Reworking the Myth of Personal Incompetence:
Group Psychotherapy for Bulimia Nervosa

page 4

Case 1

Melody, an aging debutante in her 50s, was married with one small daughter. She presented for treatment with the complaint that she 'eats for three." She spent the major portion of her life worrying about her body size and the appearances of her home and child. Her activities revolved around exercise, charitable functions, and teas. She complained of dysphoria and free-floating anxiety bordering on panic.

In the group, she painfully described how badly she felt inside. She believed her life would he perfect if only she could lose 20 pounds. She had great difficulty understanding that the next bite of food would not magically obliterate the bad feelings and that fixing the outside would not alter the inner emptiness. She continued to focus on externals until one member gently confronted her, "We've heard a lot about your body, but we've not heard anything about your mind." The group accurately identified that her hunger was for a feeling of value. She painfully confessed her belief in her personal incompetence that she couldn't be anything but slim and beautiful. Her self-doubts were expressed in the following poem:

I am no good
I have no brain
Anything J achieve is by mistake
Therefore secretly
I VOMIT my achievements
I live through my body
My body is my only worth
No wonder I have so many
problems.

The group challenged this myth based on her active and intelligent participation with them. Melody became an important and respected group member. As the feeling of incompetence gave way to a more solid sense of self, she was transformed into a person with talents and ideas She helped the neophyte members work through their own feelings of incompetence and became a role model with whom others identified. At the time she left the group, she planned to return to school to pursue a graduate degree in design a sublimation of her concern with externals.

According to Yalom,4 the group recapitulates the nuclear family in ways that could never be accomplished in individual treatment precisely because the group feels like a family. Unconsciously, members take on the same role in the group that they assumed in their family-of-origin. The pathologic behavior is reactivated and reworked when the therapist and the patients, who symbolically represent the parents and siblings, foster the resolution of unconscious conflicts. Dysfunctional communication and pathologic behaviors can be identified; new behaviors can be practiced, and change can occur as the patient undergoes a corrective emotional experience. The following case illustrates this point.

continued

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