Reworking the Myth of Personal
Incompetence:
Group Psychotherapy for Bulimia Nervosa
page 3
BULIMIC PROFILE
In understanding the impact of group psychotherapy on the bulimic patient, a
representative personality profile, illustrated by the following vignette, is
useful.
Vignette
Lauren, a woman in her mid-20s, has a 5-year history of bulimia.
From a prominent family, her parents placed a high premium on appearance,
conformity, and achievement. Lauren was an appealing, but chubby, child who was
often nagged about weight by her intrusive mother. She recalls her preteen
years as uneventful, although they were punctuated by several efforts at
dieting. When she was 17, her parent's separated-a traumatic event. One year
later, she left home to attend a highly competitive university. She did well as
an undergraduate, but her confidence was shattered when her college boyfriend
left her. At that time, she began binging and purging. She was able to go on to
law school and graduated in good standing despite her illness.
Shortly thereafter, she presented for treatment: attractive, composed, and
well groomed. Beneath her veneer of success lay crippling self-doubt - her slim
body was her only proof of adequacy. She complained of loneliness and of being
unable to form new relationships, particularly with men. To avoid pain, she
avoided contact. Food became her intimate companion and purging a desperate
attempt to feel in control of her life.
Women such as Lauren enter treatment possessed by an ego-alien compulsion.
Isolated by their symptoms, they join together in group therapy to share,
support, and enrich each other in a way different from any other previous
experience. This point was illustrated when one patient asked another to
describe a binge episode. As the patient described her odyssey from one
restaurant to the next, the first patient admitted, "I thought I was the
only person in the world who did that." For the bulimic patient, this
universality of experience may exist only in the group.
Instillation of hope, interpersonal learning, and identification are among
the most important therapeutic factors operative in the change process.4
When an experienced patient states to the neophyte patient, "I was
once where you are now," the experienced patient becomes, at once, guide,
inspiration and teacher. The following case studies illustrate this.
continued
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