Schools & Program Visits - Apr, 2002 Issue #92
Drema Stroud, Director of Admissions
Visit Report on March 24-25
Loi Eberle, M.A., firstname.lastname@example.org.
Educational Consultant & Editor
Woodbury Reports, Inc.
Recently I had the opportunity to visit Remuda Ranch, a well-known and highly
respected facility that works with adolescent girls and women diagnosed with eating disorders. What I saw during my visit reflected
Remuda’s own description of their program: which has as their focus, “the psychological, nutritional, relational and spiritual aspects
of the recovery process.” They speak of their program as a way to “prepare” the woman, rather than “take care” of them. I was part
of a tour that visited all four of Remuda’s lovely facilities, three of which were located in the desert near Wickenberg, Arizona,
with the fourth, located outside a suburb of Phoenix, in Chandler, Arizona.
It made sense both logistically and philosophically, to begin our tour by visiting the seven transitional home facilities located
in a cul de sac in Chandler. The participants who live here are in the final, Independent Living phase of the Remuda Program. From
the time an adolescent girl or woman is admitted to Remuda, explained Program Director, Amy Spohr, the Ranch staff helps her to begin
planning for her aftercare. Typically, Remuda’s programs involve 45 to 60 days in the intensive part of the program, which is followed
by between 14 and 90 days in the transitional, Independent Living phase. Women with acute and chronic eating disorders who arrive
in the program at 50 to 60% of their body weight usually stay at Vista, the more intensive facility near Wickenberg, for 60 to 120
days. All the adolescent girls who are stable enough to be admitted to Remuda stay at the Del Sol facility, also near Wickenberg.
Their minimum length of stay is 60 days. When it is determined that a girl is ready, she moves to a transitional home in Chandler.
The ranch staff explained that their followup coordinators work within the admissions department to “triage” aftercare followup once
someone leaves the ranch to return home. They continue with frequent calls up to about five years after she has left the program.
Some of the therapists around the country who occasionally are part of Remuda’s aftercare support system were also on the tour, and
reported about how Remuda maintained contact with the females who had participated in their program. Remuda employs Master’s Level
Therapy Assistants and a Follow-up Coordinator, whose function is to provide education and tools to support the discharge plan. As
soon as a girl or woman is admitted to Remuda, their registered nurse assesses potential impairments the girl might have to her recovery,
and a multidisciplinary team creates her treatment plan. Her aftercare plan is reviewed at regular intervals throughout the course
of treatment. Having an eating disorder is a very difficult and life-threatening condition, and requires ongoing awareness and focus
to overcome. Recovery is possible, however, and while there I heard stories of those who were no longer suffering from this condition.
When visiting one of the adolescent transitional homes in Chandler, I felt like I was in a typical home in the Phoenix suburbs. The
girls were watching a video when we arrived in the pleasantly furnished home. Upstairs, the bedrooms looked like they belonged to
adolescent girls! As part of reintegrating into their former life, the adolescent girls attended the school system in Chandler and
participated in various activities such as learning about life skills, boundaries and relationships, expressive therapy, cooking and
body image groups and a three-hour “experiential” at the local mall. Women in this phase participated in a similar kind of program,
except they were required to work part time at jobs and do some volunteer work. The girls I saw at the Chandler home were friendly,
pleasant looking girls. However, some of them had arrived at the Ranch with a very different persona.
When we visited the Del Sol facility for adolescent girls, in Wickenberg, some girls were still in somewhat acute condition, needing
stabilization and ongoing monitoring. I saw girls playing catch who were wearing tubes through their nose, through which they received
nutritional feedings while they slept. I learned that some of them are not permitted to be involved in intense physical activity,
since they had been exercising compulsively to burn calories. Some girls had to be driven in golf carts, rather than being allowed
to walk to the various buildings on the ranch for this reason.
In the dining room, where obviously a key part of the therapeutic work takes place, we were shown the table at which support staff
sat, available to help girls who were having difficulty at a meal. Some girls used “distraction” techniques, such as cross word puzzles
or beading necklaces during a meal. The windows in this room looked out over a restful fountain, creating a sense of peacefulness.
This feeling pervaded all the ranch facilities, helping them to achieve their mission of providing a safe and secure healing environment.
We also visited horse barns and spoke with the two, vital and active women who were in charge of the equine therapy, one of the broad
range of therapeutic activities offered at the ranch. They talked about how equine therapy is very effective for helping the women
surface and overcome their fears. It is also used as a privilege, since for their own safety, no one is allowed to ride until they
achieve a designated percentage of their ideal weight that is determined by the treatment team.
We also attended a chapel service, which is a key part of this “Biblically-based Christian treatment” program. The staff and the written
materials are very clear about the Christian emphasis of the Remuda program. It was interesting to hear their staff psychiatrist describe
the medications that have been found to be helpful when dealing with eating disorders, especially since many in the program have a
dual diagnosis with other personality disorders. He described the “optimum eating disorders psychopharmacology as: prayer, food and
water, good nutrition, and time, which is better than Prozac any day.” They also use a form of Dialectical Behavior Therapy (DBP)
that, for the “mindfulness” part of the work, focuses on the “presence of Christ”.
In addition to the interactive and experiential groups that are conducted daily to maximize their understanding of their disorder
and to encourage participation in treatment, the girls also attend academic classes. Some girls have exerted so much pressure on themselves
to perform academically, that their most important work is to let go of some of their self-imposed demands in order to first address
their more pressing emotional needs.
Another part of Remuda’s program that is strongly emphasized is working with the entire family system, when one of the members has
a serious eating disorder. A good deal of this work takes place during family week, when every effort is made to get the entire family
to attend 40 hours of workshops that take place at the ranch.
The ranch conducts these family workshops 50 weeks a year, to accommodate families at the appropriate time during their family member’s
treatment. Every Monday, Ward Keller, President & C.E.O. of Remuda Ranch, tells his story to a new group of families. He does
this in order to show how his previous behavior within his family had contributed to his 10 year old daughter’s eating disorder. As
he described his denial, perfectionism and oppressive control in his family system, it was inspiring to hear him speak about how he
learned to understand his role in the situation. He truly had earned the ability to poke fun at his previous expectations for his
family members and the insensitivity he had demonstrated. He spoke of how he had contributed to his daughter’s emotional fragility
to the point that she was “broken” by unpredictable events of life. He had worked hard to change his attitudes and behaviors and was
motivated to tell his painful story each week to encourage other “family systems” to risk looking deeply into their own behaviors.
In a Biblical sense, he was advocating taking the “log out of their eyes” in terms of what was contributing to a life-threatening
eating disorder. It reminded me of the frustration and sense of powerlessness I frequently witness, when highly competent people are
confronted with perhaps their only area of inadequacy: their children.
I am aware of other programs that also consider it extremely important to work with the entire family. It seems so obvious that a
child who is acting out is often reacting to a dysfunctional family. Yet some authorities, such as Judith Harris in the Nurture Assumption,
make the case that families are unfairly blamed when their children are struggling. She feels research shows that peers, more than
families, exert much more influence, as does society’s values of cynicism and insensitivity. A recent Spokesman-Review newspaper headline
announced: “Even Good Parents Can Have Bad Kids, Say Experts”. Are parents who want to do anything and everything to help their child
perhaps unfairly blamed as the culprit, when other influences have had a much greater impact?
I posed this question to the group of therapists at dinner after we completed our visit at Remuda. By the way, the well-prepared and
highly nutritional food we ate at Remuda was better by far than any I ate at restaurants on that trip! These aftercare therapists
I spoke with made a very strong argument for family participation in such a program. They remarked that the family may or may not
have contributed in a great degree to the formation of the problem behavior, however, if properly educated, they can play a crucial
role in supporting their child’s recovery. I feel it is important that the focus of family education should not be about blame, but
rather, responsibility. There is a powerful sense of hope that can arise in a family when they understand how each person contributed
to a situation. That knowledge empowers them to see the impact their actions can have on a family member’s recovery.
After visiting Remuda Ranch, I can say that it is a place where girls and women are allowed to rest and retreat while they are shown
tools to help them recover and are supported in developing a lifestyle where these tools make sense. The program certainly appears
to address all the important aspects of healing. If a girl or women is comfortable with the Christian orientation of Remuda Ranch
and the family is able to finance it, this program can promote a healthy recovery of a very serious eating disorder and help her create
a good quality of life. After that, it is up to her.