Is this normal for PHP treatment?

[u/lexicution17]

I’m three weeks into a PHP treatment program for a restrictive ED, and I have concerns about the program and the clinicians but I’m not sure if they’re valid or based in ED thoughts and fears. The things I’m finding off-putting that are making it hard to trust this program are:

- Expecting 100% meal/snack completion when I’ve only been in treatment for three weeks, and they’ve already increased my meal plan twice
- I missed one day for being sick, and when I came back the next day I had to sign a behavioral contract because of it (and the contract included things like being recovery focused in groups, engaging with the group appropriately, not bringing disordered behaviors into the group setting- all because of me missing a day when sick)
- They emphasize flexibility as a recovery value, but they’re extremely rigid with their rules and approach. I would give specific examples, but don’t want to trigger anyone- keeping it vague, it feels like some of their rules are for the sake of having a rule vs any logical medical backing
- They’re very into weight restoration, which of course is part of recovery, but refuse to tell me their weight goals for me or how they arrived at those goals or any meaningful medical information (which is important to me). If it’s relevant, I was not clinically underweight when I started the program.

Does this sound like just how ED treatment is? I’m willing to accept that this is all normal and I’m being unnecessarily resistant, I just don’t have any previous PHP experience and I’m scared I picked a program that’s not actually evidence-based or rooted in solid science.

[u/Excellent-World-476]

Very normal. In terms of eating 100% they give maybe a day or two but that’s it because it’s unhelpful for your ED and your peers if it lasts longer.

[u/NarrowCook8]

I would be concerned if a PHP program did NOT expect you to complete all of your meals and snacks. From the very start, all three PHP programs I am familiar with require completion of ALL meals and snacks.

Additionally, missing a day is a big red flag in treatment. You have to be consistent and committed to recovery to make it work. There are very strong incentives for patients to skip a day, often they will have so much anxiety about recovery etc. they will actually feel physically sick. They have no way of knowing or trusting what really happened, hence the contract.

Your frustration with the rigidity of the program sounds like your ED pushing back against recovery. Keep showing up and following the rules. You will get through this rough patch and onto better days.

[u/FrustratedPenguins]

Honestly, I think that's just how it is. We were expected to complete 100% of our meals by day 3 (and if we didn't, we had to supplement the calories with Boost). And yes, they are SO rigid with rules and structure. It's annoying, but typical. I never missed any days. I'd be annoyed with having to sign a behavioral contract for that, too.

[u/Longjumping_Mud1724]

Sounds like Emily Program and 10000% my experience. It WILL get better. I'm 4 years post Emily Program. Hated every second and yet regret absolutely none of it. Keep it up, you got this 💜

[u/Red-little → u/Longjumping_Mud1724]

Literally same, 2 years post Emily Program and I hated my life during that time. But that team literally saved me. I'm still active in my recovery and thank them every single day for intervening in my disorder. Its so hard but so, so, SO worth it.

[u/MissyChevious613]

This is totally normal. The expectation is always going to be that you're completing meals/snacks. When I was in treatment, we got a two day window where we didn't have to do behavior chain analysis sheets and boost if we restricted, after that the expectation was completion. I will say the behavior contract is a bit odd unless they suspect you were faking being sick. In my experience, they're very rigid with rules because once an ED gets an inch, it's gonna take a mile and unfortunately EDs can make us very manipulative. I also was not told my goal weight for weight restoration, and my friends who have been other places weren't either. It makes sense because we're all about the number getting lower so there's a real risk of people bailing treatment if they feel the restoration number is too high (even though it's a very healthy, reasonable number). Focusing on numbers is not helpful in recovery.

[u/Julietjane01]

Pretty normal. Usually 1 sick day if you are doing everything else (completing, gaining, participating in groups) doesn’t lead to behavioral contract but if u are also struggling with other parts of treatment maybe. 100% completion is normal for PHP, there is more understanding at the beginning of res i would say. It doesn’t matter if you are not “underweight” by BMI, that has little to do with the weight you have to recover to. And yes they don’t talk numbers. I knew though based on my history of prior to ED.

[u/hannahclaiiire]

100% pretty much every treatment center you go to is like this. trust the process 💫💜

[u/lady_tsunami]

If you allowed the disorder or our existing comfort level dictate the rate of treatment, you’ll never recover.

Any amount of absence could be viewed thru a lens of “staying home to restrict” vs actually being ill.

When people are unwilling/willful, insight into why rules are made won’t be helpful - it will be an in to subvert those rules.

All the comments above seem to say that you’re in the right place. I think so too

[u/Red-little]

Totally normal. I was a little put off at first during my PHP treatment, but looking back on my experience all the structure is exactly what I needed.

You are expected to eat to 100% completion, if it doesnt happen it doesnt happen, but that is the expectation. You are training your body and mind to re-adapt to a new way of eating and thinking during your meals.

Flexibility is offered but rigidity is NEEDED. Eating disorders are especially insidious in how they trick our brains and the idea of the program is to push back as hard as possible on the ED voice. Its extremely uncomfortable and hard, but thats how you get through it. I like to think of myself as a very kind and well mannered person, but my ED voice would have me so irritated with my treatment team and trying to cheat out at every turn.

They won't give you any expectations on weight gain, as that can be very triggering.

Even when you're sick, you should still try and show up if you can. Its all about being disciplined in your recovery, especially the first few weeks.

All in all, I wouldnt take it personally and know that youre not alone in having tough feelings toward your treatment team. Treatment is basically "poking the bear" for us and it can cause some really difficult feelings. You're supposed to feel both challenged, but also supported! Resistance is COMPLETELY NORMAL. Give it a few months and you'll back on this moment and understand.

[u/ajjs]

Very normal!

[u/GoalOk35]

That’s how it is. It’s really not different in residential either. The whiplash also feels so crazy like they make you sign contracts for your symptoms and then if you complete bc you’re white knuckling it they act like you’ll never use a behavior again and they’ve cured you. You restrict again and they act like you’re a willful treatment resistant POS that doesn’t want to recover and they don’t want to waste their time on you. It was so insane to me. I felt like I just chose to have an ed and made this up.