Sharing the pain and the promise in group

Group therapy is frequently mentioned as a useful treatment method for eating disorders. Group can be a crucial aspect of treatment for many eating disordered patients yet contraindicated for others. For example, many anorexics seem to have poorer outcomes than bulimics with group therapy, partly due to the fact that they tend to be more rigid, withdrawn, and anxious, and also have extreme difficulty identifying and expressing feelings. However, many anorexics have had valuable group experiences that have indeed helped them overcome these obstacles. Although group is not appropriate for every person, those for whom it is seem to benefit greatly from it.

This chapter will serve as an overview and summary of the various issues involving group therapy in the treatment of eating disorders, from why it works to variations on group structure, philosophy, and settings.

WHY DOES GROUP THERAPY WORK?

EDUCATION

Group therapy can be a good forum to educate patients on important topics that may not be addressed elsewhere, such as nutrition, medical consequences of laxative abuse, or assertiveness techniques. Educating patients in group saves individual therapy time for more personalized and deeper issues. Group members also educate each other from their varied experiences in identifying and solving problems. Each group session can be educational, psychodynamic, cognitive behavioral, or a mixture of all three.

UNIVERSALITY

By sharing with and listening to others, patients learn that they are not alone in their suffering, their feelings, and their experience of having an eating disorder. Even though individual stories vary and patients are all unique, a camaraderie exists among people who are suffering from eating disorders. It can enhance a person's self-esteem just to realize that she is neither crazy nor alone. Some patients handle certain issues better than others, and they help each other in this way. Furthermore, a common trait in individuals with eating disorders is the desire to be special and unique, and the eating disorder helps provide that. In a group of peers also with eating disorders, patients must explore and find other, more constructive ways to be unique.

SUPPORT AND ACCEPTANCE

All people benefit from being accepted and cared about, even if they need to make changes. Eating disordered patients often feel or have been rejected by their families and others, and the only support system they feel they can count on is the therapy group. In a positive group therapy experience, group members provide acceptance while at the same time supporting and encouraging necessary changes. Through a positive group experience, patients can learn compassion and empathy for others and then extend this compassion and empathy to themselves.

INTERPERSONAL RELATIONS

Often patients have lost or never acquired the necessary trust or interpersonal skills to develop quality relationships. With the help of other group members, patients can learn what their feelings are and how to communicate them. Patients who otherwise have a hard time forming relationships can eventually learn to share, get close, trust, love, and be loved.

CONFRONTATION

If group therapy always consisted, session after session, of everyone being nice and encouraging, it would not only get boring, but very little growth would take place. Once an atmosphere of trust and caring is established, the therapist facilitates group members in confront- ing each other about inconsistencies, self-destructive behaviors, and issues of disagreement. The therapist's task is to help patients learn to challenge each other in a caring manner, so they learn that they can like or love someone and yet disagree or question them at the same time. Many eating disordered patients don't know that it is okay to get mad, discuss negative feelings, and argue, and that it is how you go about it that makes the difference.