I started an internship at Montrose Manor in July 2012. I am a qualified Counselling Psychologist who formerly worked at Therapeutic Services (University of the Western Cape) for two years. As a new therapist at Therapeutic Services, I was exposed to a broad range of client problems, which were often severe in presentation. However I was seldom afforded the luxury of focussing on clients’ issues which were of personal therapeutic interest to me as a result of the high change-over of clients and the brief way of working.  On leaving student counselling I decided I wanted exposure with specialised treatment methods in order to deepen my knowledge of specific client problems. I heard about Montrose Manor and became very interested in learning more about the treatment of eating disorders.
I started my 3 month internship in July 2012. I met the team of counsellors, nurses, kitchen and admin staff and the community of clients and began to find my way as an intern. For the first two weeks I joined most of the groups as an observer/counsellor, but have slowly become more actively involved as a counsellor and have conducted a few groups on Transactional Analysis. I really enjoyed joining the art and drama groups and was exposed to new and quite exciting ways of working therapeutically.
Having not worked in an inpatient treatment centre, I learnt the most in the very first few days. More specifically, the basics of having inpatients as opposed to outpatients. I learnt about meal plans and living arrangements specifically suited to individual needs. I have also learnt the importance of very strict house rules for clients in managing their eating disorders, such as rules about kitchen access and allowances for time out on weekends. I learnt about certain behaviour which is not conducive to recovery, termed “ED behaviour”, and how to manage this behaviour within a very strict inpatient approach. This was completely new to me. My knowledge on what constitutes a healthy BMI, weight and healthy diet has increased considerably and I began to ponder about very new topics such as how diet soda, chewing gum, sweetners and caffeine are intricately linked with an Eating Disorder.
In short, I very quickly had to step out of the comfort of sitting with a client in a therapy room for one hour a week, and step into a live in, home-like situation where client behaviour is monitored in a very structured way, which is imperative to treatment. Each usual daily activity is treated as an opportunity for therapeutic growth and every decision in the house has therapeutic value.  I have assisted in the supervision of clients with eating, walking, and general living which is an integral part of learning a new way of living in recovery. I felt a little overwhelmed at first to practice new boundaries when engaging with clients in a more normal household setting. I quickly learnt to access my “just human” approach to therapy instead of the strictly theoretical and boundaried way of working before.
I joined an intensive round the clock programme, which includes a broad range of intervention from educational lectures, individual sessions, group therapy, family therapy, art and drama therapy and exposure therapy. Exposure therapy is used particularly for clients who need special exposure with food shopping, cooking and food preparation. This meant I have accompanied clients on shopping expeditions, assisted them in the kitchen with cooking, baking, preparing meals and even sharing a meal with some. Each hour and day has provided new opportunities to learn about intervening with eating disordered clients in an inpatient programme. And that was just my first month 🙂