2009
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I was at CH twice. I was there from May-early Sept in 2007 and for 45ish days in the spring of 2008. Overall, my experience at Carolina House was very very good. Prior to that in 2005/2006, I had been at Renfrew in Florida for about 2 months. Renfrew is definitely a solid program, but CH’s size and more individualized treatment better suited my needs. I chose to go back a second time when I was struggling, confident that it would be what I needed (it was!), and they really worked with me in terms of my treatment plan. At the time of my second CH stay, I was living in Durham and working in Raleigh, and I continued to see my OP therapist once a week while at Carolina House (in addition to seeing my CH therapist). For the last three weeks of my time at CH, I went back to work part time during the day. I say this simply to illustrate that they are a flexible program.

I’m just going to do a laundry list of stuff that’s good to know about CH….

1) Food: There are 3 meals at CH (duh) and 3 snacks. When I was there, pretty much everyone was on 3 meals, 3 snacks. A few people did not have a morning snack, but the meals, afternoon snack, and night snack are mandatory. On your first day, you’ll meet with the nutritionist, E. Based on your history, your weight, & your current eating patterns, E will come up with a meal plan for you. I pretty much have only struggled with restricting, and I was always surprised how reasonable the MP seemed for the first few days. She does not give you an obscene, unreasonable amount of food at first (though that point can come!). E typically will increase your MP after a few days and then adjust it about once a week, depending on where your weight is at, if it needs to be going up, staying the same, whatever. If you are on weight gain, the rate of gain is typical for a residential facility, about 1.5 to 2 pounds a week. Since the human body is not a machine, this can’t be predicted exactly; however, E is pretty cautious with the MPs.

The MP is based on exchanges. You’ll be given a total number of exchanges for each day: X starches, X protein, X dairy, X fruit, etc. It’s up to you to distribute the exchanges throughout the day as you wish. Every few days you’ll fill out meal cards for the upcoming couple of days, and you can write in how many starches (e.g.) you will eat at breakfast, how many at starches at snacks, how many at lunch, etc. If you have, say, 4 fruits for the day, you might have two at breakfast, one at lunch, and one with afternoon snack. Or maybe you’ll have one at breakfast, one at morning snack, one at lunch, and one at night snack. If it is, for example, easier for you to eat breakfast, you might put a few more of your total exchanges at that meal than at lunch. The distribution of exchanges is up to you; the day’s totals, however, must add up to E’s plan for you. Does this make sense? Often E will do your first few days with or for you. After that, the other residents can help you out at first as well.

The food itself is pretty flexible. Not only do you decide how much you’ll eat at meals, you also get to choose what specifically you’ll eat and prepare your meals. Dinner is the exception (I’ll get back to that). Carolina House has a normal kitchen with counter space, two sinks, a dishwasher (or two? they just recently redid that), and a large pantry. The pantry is not locked, although outside of meal and snack prep, you’re not supposed to go into the pantry (unless you ask/have a reason). The knives, grators, and scissors are in a locked cupboard, and a staff member will get whatever you need out for you. Okay, so meal prep works like this: before a meal, you get your meal card from the staff member who is working at that time. Let’s say it’s breakfast, and you have a certain number of starches, fruit, dairy, and fat planned for that meal. You can decide if you want to eat your starches all as cereal, or perhaps as some cereal & a piece of toast. You can choose if your fruit is fresh, dried, or juice. Your fat may be butter or cream cheese or perhaps nuts to add to something. Dairy can also be whatever you choose (milk–it’s 2% at CH–or yogurt or cheese). Basically, there is a lot of flexibility and choice. Once you have your meal assembled, you show the staff member, who compares your food and portion sizes with your meal plan. Once the staff has made sure that you have all your required food, you take your meal over to the table (we have assigned seats and rotate about once a week). Once everyone is ready, you start to eat.

Meal prep often feels chaotic, hectic, and overwhelming, especially at first, when you don’t know where things are, when you’re still learning how to eye-ball portion sizes, when you don’t really know what you want to eat or what there is to eat, when it feels like there are people everywhere. Everyone is overwhelmed by it at first, but after a few meals or days, you get the hang of it. Regarding portion sizes, there’s a chart/list that tells you how much raisin bran, for instance, is the equivalent of one starch. It’s 1/2 cup actually. At CH, there are no measuring cups or spoons used in meal prep. You eyeball everything, but Ellen, the staff, and the other residents will help you learn what 1/2 cup looks like in a bowl vs. in a glass, or what 2T of something might look like.

I mentioned dinner was different–everyone has the same dinner template (2 starches, 3 protein, 2 veg, 2 fat). Sometimes I would add some of my other exchanges to dinner (like a fruit or a dairy and maybe a starch) to make the daily distribution more even; however, most people just eat the standard dinner w/o any additional exchanges. the chef/culunary guru, prepares a common meal (residents help her with meal prep on an assigned basis, or prepare the meal themselves for the whole house, although shei helps you out). In addition to dinner being prepared by chef, there are a few other random stipulations at other meals. One day at breakfast, it might be cereal day, so one of your starch exchanges that morning HAS to be cereal; another day at breakfast (it used to be Sundays) was waffle or pancake day (they have frozen waffles), so you have to have one of those two for at least one of your starches.

Coffee. Important. : ) Everyone is allowed one cup of coffee (or caffeinated tea) a day, at breakfast. Renfrew did caffeine tapers. Carolina House does not. They give you ibuprofen. So, if you are consuming a lot of caffeine right now, you might want to start cutting back to make the transition to one cup a day easier.

When I was at CH, veganism was allowed. It no longer is, although vegetarianism is permitted.

The expectation is that you finish your meals and snacks. If you refuse, you have to have a supplement. If you eat less than 50% of your meal, you have two have 2 supplements, if you eat more than 50% but not all of it, you have to have 1 supplement. If you don’t complete a snack, you have to have 1 supplement. Supplements are usually Boost, although when I was there, I did a mixture of Boost and ClifBars. Supplements are also used to augment the MP. For some folks, trying to eat their entire MP in terms of regular food just is too much volume, so they will choose to incorporate supplements into the MP as well.

Once a week, there’s a restaurant outing during lunch. All the residents go, as well as several staff members. It can be stressful, but it’s a good challenge, a nice time to get out, and it can be fun.

Okay, I think that does it on the food. I don’t have so much to say about the other things!

2) Weight: Your weight is checked M-W-F mornings before breakfast in the nurse’s station. You just pop down there and get weighed in a t-shirt. It’s blind weights from day one for everyone. E will tell you if your weight it doing “what it is supposed to be doing”, but she won’t tell you numbers. She will, however, reassure you that you are not gaining too quickly, if that is a concern of yours (although keep in mind, that 2 lbs a week is appropriate/acceptable). If you are at a healthy weight, your weight will still be monitored–to make sure it stays at a healthy weight. I know that people who struggle with B/P or COE often lose a bit of weight (not b/c Ellen is aiming for weight loss but b/c the crazy water retention associated with those behaviors levels out).

3) Living. As you can see from the online pics, CH is a house with bedrooms. It’s 2 or 3 women per room. You have your own bed, nightstand, nightlight. You share the closet (plenty of space), and you share the bathroom with the adjoining bedroom, so 4-6 people share the bathroom. Each bathroom has two sinks, and the shower/toilet are separated from the sink area (there’s a door). You aren’t upstairs or in the bedroom that often, so it really doesn’t matter who your roommate is, per se. You really are only in there for sleeping. Both times I was at CH, I was in the green bedroom (just a coincidence, though). I’m quite partial to it. : ) Even though I never had to switch rooms in either of my stays, it is pretty normal that you’ll have to move rooms at some point, for a variety of reasons.

4) Bathrooms: This was probably the hardest thing for me about CH. Everyone is on supervised bathrooms at first. It does not matter if you have never purged or done anything eating disordered in the bathroom in your life, you will be on supervised bathrooms at first. It basically means: you must ask to use the bathroom and you’ll be supervised. You have semi-privacy. A staff member stands outside the bathroom door, which is cracked open, with her back to the door. You do your thing, and then before flushing you’ll say “okay” or tell the staff member that you are finished. She will then peek quickly into the toilet bowl (to make sure you haven’t purged or put food in the toilet or whatever), tell you okay, and then you can flush and wash your hands. for me, this was always just …awkward. I was fine peeing, but man, I think having someone hovering outside the door totally contributed to my constipation. There is a lot of poop and constipation talk. Everyone seems to deal with it. One of the nurses, Shirley (she’s fabulous!!!), is great to take you to the bathroom if you just need time and privacy and not a cluster of residents standing in line outside the door. The length of time on supervised bathrooms varies–CH says that the typical length of time is two weeks; however, it seems like every therapist has a different degree of strictness in that arena. Some people never get off supervised bathrooms (but in that case, it’s because they really do struggle with purging or something similar).

5) Groups: there are a plethora of groups at CH. Some meet a couple of times a week, others meet just once a week. Overall, the groups are pretty well run and useful. There’s a DBT skills group a few times a week, art therapy twice a week, yoga twice a week, a spirituality group, a nutrition and ED education group, a body image group, a culinary group, and some others that I’m no doubt forgetting. These groups are typically lead by staff therapists, i.e. by people who have at least masters degrees, and tend to be pretty interactive. Another group that meets three times a week is “interpersonal” (an interpersonal relations process group). I always liked this group and found it helpful, but some people absolutely loathe interpersonal. It’s basically a time to talk about what might be going on with you personally or what might be going with you in relation to others in the house; it’s a chance to name struggles and ask for support. It’s a chance to ask others what might be going on with them. Essentially, it’s an opportunity to be very real. It can be uncomfortable, awkward at times, but I found that when I spoke up, I always benefited. In addition to these groups, some of the other structured time includes body movement, a community meeting, and “household duties.” Body movement is typically going for a walk (i.e. walking up and down the drive for 30 minutes). You do have to be medically cleared to participate in body movement, which requires seeing the doctor (who comes to the house once or twice a week), and your vitals (esp. blood pressure) have to be stable. There are brief, daily community meanings in the evening (generally had little point), and once a week in the afternoon there’s an entire community meeting, which all the staff and residents attend. It’s a chance to raise concerns about the house schedule, for example, or to hear community wide announcements. Every now and then, tense things would come up, e.g., the executive director (Stacie) might look at us with her piercing blue eyes and say, “There seem to be a lot of secrets in the house right now” …and then wait for confessional to begin… but typically, community meetings were pretty business like. Household duties occurs on weekdays before dinner, and all the residents pitch in and do things like sweep, vacuum, empty the trash cans, clean the bathrooms, water the plants, etc.

6) Individual Therapy: You are assigned an individual therapist your first day, and you’ll meet with him/her either your arrival day or your first full day and do an intake (pscyhosocial history). Twice a week you have individual therapy, and typically one of those sessions will be a family session (done over the phone usually). In addition, it’s possible to check in with your therapist briefly (for 10 or 15 minutes about) every day. And you see them off and on all day, whether it’s because they are leading a group or just because the house is relatively small so you see lots of everyone. Prior to my first time at CH, I remember thinking that therapy twice a week was not going to be enough (I see my OP therapist 3 times a week!), but b/c you interact with your T on so many levels at CH, the amount of contact and individual attention does feel sufficient. In addition to your individual sessions, you have to meet with the doctor at least once and then on an as-needed basis thereafter (your insurance will get billed for each visit for the MD–although double check to make sure that’s still the policy–so I advise only seeing her if absolutely necessary). The psychiatrist comes to the house twice a week. Everyone meets with her weekly, and if you are in the midst of med changes or are on a lot of meds or just need to see the psych, you’ll meet with her both times she’s at the house. You’ll meet with E (dietician) as needed, usually 1-3 times a week. She’s around every day, so you can always check in with her as you need to.
7) Outings/Free time/Church: There’s a good balance between groups, therapy, and down time. Sometimes to me it felt like too much structure; at other times, I wanted way less structure. *shrug* There are some scheduled outings. I mentioned the restaurant outing on Thursdays. In addition, there is a trip to Starbucks (“Expressions and Espresso”), during which we could have coffee (decaf) or some other coffee drink from Starbucks (decaf…) while we journaled on an assigned topic. It used to be a weekly group, but I’ve heard that it’s now every other week. Every other Saturday we have a group called “Shake Your Soul” that’s held over at Duke. It’s a body movement dance group thing. I HATE any kind of dancing; I always feel really self-conscious, inept, and like everyone’s judging me. I actually felt comfortable in Shake Your Soul. P, the leader, is really cool. She is recovered from an ED, and prior to coming to NC, she worked with Anita Johnson (the author of “Eating in the Light of the Moon.”). Saturday afternoons there is a group outing. As a house, you decide what to do. We often went to the movies or to Barnes and Noble. Those two things were outings that, as a house, we could actually agree upon. Other Saturday afternoon outings included various museums, the gardens at Duke, & going to Paint-Your-Pot (although b/c of the expense, we weren’t allowed to do that one that often). But it seemed like the movies and B&N were the default outings.

There is a lot of free time on Sundays. Between breakfast and lunch and then again between lunch and dinner there is nothing scheduled. On Sunday morning there is the option of going to a church service in the community. Either each Tuesday or Wednesday during the evening community meeting, staff will ask if anyone would like to go to church on the upcoming Sunday. Generally, it is possible to work out two different services to attend–e.g., one service might start at 10:30 and a different one at 11:00, so two different groups from CH might attend those services. And invariably, some people chose to stay at the house. Actually, it seemed like most of the time, most stayed at the house on Sunday mornings, and usually only one group went to church and agreed on one denomination/service. Sunday afternoons are completely free–no option of house outings, just free time at the house (and a time for visitors to come).

Carolina House has a level system–they are constantly changing the level names, so I won’t even mention what they were called when I was there. Everyone starts out at the same basic level, which essentially means lots of supervision: supervised bathrooms, can’t go outside w/o staff, can’t go upstairs w/o staff (though that maybe has changed???). Over time, you move to less structured levels. That first initial level of less structure means that you can go out on a “therapeutic” pass with family (if they are local or in town) or sometimes with other residents. A “therapeutic” pass means you’ll be doing something recovery-oriented, e.g., eating a snack out or going out for a meal, or perhaps going clothes shopping. At an even less structured level, you can go on passes by yourself for whatever reason you want (run errands, just get away from the house, etc.). Your individual therapist determines with the team what your level is, and it is your individual therapist who approves your pass requests. In my experience, they were never too picky about the nature of the passes–”therapeutic” was defined very loosely.

Where do you live currently? Will you be driving or flying to CH? Will you have a car there? Having a car makes arranging passes infinitely easier, but people w/o cars still go on passes, of course. Sometimes they pair up with residents who do have a car (usually at least 2 or 3 folks have cars), or sometimes people will get a taxi together.
8) Phones/Computers: You can have your cell phone. Your phone is stored in a locked box in the nurse’s station. Every day–actually 6 of the 7 days when I was there–there is designated phone time during which you can have your phone & call whomever. During the week, it’s typically every evening for about an hour. On the weekends, phone time is longer. In addition, you can fill out a phone pass form thing. If you need to make phone calls during business hours (e.g. to school, work, pay bills, talk to your home therapist, etc.) or during times that are not designated “phone times,” that is almost always possible. You just fill out a request slip and your therapist signs it. Again, my experience was that they were very flexible about phone use. If you needed it outside of phone time for a legit reason, you could use your phone.

They did not allow laptops when I was there–there really wasn’t any reason to have them. (Although, again, if you NEED your laptop for some reason, talk to CH ahead of time and see about bringing it. I did have mine the second time I was there b/c I was working some of that time and did some work in the evenings at CH on my computer). There is a computer (maybe 2 now?) available for residents to use. You can’t spend forever and a day on the computer–it may be that you still have to fill out a request form (I *think* we did when I was there)–but things like paying bills, registering for classes, booking flights, looking up church services, all that kind of stuff is allowed. Checking email is too, and as long as there aren’t tons of people wanting to use the computer, you can take your time (& go on facebook or check out all your other favorite sites).
9) Staff: It’s a good group of staff. The staff therapists are all very competent. My individual therapist from CH no longer is there, unfortunately. I guess all this is pretty subjective. Regardless, though, she knows her stuff inside and out. As a nutritionist, she is absolutely competent. Shirley, the head nurse, is wonderful in my opinion. She gives the best hugs. : ) Clearly, I had a problem and needed help, and they were in the position to help me. In any case, I thought you might be interested in knowing that both of them have been to seminary. Neither are overtly (or covertly) Christian in their therapeutic approach, but certainly you could bring up faith concerns with either of them.

The day-to-day stuff at CH, e.g. meal supervision (both meal prep and eating), bathroom supervision, taking residents on outings, doing body movement with residents, etc., is done by RPAs. Most of them are on the “younger” side (in their 20s or 30s, I’d say), and some you will like better than others. I liked all of them; they were all nice and their hearts were definitely in the right place. There were certain RPAs, however, that I’d feel more comfortable approaching for support or to check in with. All of them are available to answer questions, help you in the kitchen, listen, and be supportive in whatever ways they can.
10) What to bring/not bring/mail/packages: I’m sure you’ll get a packing list that will have most of the basics. You don’t need to bring towels or linens (although a favorite fleece blanket is nice!). You do need a hat (baseball cap, e.g.) to wear during meal prep in the kitchen. Some other good things to have with you–pictures, stuffed animals, slippers, a few loose fitting comfortable pants (definitely if you are on weight gain), journal, pens, any arts and craft supplies that you might use (do you knit? crochet? bead? that kind of stuff, none of which I do!), puzzle books, books to read, stationary, stamps …hmmm, this is sounding like a summer camp packing list! Bring anything that could make your time more comfortable. Some girls bring tons and tons of clothes and pairs of shoes. It seems a bit excessive…. we don’t go out that much, and when we do, it’s as a herd to places like the bookstore… In any case, bring comfortable clothes! And some looser fitting stuff. And if you are re-feeding, you might get a lot of night sweats, so you might want several t-shirts available–sometimes I’d change my t-shirt twice in the middle of the night. There are washers and dryers (free) in the house as well as laundry detergent. You can do laundry whenever you need to.

On your first day, when you arrive, someone (staff member) will go through your luggage and “confiscate” anything that is not allowed. So things NOT to bring–perhaps this is obvious, but maybe not …b/c someone at Renfrew did bring a scale. So, don’t bring a scale! They’ll confiscate it! : ) Also no tape measurers, exercise equipment, calorie books, anything that could possibly be used in an eating-disordered fashion. No gum. Magazines that might be construed as “triggering” or could possibly be misused will be confiscated (anything like Cosmo, People, Runners’ World …they even took my Newsweek! Apparently b/c there were advertisements that were food or diet or drug related, or something…). I’m one of those people who tends to pack things in plastic bags, and all my plastic bags were taken too (b/c one could purge into the bag). I also had brought a page-a-day calendar. Also not allowed. Apparently I was supposed to be focusing on my time there, not counting the days! I just wanted to do my Sudoku a day… Overall, don’t bring anything that you know you could be using to harm your recovery, and don’t be surprised if a few harmless things you bring end up being taken from you (returned when you leave, though, of course!).

All medications are locked in the nurse’s station along with various medicated ointments, band-aids, etc. Sharps (nail clippers, razors, scissors) are kept in a locked drawer upstairs and can be checked out in the morning and evening. Oh, your wallet, car keys, and other valuable are also kept in a locked box in the nurse’s station.

You can receive snail mail, and I recommend that you tell everyone you know to send you mail. Mail is fabulous while in treatment. You can also receive packages, which you’ll have to open in front of a staff member. No food or gum, no magazines (like the ones I mentioned above. Perhaps National Geographic would be okay. Or Ranger Rick. Or Highlights.).

Yes, outings are covered by the CH =) You want to bring extra money along in case you personally want to buy something (Barnes and Noble is a VERY common outing, plus there’s Target once a week) but Putt-Putt, movies, things like that are paid for by the house.

on PHP there are apartments we can stay in. I stayed on partial in the apartments for AGES. They’re about 20-25 minutes away at a weight loss centre (I know, ironic, isn’t it?) called the Structure House that’s also owned by CRC. They’re nice! It depends on your insurance what you’ll pay. Generally it’s $50 a night…I have Cigna (who didn’t even cover me that well at the CH) and we ended up paying $30 a night for over a month that I was at the Structure House.

I’d also like to add that my experience at the CH was amazing. I couldn’t have asked for a better place. They honestly saved my life. The staff is so wonderful, the groups are BEYOND helpful, meals get tense at times but…well, that’s to be expected. Usually at b-fast we read horoscopes or the paper outloud so that takes away the tension there =) All of the staff there are great and easy to talk to.