Intensive Outpatient Program For People With Eating Disorder

Presenter: Katherine
Guest: Sue Paton
Guest Bio: Sue Paton is the Clinical Director of an intensive outpatient treatment centre, EATFED in Sydney.


Health Professional Radio

Katherine: Thank you for listening to Health Professional Radio. My name is Katherine, and today, we are joined by Dr. Sue Paton, the Clinical Director of an Intensive Outpatient Treatment Centre, EATFED, in Sydney, for eating disorders. Welcome to our show, Sue.

Dr. Sue Paton:    Hi, Katherine.  Glad to be here.

Katherine:   Thank you for joining us.  Can you tell us … let’s start with a little bit about yourself and how EATFED was started as well.

Dr. Paton:   Right.  Okay, well, I’ve been a psychotherapist in private practice for the last 17 years, mainly working with women.  One of the very first things I did was run group therapy for women out in Sydney’s western suburbs.  I did that for seven years, and that was basically to help women understand what was going on in their families and their relationships, so they could make a difference in their own lives.

From that, I moved into the inner west.  That’s where we are at the moment, in Leichhardt.  How we came to be treating eating disorders was through my business partner, Evonne, because she’s also the Program Director at EATFED and she has herself recovered from bulimia. We had put our heads together and thought, “We really need to do something about this demographic”, because the treatments that we saw that were out there weren’t actually giving people recovery.

Yvonne herself had worked in one of the day programs here in Sydney, and was not very impressed from the treatment that the women were getting.  We actually were in a bookshop together and it was one of those serendipitous moments when one of those books just fell off the shelf, and I picked it up.  It was a book called, “Eating in the Light of the Moon.”  It was about working with women with eating disorders based on myths, metaphors and story-telling.  This is a book by Dr. Anita Johnson.

Katherine:   Right.

Dr. Paton:   So I brought it home and I read the first few pages, and I said to Evonne, “You have to read this book.  This book is amazing.”  Because she clearly had, in my opinion, got inside the psyche of someone with an eating disorder and really understood what was going on.

Katherine:   Right.

Dr. Paton:   I did something that I’ve never done before, and that was I emailed her.  I said to her, “I really loved your book.  Thank you for writing it.  Is there any way we can bring your treatment to Australia?”  Twelve months later, she was here in Sydney, training our staff.  That’s how it came about.

Katherine:   What a fantastic story.  I love how it all came about and …

Dr. Paton:   Yes.

Katherine:   What a great [indecipherable 02:41], and now you’ve created EATFED together.  How long have you been running that?

Dr. Paton:   Well, we started our first group back in June last year, so June 2012.

Katherine:   Okay.

Dr. Paton:   We haven’t been running very long, but we’re having great success.  It’s really a wonderful program, and we love seeing the changes in the women that are coming through the program.  From the time they come in to the time they leave, they’re completely different.  It’s great.

Katherine:   Right.  Can you tell us a little bit about the program?  What does it entail?

Dr. Paton:   The program … it’s an intensive outpatient program.  It’s the only one of its kind in Australia at the moment.  It’s an 18-week program.  What typically happens is that someone will come in and they will spend the first six weeks of that 18-week program doing three therapy groups a week.

They’re broken into three different sections.  One is a life skills group, the other one is a food and feelings group, and the last one is a group process where all the girls get together and process what’s come up for them through the week.  That’s the first six weeks.

Then, after that six weeks, if everything’s going well, we then step down to two times a week.  We drop the life skills component and then the last six weeks is spent in group process.  That’s the basic course.  Sometimes people might have to do a little bit extra.  It just depends on how they’re going.

Then, after that, there’s an eight-week, what we call a ‘maintenance group’.  You come in for an hour-and-a-half once a week to be with the other graduates of the program, just to keep you on track and make sure that you’re doing everything you need to do in order to progress your recovery.

Katherine:   Right.

Dr. Paton:   Yeah, so, that’s pretty much the program.  Along with that, I should say, you also have an individual therapist that you see once a week.  That’s there to support you through the program.

Katherine:   I see.  Before, when you were mentioning EATFED and how … the reason why you started it was there was nothing in Australia like it?

Dr. Paton:   Yeah.

Katherine:   I understand that the treatment available in Australia at the moment is a bit homogenous, and, [indecipherable 05:08] a bit behind.  Can you explain a little bit about that?

Dr. Paton:   Well, actually we have had some of the eating disorders experts, and they include Dr. Anita Johnson, but also another woman named Carolyn Costin, who’s been doing some work with the Butterfly Foundation.  She has said we’re about 20 years behind, particularly in America where they have residential treatment programs.  They have partial hospital programs, and they now have lots of outpatient programs.

In Australia, unfortunately, we have either hospital or day programs.  What I see as the problem with those particular treatments—and not that we don’t need them, because we do—they focus on the food, and so they’re really focusing on … say, for anorexia, they’re focusing on feeding, getting the weight back up to a healthy range, which is important.  Also with bulimia, often the women will go into a hospital with the bulimia, just to have a reprieve from the actual symptoms, which are the binging and purging.

That’s great, and we need all of that, but, where I think we fall down in Australia is that when you come out of hospital, you may go into a day program.  But again, that’s focusing on food.  There’s a little bit of therapy sometimes, cognitive behavioural therapy.  But there is a high relapse rate with that type of therapy.  Our program is really focused on what is actually causing the eating disorder.

One of the things that the women get quite surprised at when they come into our program is that we say to them, “We actually don’t want you to stop the behaviours,” at the beginning of the program.  That’s in complete opposition to what is asked of them when they go into hospital.  When they go into hospital, there is no binging and purging – there’s nothing allowed in terms of the behaviours to continue.  What we do is we look at the behaviours to try and understand what the eating disorder is trying to communicate.

We keep an eye on it, and definitely, anybody coming to our program has to be medically cleared.  They have to be medically stable.  We are always very concerned about the women who come in with anorexia and how much they’re restricting.  We’re very different in that way of how we treat the eating disorder.

Katherine:   Right.  What would you say would be a typical patient’s age range?

Dr. Paton:   At the moment, our demographic really – who are actually in the program, they’re all in their 20s.  The youngest is 20, oldest is 30, and that’s actually really shifted over the last six or seven months.  We do occasionally have women older than that.  Now, we get them in their 40s, late 40s, but mainly, it’s that demographic.

We do get younger adolescent girls coming in, but our programs are only for women over eighteen.  For the younger ones, we tend to do more individual therapy with them, and we also include the family much more with the adolescents.

With the women in the program, we do regular family evenings.  The families come in and get educated around the eating disorder, how to deal with their daughter or wife or whoever it is that’s in the program.

Katherine:   Right.

Dr. Paton:   They get that education along the way.

Katherine:   Yeah.  That’s important as well, for the people that love them and are with them at home.

Dr. Paton:   Yeah.  Well, they often don’t know what to do or how to be with them.  They really need that help.

Katherine:   You told us a bit about your program, but I understand you offer a program in the evening for people obviously who work or go to school during the day?

Dr. Paton:   Yeah.

Katherine:   Can you tell us about your evening program?

Dr. Paton:   That’s the idea behind our program, is that women can still continue to study or work, because as I’ve said before, often, post-treatment out of other hospitals is day programs, and they’re held during the day, sometimes five days a week.  It comes at an enormous cost to these women already, emotionally and physically.  But then, when they have to give up their jobs or their study, that’s even more …

Katherine:   Yeah, it puts their life on hold.

Dr. Paton:   Absolutely.  This way, they can still go to work or study, whether that is sometimes part-time or whatever that is.  They’re able to do that alongside of their normal day-to-day activities.

Katherine:   Okay, sounds great.

Dr. Paton:   Yeah.

Katherine:   Well, thank you so much for your time today, Sue.  For those of you that would like to learn more, you can go to  Thanks again.

Dr. Paton:   Okay, thanks, Katherine.  It’s been a pleasure.

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