Don’t Sacrifice for the Status Quo
Why I started the job and why I quit.
In August of 2020, I drove to the corporate headquarters of Eating Recovery Center for my first day of a weeklong training for onboarding new employees. I had been hired a week before as a behavioral health counselor with the expectation that, come my graduation from Northwestern’s graduate program in clinical mental health counseling in December, I would be promoted to a group therapist. I arrived early, parked my car, and took a moment to snap a photo of my new employee badge. This step felt monumental in my journey.
Seven and a half years ago, I walked through the facility’s doors as a tired, mentally unwell teenager to be admitted to their eating disorder unit and now I was holding my new employee paperwork in hand, ready to enter as a professional in this field of work. I took a deep breath, which unsuccessfully did little to quiet my nerves, and turned off my car’s ignition. I opened my car door and walked inside, beaming while also shaking, thinking this was the beginning of my career.
Day one of orientation began with a series of presentations about ERC. A few years have passed, and I can’t recall everything discussed on that first day. I have brief memories of going through how to get signed up on ERC’s employee portal, how to contact the floor manager of the unit we’d been hired on, and what time the catered subs would arrive for lunch.
But what has stuck with me these last two years was the disproportionate amount of time spent discussing the impressive expansion of ERC’s facilities across the country.
I remember being told repeatedly about ERC’s long waitlists and inability to grow fast enough to treat everyone in need. This was followed by startling facts regarding ERC’s rapid expansion since its founding in 2008.
Now, two years later, I am looking at ERC’s website’s front page where they boast of their 35+ facilities and the 20,000+ patients and families that they have guided into recovery.
Two years ago, I remember feeling unsettled by these facts, and reading them today still strikes me with the same anxiety. For good reason, too.
In August of 2020, I was in the middle of researching my capstone presentation for my graduate program. I had chosen the topic of somatic experiencing in the treatment of anorexia nervosa. Somatic experiencing is a form of psychotherapy primarily used in the treatment of trauma-related disorders. It takes a bottom-up approach to psychotherapy, which emphasizes the importance of the body’s communication in healing.
I wanted to make an argument for why this alternative intervention could be a more viable option in treating anorexia, which causes a disconnection from the body. In order to do so, I needed to write about why the failures found in the current recommended treatment model for eating disorders made it necessary to consider different approaches. Essentially, I needed to poke holes in the approach to prove the norm wasn’t necessarily the best option.
The current recommended treatment approach for eating disorders is a stepped-care model. Stepped-care is a staged system matched to the individual’s needs with a hierarchy of interventions ranging from the least to most intensive.
In eating disorder treatment, the staged-care system involves inpatient care as the most intensive support and outpatient treatment as the least intensive. In between these options are residential care, partial hospitalization programs, and intensive outpatient treatment, all varying in the amount of support offered based on the severity of eating disorder pathology being presented (Streatfield et al., 2021).
Among eating disorders, ERC is the country’s largest and most influential example of this model of care.
In order for a recommended model of care to be evidence-based, it must incorporate these three essential components: research evidence, clinical expertise, and patient values, preferences, and characteristics (Peterson et al., 2016). When researching for my capstone presentation, I searched for studies that proved these eating disorder stepped-care treatment programs incorporated these three components.
Instead, I found these program’s websites and promotional materials ensuring lasting recovery for their patients, but no systemically collected objective data to support these claims. Instead, the systematic data commonly came from hospital-based programs supported by university funding, rather than these privately owned and operated treatment facilities (Attia et al., 2016).
The lack of empirically backed effectiveness of these programs explains the unsettledness I felt while listening to ERC’s HR representative brag about their success.
“1,600 employees, 35 facilities and counting, waitlists, sicker and sicker patients calling about admission…”
I looked around the room at the faces of the other new employees. Though buried behind masks — as this training was during the height of the pandemic — I didn’t see anyone else appearing upset.
My legs were bouncing, my hands were sweating, and I couldn’t keep my gaze on the person presenting. I was erupting in furry. Why was this company so proud of its expansion if there was no real indicator stating that these programs were an ethically and empirically correct approach to treating these complex illnesses?
At 4 pm the first day of orientation ended. I walked out to my car, turned on the ignition, and buckled my seatbelt, but didn’t move. I sat there, staring blankly out my windshield. The rest of the new employees drove off and the parking lot slowly emptied while I collapsed into an existential debate with my own mind.
I had applied for this job at ERC despite knowing I had mixed feelings about eating disorder treatment programs. After spending years of my life in and out of facilities just like this one, I knew from personal experience I didn’t agree with traditional models of care for eating disorders. However, I had applied anyway.
I applied because ERC dominates the eating disorder treatment options in the Denver area. I wanted to be an eating disorder therapist and, therefore, ERC was one of my best and only options for jobs post-graduation. I had my reservations when applying, but I figured my passion for the individuals who walked through these facility’s doors would outweigh the disagreement I felt with the corporation.
But as I sat listening to HR’s lectures, I couldn’t help but feel as though they saw their patients — those suffering, those seeking help, and those in need of care — as dollar signs. More buildings, more programs, and more employees all meant more people collapsing into the vicious cycle of an eating disorder.
It meant more people were sick. It meant something wasn’t working. Shouldn’t we celebrate the lack of waitlists? Shouldn’t we desire a closing of facilities? Where was the humanness, the care, the sadness? And all this celebrating came within the context that these programs didn’t have any solid data supporting the long-lasting recovery of those who walked through their doors.
Concluding Thoughts
I spent four years in and out of eating disorder treatment centers. Of those four years, 18 months were spent inside one of ERC’s facilities. Of the other two and a half years, one was spent outside of treatment and the last 18 months were split amongst three other facilities. This means I spent the most time in ERC’s program. Now, I’m only one person, so I can’t speak for the entire population of individuals who have been subjected to the stepped-care model for eating disorder treatment. But I do know that I experienced ERC as cold, corporate, and money hungry. I felt trapped inside their hallways and therapy offices.
As I drove away at the end of my first day of training, I didn’t feel empowered or excited about my career as an eating disorder therapist. Instead, I felt reconnected with that past version of myself, the one sitting in the admissions office, waiting for a therapist to escort her to the locked eating disorder unit. I felt more like a patient than I did as an employee.
I felt a rush of coldness erupt from my gut as my mind was drowned in the corporation’s agenda for growth. And, in that rush of coldness, I found some wisdom. I wouldn’t realize it right away, but I’ve come to understand that my gut reconnected me to my past self because my past self was the future clients I would work with.
Not patients. Clients — the people who were struggling and needed genuine care and love.
My old self held the knowledge of what it was like to be called a patient, to be seen as a number, to be understood as a dollar sign. My old self was the wisdom in this process. She was the one looking around the room, questioning why no one else appeared agitated by the foundation on which this corporation existed. My old self reminded me no job was worth sacrificing what I believed in.
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