What is the difference between in-patient and out-patient treatments? What are the various levels of treatment for someone healing from an eating disorder? How can parents be productively and actively involved in their child’s treatment? In this podcast episode, Dr. Cristina Castagnini speaks about Seeking Care and Understanding Treatment with Dr. Michael Wetter.


An image of Dr. Michael Wetter is captured. Dr. Wetter is featured on the Behind the Bite podcast. Dr. Michael Wetter, Psy.D., is a clinical psychologist with over 25 years of experience, who has a private practice in Los Angeles and is the Director of Psychology at UCLA Medical Center, Division of Adolescent & Young Adult Medicine. He is an Adjunct Professor of Psychology at Pepperdine University and has served in leadership positions at nationally ranked hospitals including Kaiser Permenante and Cedars Sinai Medical Center. Dr. Wetter is an award-winning author of books including “Earn It: What to do when your kid needs an entitlement intervention” and “What Went Right: Reframe your thinking for a happier now". You can learn more about Dr. Wetter by visiting his website at www.drwetter.com. Connect on Twitter or LinkedIn. Contact his practice at 818-835-7707 or email him at drwetter@drwetter.com.


  • Restrictive treatment
  • Residential treatment
  • Partial hospital program treatment
  • Intensive and traditional out-patient programming
  • Different treatment modalities

Restrictive treatment

There are multiple levels of intervention available for people who need treatment through an eating disorder. First, what the doctor needs to understand is how the disorder is manifesting itself in the patient. Common types of eating disorders are:
  • Anorexia nervosa and its subtypes,
  • Bulimia nervosa and the degrees of bulimia
  • Avoidant restrictive eating intake disorder.
What will really determine the disposition and effective recommendation is where along the line of continuum of the particular disorder does the patient fall. (Dr. Michael Wetter)
When medical staff are concerned about a patient’s medical stability, psychotherapy is not the main course of action, but the goal is then instead to preserve the patient’s life. This is when the protocol falls under restrictive treatment:
  • The average length of stay in the hospital is 10 days.
  • The focus is on making sure that the patient is getting the nourishment and nutrition that they need.
The goal is not to get fat; the goal is to become medically stable. The hardest part for these patients is the understanding that the improvement means weight restoration to a certain degree, which means gaining weight, and that is completely terrifying for someone who is suffering from an eating disorder. (Dr. Michael Wetter)

Residential treatment

When a patient is in residential treatment, they live in accommodation and take part in a program that provides immersive treatment.
  • Patients have all their meals there
  • They take part in group and individual therapy
  • Nutritional therapy is provided.
Residential treatment provides an immersive therapeutic experience that is guided by professionals for the patients that centers their healing and well-being.
I would venture that for many of these patients it is a shock to the system because the child is not being confronted, it’s the eating disorder that’s being confronted, and it has nowhere to run. (Dr. Michael Wetter)
The average length of stay depends on the facility and the individual, but it can be anywhere from eight to 12 weeks.

Partial hospital program treatment

PHP treatment is similar to day-treatment where the same types of programming are afforded: individual and group treatments, nourishment, medication prescription. The difference is that patients go in every day and then go home at night. PHP treatment is a step-down from residential to going back home.

Intensive and traditional out-patient programming

IOP treatment is similar to PHP where a patient stays at home and goes in for treatment anywhere from three to five days a week. A patient may have a single meal at the hospital or treatment center instead of having all three meals. The focus here is on individual and group therapy instead of focusing solely on medication. After intensive comes traditional outpatient programming, where a psychologist and dietician or an ad-hoc team will work directly with the patient.
The most important part of all of this is getting the initial assessment and not making the assumption that this is the level of care that my child needs, but really getting that professional assessment and recommendation of “this is where they can best be served at this state and at this place in their diagnosis”. (Dr. Michael Wetter)

Different treatment modalities

  • Cognitive-behavioral therapy (CBT)
  • Family-based treatment (FBT)
  • Family-based therapy
I would encourage parents to really understand FBT more before you say “yes” … FBT is really creating a residential treatment program at home. (Dr. Michael Wetter)

Books mentioned in this episode:

BOOK | Dr. Michael Wetter  - “Earn It: What to do when your kid needs an entitlement intervention” BOOK | Dr. Michael Wetter - “What Went Right: Reframe your thinking for a happier now"



I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!


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