Group therapy for eating disorders: A step-wise approach

Abstract

Group therapy is emerging as a favored treatment for eating disorders. Open-ended psychodynamic group therapy is an effective treatment for the underlying conflicts in eating-disordered patients, yet these groups are difficult to form. The authors suggest a specific sequence using time-limited psychoeducational groups initially for symptom control, then offering an open-ended group for patients who are ready to address deeper issues in a group therapy setting.The incidence of anorexia and bulimia nervosa continues to rise. Investigators estimate that 5-10% of adolescent girls and young women are affected by eating disorders (Pope et al., 1984). Despite the great attention and interest these disorders have received from researchers, clinicians, and the media, a destructive preoccupation with thinness persists in young women. Several promising treatment modalities have emerged, but no single treatment has been shown to be universally effective. Among the treatments that have been reported to be useful alone or in combination are pharmacotherapy, family therapy, nutritional therapy, individual psychotherapy (psychodynamic, cognitive-behavioral, behavioral) and group psychotherapy. There are five major models of outpatient group therapy for eating-disordered patients: psychodynamic psychotherapy groups, cognitive-behavioral groups, psychoeducational groups, self-help groups, and combinations.Group therapy is emerging as a favored treatment for patients with bulimia nervosa (Herzog, 1988). Furthermore, there are many types of group therapy available for eating-disordered patients. Effective decisions about which type of group to recommend for patients are difficult because many different forms are touted to be effective. Time-limited psychoeducational groups and cognitive-behavioral groups have received wide acclaim for results in decreasing bulimic symptoms, while open-ended psychodynamically oriented groups are reported to repair the gaps in ego structure necessary for long-lasting recovery

Dropping Out from Psychological Treatment for Eating Disorders: What are the Issues?

“…There do not appear to be differences in the rates of dropping out from these two formats, which is curious, as the mechanics of dropping out from family therapy would appear to be more complicated. Group therapy used on its own is not common (Yellowlees, 1988); such groups are often composed of people with less severe anorexia and people with bulimia nervosa (Scheuble et al, 1987;Crisp et al, 1991;Riess and Rutan, 1992). Determining whether format type has any impact on dropping out is not possible; it is confounded with level of severity, small study numbers and results frequently mix diagnoses.…”

Eating disorders from parent to child: Mothers’ perceptions of transgenerational effect

“…In a manageable group all the participants will have the opportunity to take an active part and there will be less likelihood of exclusion. Riess and Rutan (1992), found they had fewer dropouts in time limited groups, as they presented a clear boundary for the length of commitment that was expected and made completion more likely for the client. A closed time limited group can be experienced as a safe container which provides a physical and psychological space for exploration (Tudor 1999).…”

“…However, Riess and Rutan (1992), found they had fewer dropouts in time limited groups, as they presented a clear boundary for the length of commitment that was expected and made completion more likely for the client. Smaller groups have been thought to be more containable and successful.…”

The use of group therapy to help women with eating disorders differentiate and articulate affect

“…There is extensive evidence--both formal research and anecdotal--of the efficacy of group therapy for many individuals with eating disorders (e.g., Barth & Wurman, 1986;Beresin et al, 1989;Boskind-White & White, 1983;Brenner, 1983;Brenner-Liss, 1986;Cauwells, 1983;Hornak, 1983;Hotelling, 1987;Johnson et al, 1983;Mitchell et al, 1985;Riess & Rutan, 1992). While the concept of alexithymia has not been addressed as such in these discussions, the disorder has been described and/or alluded to in many of them.…”

“…They are consoled that others can identify, because of shared experience, with the feelings and thoughts associated with bulimia" (p. 242). Other authors describing the use of group therapy for people with eating disorders have also alluded to the importance of this aspect of the group process (e.g., Brenner-Liss, 1986;Riess & Rutan, 1992).…”