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Role of Journaling and Self-Monitoring in Outpatient Eating Disorder Treatment

At eating disorder treatment centers, accountability plays a major role in helping clients eliminate their symptoms and become recovered. In the early stages of treatment, clients receive assistance with accountability through oversight and support from the fully recovered staff members. As clients become recovered, however, they must learn how to be fully accountable for their own health and wellbeing.

To ensure clients can achieve this goal, they must learn to use self-monitoring and journaling to their advantage. Staff members provide the instruction needed to master these skills and apply them throughout the treatment process and after graduation. With this approach, clients can use these tools to remain mindful and identify when they need extra support and resources in remaining fully recovered.

What Is Self-Monitoring – and How Do Clients Learn How It Works?

Self-monitoring centers around remaining mindful of thoughts, feelings, and behaviors, and then recording them for later review. Clients also record their food intake and mealtime experience information in their notes. Tracking these areas can help clients notice patterns that indicate the need for additional support, but they must know how to decipher that data. It is also vital that clients know how to track effectively to build a solid outlook of their wellbeing outside of eating disorder facilities.

Many clients need mindfulness training and other helpful activities to begin to learn the skills that support great self-monitoring. Learning to pay close attention to thoughts, feelings, and behaviors can prove difficult for many people in eating disorder treatment centers. So, it can take a lot of practice to develop these skills and apply them enough to create useful data records and use them to remain accountable.

Eating disorder treatment professionals help their clients learn these life skills and apply them throughout the process of becoming recovered. Clients can practice these skills in a controlled environment inside the inpatient treatment centers before applying them to real-life situations on outings and after graduating. Through this gradual building of skills, clients can gain confidence in self-monitoring and journaling to remain fully accountable to their healthy selves.

The Role That Journaling Plays in Treatment and Recovery

Journaling is the mindful recording of all the things clients notice while self-monitoring. Through the recording of thoughts, feelings, and behaviors, clients can see where they need extra support and reach out for resources before problems escalate. Journaling about food intake and meals also aids in remaining accountable to stay fully recovered after graduating from eating disorder treatment centers.

Writing down what they eat and how they feel is just a small part of the journaling process for clients at eating disorder recovery centers. Journaling can act as an outlet for larger than life thoughts and feelings. They can voice their concerns, address their challenges and find relief from many problems by simply writing that information down. Through this process, it is possible for clients to identify the stressors that contribute to the development of disordered thought patterns and behaviors.

Identifying their main stressors and challenges can help the most in remaining recovered. With the identification of these areas, it is possible for clients to find healthy coping skills that assist in mitigating those factors. Through this process, clients at eating disorder facilities can build the toolbox of skills they need to handle all types of situations.

Self-Monitoring and Journaling Tools Used in Eating Disorder Treatment Centers

Clients at eating disorder recovery centers have to learn how to use self-monitoring tools before they can utilize this skill effectively. Here are a few ways clients can work on building this skill.


Treatment options for eating disorders almost always include mindfulness training. With this training process, it is possible for clients to start cracking their inner code and making progress in their journey toward recovery. Simply noticing and acknowledging personal thoughts, feelings and behaviors can prove challenging for many people working toward becoming recovered. Before they can be recorded and utilized properly, it is a must that clients are accurate and honest in deciphering these inner workings.

Mindfulness helps with this by assisting clients in noticing how they are feeling, thinking and acting at any given moment. Training this skill requires a lot of living in the present moment rather than dwelling in the past or looking too far forward. With a moment by moment account of how they are doing, clients can remain accountable for their progress toward becoming and remaining recovered. As mindfulness develops, self-monitoring becomes much easier for clients.


With worksheets, clients can learn how to journal effectively and include all of the most useful information on every page. The worksheets show the structure that will best support the patient’s recovery goals. The sections on the worksheet may cover food intake times and amounts, dining location and any associated thoughts and feelings that arose during the meal. The sections may also have room to note any disordered behaviors that occurred and the situations that led up to those events.

Clients can move onto their own journaling materials as they learn how to apply the worksheet structure appropriately. While becoming recovered, clients must find the practices that work best for them to achieve great results in monitoring their wellbeing. With the move to journaling on their own, clients gain confidence in controlling their own journey toward becoming recovered.

Best Practices in Creating and Maintaining a Journal

Upon moving past using daily worksheets as a journal, clients can utilize almost any binder or notebook as their tracking location. Clients should try to stay away from digital recordkeeping methods, as physically writing the information down helps commit it to memory. Pen and paper records also help with accountability as they are difficult to change or erase without leaving evidence. Digital records can be easily altered or erased as difficult feelings, such as shame and guilt, arise. Staying fully present and in the moment while journaling also assists in facing and addressing the challenges that arise.

Clients must record their thoughts, feelings, and behaviors in real-time to avoid making mistakes while recalling information at the end of the day. Writing down events as they occur results in the most accurate, honest information possible. To make sure this happens each day, clients must have their journal on them at all times. Clients also have to make an effort to remain mindful and receptive throughout each and every day. With this dedicated approach, it is possible for clients to gather the data they need to remain recovered after graduating from eating disorder facilities.

Using Journal Entries to Monitor Treatment Progress

Each journal entry opens the door to the patient’s mind and their innermost thoughts and feelings. Clients can use this glimpse into their own minds to their advantage by looking for trends and patterns that appear. These trends tend to reveal the underlying problems that trigger eating disorder symptoms, including disordered thought patterns and dysfunctional behaviors.

Clients can look at the type of food they eat, when they eat it and how much they consume with a focus on the situations and environments surrounding those behaviors, for example. By looking through that lens, clients can identify the challenges they face in remaining recovered. They must record their observations about the data and retain those records for later review as well. Different mindsets can reveal things clients may not have considered before, so journals and observation data can provide immense value time and time again.

When needed, clients can review the journals with the staff members at outpatient eating disorder treatment facilities for helpful insights. The new perspectives can help in making sense of the data and creating healthy coping mechanisms to handle the identified challenges. Eating disorder therapists can also set up helpful exercises that assist clients in coping with the challenges that stand in their way of becoming and remaining recovered. Fully recovered staff members can also help brainstorm activities to build improve coping skills, as needed, to overcome these challenges.

Remaining Recovered Through Self-Monitoring and Journaling

With self-monitoring, clients can constantly assess their state of mind and overall wellbeing to remain fully recovered. Upon graduating from eating disorder recovery centers, clients must utilize the skills they learned to remain recovered while handling real-life situations every day. Self-monitoring and journaling support all of the other skills learned in treatment, making them some of the most important clients will use. With these two skills, it is possible to identify challenges in remaining recovered and reach out for help before disordered thought patterns and behaviors start to take hold.

A commitment to continuing these practices outside of treatment is paramount in remaining recovered and staying accountable to the healthy self. Clients can make this commitment in treatment by mastering these skills with regular practice. Treatment centers encourage this practice through life-enhancing outings and daily life activities at eating disorder facilities. The ability to apply these skills to real-life situations can promptly reveal the patient’s strengths and the challenges they face at the eating disorder recovery center.

As clients move from inpatient to outpatient eating disorder treatment, they can begin to use self-monitoring and journaling while at home. This is an important transition as it allows for the full immersion in real-life situations while giving clients the support they need to remain recovered. Clients can address the challenges they face in self-monitoring and journaling at home while going through the outpatient treatment process. Eating disorder therapists will help their clients work through these problems to strengthen their journaling and self-monitoring skills for continued wellness after graduating from the eating disorder treatment center.

Self-Monitoring – and Knowing When to Seek Help

Eating disorder therapists spend a lot of time helping their clients understand the patterns that arise in their own data. This is especially true when looking at the patterns that show the patient could benefit from a little extra help and support. With the proper techniques, clients can use these patterns to learn when they should contact their care team for treatment options for eating disorders.

After becoming recovered, clients often need a little extra help to remain accountable to their healthy self. Through eating disorder facilities’ alumnae services, clients can build their peer support network and stay connected with their treatment staff. If problems arise in remaining recovered, clients can also speak with the admissions specialists to determine if they could benefit from treatment options for eating disorders. The admissions specialists can also help clients determine if they could receive assistance from outside care providers.

This collaboration in acquiring the support clients need is only possible with accurate and honest self-monitoring and journaling practices. Which is why clients receive so much support from the fully recovered staff in learning these skills at inpatient and outpatient eating disorder treatment. With guidance and training, clients can master these life skills and apply them to best cope with the demands of daily life. Clients who regularly journal and self-monitor remain highly accountable to their healthy self through treatment and after graduation.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.