Stage 5: relapse prevention and discharge planning
Deciding when to discharge a young person from treatment for an eating disorder can be tricky, due not least to the following three factors:
1 patient uncertainty about whether they will ‘cope’ 2 parent anxiety about whether they will cope with their child 3 therapist uncertainty about whether suﬃcient progress has been made.
In most cases, worries about potential relapse drive the uncertainty. Some therapists say that discharge planning begins from the start of treatment, whereas others admit to avoiding the topic for fear of raising anxiety in either the patient or the parents – neither approach seems particularly helpful. It is important for patients and their families to be aware that discharge is an inevitable aim of treatment, and the 6-weekly reviews provide an ideal opportunity to put this on the agenda. It makes sense to reduce gradually the frequency of sessions prior to discharge, mainly to encourage the child and her family to see that they can cope without their therapist but also so that any speciﬁc diﬃculties as a result of stopping treatment (such as transferring weighing to the home environment) can be addressed.