wait times typically range between 4-8 months; however, BANA has seen both longer and shorter wait lists in the past.

All of BANA’s services and programs are free of charge to Ontario residents with a valid OHIP card. BANA is a non-for-profit organization, funded by the public.

Beginning eating disorder treatment can be scary. BANA commends any individual who is looking to create change for themselves; it is not easy to seek help, and it takes a great deal of courage!

The BANA clinical team encourages clients to consider the following when beginning eating disorder treatment:

  • Expect discomfort and distress
  • If change was comfortable, you would have already done it. Change requires you to step outside of your comfort zone, which may cause you to feel uncomfortable and likely face distress. We encourage clients to not let this deter them from continuing on in treatment – they are necessary feelings in the change process, and will be inevitable in treatment.
  • Practice patience
  • You have likely faced the eating problem for quite some time, and it will realistically take time to shift these habits. Patience will be important, as the benefits from changes made in treatment may take time to manifest. We encourage clients to practice skills and tools ongoingly, even if they don’t produce results right away.
  • Recovery is not a straight line, and set backs are expected
  • There is no clear path to recovery; it may involve steps forward and backwards. Set backs are a normal part of treatment, and can be used to gather helpful information for relapse prevention. Expect challenges along the way, and work with your clinical team to overcome them. The more you do, the more familiar you will become with the process of “getting back on track”!
  • The more you commit, the more you’ll get out
  • Recovery does not occur in your appointments – it occurs when you apply what is discussed in appointments to your day-to-day life. The more you consider and apply skills/tools developed in treatment, the more you will increase positive outcomes in your recovery journey.

Which therapist a client is assigned is dependent on therapist-availability. BANA clinicians carry full caseloads, and typically pick-up new clients when an opening becomes available in their schedule. Therapists contact clients who are at the top of the waitlist to inquire about starting services.

Client’s do not typically have choice over their assigned therapist, unless there is an evident conflict-of-interest or previous-standing relationship. If a client is returning to BANA programming, BANA attempts to pair the client with their previous therapist to maintain the therapeutic alliance. Upon returning to BANA, a client can request to be paired with a specific therapist; however, this does not guarantee that they will be working with said therapist.

Once a therapist has been assigned, clients cannot “switch” therapists. Exceptional circumstances will be considered; however, BANA encourages clients and therapists to overcome their differences and work together, as this is an opportunity to learn new skills, and to practice patience, acceptance, and tolerance. Because BANA is a non-profit organization, it does not have the resources to accommodate therapist-preferences for non-exceptional reasons. Furthermore, switching therapists can slow down the treatment process and lengthen wait times.

Eating disorders have been commonly shown to co-occur with other mental health diagnoses. Many BANA clients are engaged in eating disorder treatment while simultaneously accessing other supports in the community.

Beginning eating disorder treatment with a client who is accessing other mental health supports will depend on the level of intensity of those services. Furthermore, BANA often seeks consent from the client to consult with other mental health supports in order to harmonize care and avoid duplication of services.

Because client’s need to be assessed in order to determine the suitability for each tract of Eating Disorder Treatment, specifics to CBT-E and CBT-T are password protected on the BANA website. In order to learn more about the treatment-tract you have been approved for, please contact the BANA intake department for information on accessing the CBT-E or CBT-T specific FAQs. This information will only be provided to clients approved for treatment.

After a comprehensive, specialized eating disorder assessment is completed, the BANA clinical team meets to discuss the best interests of the client. From information collected directly from the client, paired with expert knowledge and clinical impressions, the clinical team determines whether a client would be best suited for CBT-E, CBT-T, or a referral elsewhere (such as more intensive eating disorder services, or an external community referral).

When deciding between CBT-E and CBT-T, the clinical team considers the client’s level of cognitive ability; their success in past treatments; the level of engagement in external resources; readiness and commitment to change/implementing tools; and comorbid diagnoses occurring.

When determining whether to refer a client to more intensive eating disorder programs, the clinical team considers the client’s severity of symptoms, BMI (automatically refer significantly underweight clients with a clinically-low BMI), and success in past treatments. Often, high-risk clients require medical monitoring, meal support, or symptom interruption in order to ensure their safety/wellbeing, and to improve their recovery outcomes.

If a client presents with primary concerns that appear to take precedence over the eating disorder, or if the client does not meet criteria for an eating disorder diagnosis, the BANA clinical team will offer a non-eating disorder related referral to external supports. BANA often refers to Canadian Mental Health Association, Windsor Essex Community Health Centre, the Sexual Assault Crisis Centre, and many other organizations and/or private practitioners within the Windsor-Essex community.

At BANA, there are general expectations for clients engaged eating disorder treatment:

  • Following BANA policies and procedures
  • Attendance in scheduled sessions, or contacting BANA to cancel/reschedule when unable to attend
  • Required weekly weighing, done collaboratively with clinician or dietitian
  • Completion of daily self-monitoring logs
  • Completion of assigned homework
  • To regulate eating, with the support of the BANA clinical team
  • Attempts to use treatment tools or meet collaboratively outlined goals, when applicable

WEEKLY WEIGHING

Once a week, clients will be weighed through a collaborative weighing process. Weighing is a pertinent part of treatment, and clients will be taught how to understand weight fluctuations, as well as how to challenge beliefs about weight/“number on the scale” and it’s relation to food and eating.  When applicable, weekly weighing is also utilized to monitor weight restoration or maintenance.

SELF-MONITORING LOGS

Clients will be asked to complete daily self-monitoring logs. BANA asks that these logs are completed in “real time”, meaning as events are occurring. This “real time perspective” provides the most accurate picture of the eating disorder, and allows clients to develop awareness around their behaviours, moods, and thoughts.

Self-monitoring logs request information on wake and sleep times; eating and drinking times – along with food content, quantity and portion sizes; eating disorder symptoms that occurred; length and type of exercise engaged in (if applicable); as well as thoughts, events and emotions that occurred throughout the day.

REGULAR EATING

A core foundation of any eating disorder treatment is regular (or mechanical) eating – sometimes referred to as “eating by the clock”. Generally speaking, this refers to the time of which and how frequently a client is eating.

Clients will be asked to aim for 3 meals and 3 snacks a day, going no more than 3-4 hours without food. Clients, their clinician and dietitian will set goals and develop tools to assist the client in this process.

Regular eating has been shown to:

  • Reduce majority of episodes of binge eating
  • Address restricting and fasting behaviours, thereby reducing physiological and psychological deprivation
  • Provide a sense of control around eating
  • Allow for stronger, more trust-worthy hunger and fullness cues to return
  • Reduce preoccupation with eating and food
  • Paired with healthy exercise, allows the body to find it’s “set point”
  • Provide direction for food portioning and balancing work, as well as intuitive eating

HOMEWORK

After every session, clients will be assigned homework. It is expected that client’s complete homework, as well as consider how homework can be applied ongoingly in order to create change. Homework is a foundational part of treatment, as it strategically encourages clients to incorporate new skills and tools in their day-to-day lives, and within the environment at which the eating disorder was developed and/or maintained.

If homework is incomplete, the clinician and/or dietitian will address this with the client, and problem-solve barriers. Homework may include an assigned reading, reflection activity, worksheet, behavioural experiment, exposure exercise, meeting a goal, etc.

At BANA and within eating disorder treatment, the role of the dietitian varies and is especially influenced by client need. In many cases, work with the dietitian is a vital component to treatment.

Work with the BANA dietitian includes psychoeducation about the body, nutrition, food and eating; support around regular and intuitive eating; striving for balance; weakening the diet mentality and challenging food rules; and increasing awareness of and connection to one’s body. Exercise, symptom-reduction, sleep hygiene and water intake are also commonly incorporated.

Depending on need, clients engaged in CBT-E and CBT-T may have the option of accessing dietitian support. The frequency of dietetic sessions may be different for every client. The dietitian may also be accessed through unique treatment plans, such as individual supportive sessions for nutrition and health, or for psychoeducation. These are approximations, and may vary from client to client.

Eating and body image are intrinsically linked. Typically speaking, when eating changes, so does the body and vice versa. If eating is disordered or symptoms remain unchallenged, it can result in maladaptive thinking regarding body shape and weight and how these may be influenced or changing. Because eating disorders incorporate both eating and body dissatisfaction, both need to be addressed in order to maximize on recovery.

There are some exceptions to this, such as in the case of ARFID. Exceptional circumstances are considered in treatment planning.

It is not uncommon that clients need extra time to solidify change. In some cases, clinicians advocate for their client(s) to get additional sessions, so long as the client has been engaging tools and skills, committing to behavior changes and goals, and prioritizing treatment thus far.

After sessions are completed, clients engage in check-ins to assess how recovery is going. If a client is continuing to struggle after treatment, they will be re-assessed in order to determine an updated diagnosis and – potentially – a new treatment plan.

Clients who need more support post-treatment may receive individual “booster” sessions or check-ins, be invited to a treatment group or skills training, or referred to other resources in the community.

Life can be unpredictable, and it is not uncommon that circumstances arise during the course of treatment that makes it difficult for the client to fully engage in treatment demands.

Client’s engaged in CBT-E or CBT-T have a one-time option of putting treatment on “pause”. Doing so will pause sessions for a period of one-month, allowing the client time to attend to other life circumstances. After the pause is complete, the client and their clinician will meet to discuss where the client is at, and make a plan to get “back on track” (if applicable); thereafter, treatment will resume at the session number where it was left off.

In some cases, one-month is not enough time to suffice. Should this be the case, clients have the option of returning to the bottom of the treatment waitlist – this should provide additional time to attend to other life circumstances.

Because treatment at BANA is voluntary, a client can terminate their treatment at any time, and will be welcome to return to BANA in the future should they find themselves in a better position to fully engage in programs.

BANA welcomes supportive persons in sessions. It is not uncommon that loved ones attend sessions with clients in order to better understand the nature of the eating disorder, and their role in their loved-one’s recovery (including tips on how to support).

BANA asks that clients provide advanced notice before bringing a support person with them to an appointment. Advanced notice allows for the clinician and/or dietitian to plan the session accordingly, and to seek written consent from the client for confidentiality purposes.

BANA offers services in English and French, as there are members of staff who are francophone. For services in other languages, translators can be used.

Treatment at BANA can be offered virtually; however, it is best that the client and BANA clinical team make this decision together in order to ensure it is in the best interest of the client’s recovery.

Virtual treatment requires the client to have a private space with internet access, free from distractions and interruptions. Treatment materials, as well as session links, will be exchanged via email; therefore, the client will be required to have an email address, and to check it regularly. Clients will be required to send their clinician and/or dietitian their completed self-monitoring logs before every session. Clients who opt for virtual treatment will be required to have a scale at home, as collaborative weighing will still be an integral part of the treatment process and will be completed weekly.

For virtual sessions, BANA utilizes the “OTN” and/or the secure version of the “ZOOM” video-conferencing platforms.

For accessibility purposes, BANA has been working hard to convert materials into multi-media formatting, as well as to offer materials through a variety of platforms. Materials can be accessed through hard copies, online through the BANA website, electronically through secure email or USB’s, and in some cases can be provided in audio-recording or video format.

TOGETHER

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