Group Therapy for Eating Disorders

continued

OPEN OR CLOSED

A group can be short term and closed, allowing no other patients in, or long term, allowing or not allowing others to join throughout the group's existence. These judgments are made depending on factors such as the therapist's philosophy, the patient population, finances, and the group setting. For example, a group in a hospital will generally be ongoing and accept new members whenever there is a new hospital admission. A group run by a therapist in private practice might have eight specific members and last a year or more. Often, groups in private practice are started and then the group itself decides what type of group it wants to be. For example, group participants can make a commitment for six months, agreeing to take a certain number of new members, or they can commit and pay for four weeks at a time and reevaluate after each four-week period. It is important for some pledge to be made to establish a working group where all members have the same commitment and expectations. The group commitment helps separate a therapy group from a support group.

SUPPORT GROUP

A support group is usually a "drop-in" group where new people can come in at any time. An Overeaters Anonymous meeting or ANAD group, where the participants may vary greatly from one group to the next, is an example of a support group. The nature of this kind of group with varying members does not allow for continuity or for the same kind of intimacy and depth as a therapy group. Support groups are usually free and are set up to provide support and education to members, not to provide therapy. Support groups are valuable and have their place, but they are different than a group run by a therapist where the members are committed to coming for a certain period of time.

FORMING THE GROUP

PLACE, TIME, SIZE

The therapist or facilitator, with or without group input, must ultimately determine where the group will meet, for how long it will meet, and how many members to include. A common format is an hour and a half with eight to ten people. Obviously, this does not include the multifamily group or drop-in groups, which are often larger than this and are still effective.

CRITERIA FOR MEMBERSHIP

Having the correct diagnosis should not be the only criterion for allowing patients admittance to the group. Group therapy is not appropriate for many patients. They may not be ready, willing, or capable of sharing with others or hearing what others have to say. Some patients are too self-absorbed, deviant, distraught, or impulsive to be able to benefit from group or be of benefit to anyone else. Some patients simply cannot "be there" for the others, and putting them in a group would be counterproductive for everyone.

The group therapist must ultimately decide who will benefit from group and who will not. An individual interview or screening process is a good idea. Patients for whom the therapist feels group is appropriate but who are resistant should be encouraged but not coerced, because the likelihood for their success in group is minimal.

CAUTIONS AND CONCERNS

The following are common concerns regarding possible occurrences in group therapy. The therapist must deal with these problems and either make changes or terminate the group.

Patients getting too many negative ideas from each other. If a young girl has never heard of drinking ipecac to induce vomiting and learns this technique in group therapy, she may try the technique out herself, leaving the group leader or member feeling responsible. Don't let the group turn into a sharing session of eating disorder techniques. One way to avoid this problem is to make a rule that specific behaviors, such as purging techniques, cannot be shared in group. Instruct the group that if someone wants to discuss an incident in which she vomited ten times, took diuretics, or went on the Stairmaster for two hours, she is to use the terms purged or exercised and is not to give any specifics about the means, the amount, or any other details.

This way, a patient can get help and support from the group without giving clues or ideas about purging techniques to other group members. This also helps others avoid competitive thinking: "I only exercised for one hour; I need to do more." Although specific details can be useful to explore in individual therapy, the point of group therapy is to get help on how not to use vomiting, exercising, or other eating disorder behaviors as a means of weight control or as a coping method for dealing with feelings. In a similar vein, it is wise to ask patients not to discuss actual weights or the amount of weight they have lost or gained. Avoiding this kind of discussion will help reduce some of the competition that inevitably happens in eating disorder groups.

Sometimes groups can become dumping or gripe sessions, where members complain that recovery is impossible and there is no hope. It is destructive for a group if a member continues on a litany of horrible things she is doing or can't stop doing, especially if she's not really asking for or accepting help or support. Make a rule that no one is allowed to just come in and "dump." Explain that this does not mean that complaining is not allowed, but that if someone has a problem or is experiencing pain or suffering she must not only share this with the group but also must ask for the group's advice and support.