After IOP or PHP: What Outpatient Eating Disorder Care Looks Like

By Deva Murphy, MSW, LCSW, eating disorder therapist at Shoreside Therapies in Milwaukee

Finishing a partial hospitalization program (PHP) or intensive outpatient program (IOP) is a real accomplishment. It's also the start of a new phase that many people, and many parents, don't feel ready for. Here's what the step-down to weekly outpatient care usually looks like, what tends to get hard, and how we work with it.

"I was doing really well in treatment, and now everything is harder."

That's one of the most common things I hear in the first few weeks after someone steps down from a program. And it makes sense.

In PHP or IOP, there's a tremendous amount of external structure: supported meals, groups, regular check-ins, accountability, and other people around who understand what recovery requires.

Then suddenly you're back in your everyday environment. The treatment "bubble" has popped, so to speak. Now you're making decisions about meals and snacks, following your meal plan, managing urges, navigating work or school, being around family and friends, and running into triggers, without a treatment team physically there for most of the day.

I try to normalize that a hard transition doesn't mean treatment didn't work. In many ways, this is where someone starts practicing their skills in the place they'll ultimately need to use them.

What tends to slip when the structure goes away

Meals and snacks are often the first place you see bargaining start to happen.

Maybe it starts with delaying breakfast. A snack becomes optional. Portions get a little smaller. Exercise gradually increases. Foods that were being challenged in treatment quietly disappear again.

Each change can seem insignificant on its own, but together they can create a gradual drift back toward the eating disorder.

That's why outpatient work often focuses on catching those changes early. We're asking, "Where is the eating disorder starting to negotiate again?" rather than waiting until someone is fully back in old behaviors.

How weekly outpatient therapy is different from the program

PHP and IOP are designed to provide a much higher level of structure and support. Outpatient therapy is different because we're working with what's happening as you, or your teen, return to real life.

We can look at what happened at dinner Tuesday night, what came up after seeing a photo over the weekend, what happened when someone commented on what they were eating, or why exercise suddenly felt urgent after a hard day.

There's also more space to work on the things that may be keeping the eating disorder going: perfectionism, anxiety, OCD, trauma, grief, identity, relationships, self-worth, or difficulty tolerating uncertainty and uncomfortable emotions.

The goal isn't only to stop eating-disorder behaviors. It's to help build a life where you increasingly don't need the eating disorder to cope.

Coordinating with the program you're leaving

Ideally, the transition begins before discharge.

With the appropriate releases in place, I want to communicate with the treatment team about:

• What they've been working on and what progress has been made
• What's still difficult
• Continued treatment goals and areas of focus
• Their current recommendations
• What they see as the biggest relapse risks

I also want clarity about the rest of the outpatient team. Eating-disorder treatment is usually multidisciplinary, so depending on someone's needs, that may include a therapist like me, a dietitian, a medical provider, and a medication prescriber.

Continuity matters. We don't want someone leaving a highly structured environment and then hitting a gap where they're essentially managing recovery alone.

When it's time to step back up in care

I look less at one hard day and more at the overall trajectory:

• Are eating-disorder behaviors increasing despite outpatient support?
• Is it getting harder to follow nutrition recommendations?
• Are binging, purging, restriction, or compulsive exercise becoming more frequent?
• Is it harder to interrupt behaviors on your own?
• Is the eating disorder getting in the way of work, school, relationships, or daily life?

Medical status matters as well. Changes in weight or vital signs, fainting, electrolyte abnormalities, dehydration, or other signs of medical instability need medical assessment and may mean outpatient treatment isn't enough right now. If you're seeing signs of medical instability, contact your medical provider or go to the emergency room rather than waiting for your next therapy session.

It's also important to see stepping back up as getting the amount of support someone needs at that moment, not as a failure or going backward. Recovery is never a straight line. Increasing support earlier can keep someone from struggling much more before they get the help they need.

Outpatient eating disorder care in Milwaukee

Shoreside offers outpatient eating disorder therapy in Milwaukee for teens, young adults, and adults stepping down from PHP or IOP. Deva Murphy, MSW, LCSW sees clients in person at our Milwaukee office and online across Wisconsin, Minnesota, and Illinois, and coordinates with the program you're leaving and the rest of your care team.

If you're a parent who's still trying to figure out what you're seeing, start with Is It an Eating Disorder or a Phase? A Guide for Milwaukee Parents.

The best time to reach out is before discharge, so there's no gap in care. Start with a free 15-minute consultation.

This article is for general information and isn't a substitute for medical or mental health care.