The drive for autonomy is one of the must fundamental human drives that exists. Autonomy is a founding principle of our country, and ideal that has been fought for and sought by many people over the course of human history. The ability to be free from the influence of external forces, to do things by oneself and for oneself is a substantial part of what we believe it means to lead a full life. Autonomy is powerful, and the Eating Disorder takes that power away from a person when it enters into their life.
At first, the Eating Disorder might present itself as a force that enables an individual to do something they want for themselves. An eating disorder may start out as an effort to change one’s appearance, to cope with feelings, to become more “healthy”, but this guise quickly shifts into the person no longer being in the driver’s seat with their behaviors. Thus, recovery from an Eating Disorder is a way to restore autonomy and power to a person. This important process in recovery begs the question, how can you restore autonomy to a person when they need to be so closely supervised in treatment?
This is a question that is often considered by treatment professionals, and it can be somewhat of a quandary. When a person is in the throes of the Eating Disorder, they need some containment to prevent the behaviors from continuing. Yet, they also need to be developing autonomy because it is an essential part of the recovery process. In residential treatment, for example whereby clients are engaged in treatment 24/7, how is it even possible to meet these concurrent needs? The Cielo House residential treatment program in Moss Beach strikes this balance in a unique way through an approach we call “Structured Autonomy”.
Structured autonomy is a theme that runs through many of the treatment methods we employ at Cielo House. For instance, the way that meals are handled in the program support this idea. All of the meals are supervised by dietary staff, who actually sit and eat with the clients in a normalized fashion. They are there to ensure that clients get their nutritional needs met and that the eating disorder behaviors do not interfere with their progress. However, the clients are responsible for portioning and plating their own meals, and learning to gauge their nutritional needs. If they are a little bit off, the staff will help them arrive at the correct quantities, but the staff are constantly directing the clients on how to do it for themselves. Slowly, they learn and make habit of the appropriate nutritional guidelines to meet their specific needs, so by the time they leave treatment they can do it on their own.
Additionally, we often give clients specific autonomous opportunities to test and challenge themselves, as well as to continue developing a sense of autonomy. We learn where clients have difficulty and give them extra practice in those areas. For instance, if a client indicates they have difficulty eating alone, we will make it possible for them to practice doing so before they leave treatment. If they struggle with being comfortable with free time and they have difficulty just being without scheduling something to keep them distracted, we will give them an afternoon pass to practice peacefully enjoying spare time. It can feel surprising to clients to learn that we trust them to have these independent experiences in treatment. Yet, we know that they need these experiences to develop autonomy, because autonomy is an antidote to the eating disorder.
Cielo House offers the various levels of care because each level of care features different levels of autonomy within it. It is important to match up the person’s ability to enjoy and effectively utilize independent time with the appropriate level of care. If someone is not ready to have as much independence because their “independent” time is spent engaging in the Eating Disorder, then we can utilize that information to adjust their treatment plan or the level of care. Time spent with the Eating Disorder, after all is not spent building autonomy. When done correctly, treatment does not have to feel excessively restrictive. Clients need the ability to start building trust within themselves, to start growing the sense of autonomy that was deprived them by the Eating Disorder, and there is no better time to start that process than with a highly supportive team of caring professionals in treatment. The best part about the structured autonomy approach is that when a client makes progress in treatment they understand that it is not due to the efforts of the treatment team, rather it is due to their own genuine developing sense of autonomy.
Matt Keck, MFT is Found and CEO of Cielo House Comprehensive Eating Disorder Treatment programs. He has witnessed the power of autonomy for countless individuals who have recovered from Eating Disorders, and continues to enjoy seeing them find themselves through treatment.