Group Psychotherapy in a Team Approch to Treatment

Let's continue our discussion of some of the helpful contributions to eating disorders recovery that come from a multidisciplinary approach to treatment. Today, I would like to spend a few moments on the topic of group therapy.

Group therapy has emerged as a popular treatment for eating disorders. Curriculum found in many Intensive Outpatient and Residential Treatment Facilities include a wide variety of group therapy modalities. Indeed, patients may spend more time in group therapy in these settings than in individual therapy sessions. Group therapy can also be integrated into an outpatient treatment plan to ensure that a helpful variety of therapeutic approaches are included in patient care.

A group therapy experience allows for interpersonal validation, acceptance that comes through shared experience, support from others in recovery, and provides a setting in which patients can acquire and practice skills for enhancing social and emotional functioning. As many of you are aware, group therapy can be a vital means for decreasing isolation, distrust, and interpersonal ineffectiveness. Symptom reduction, improved self-esteem & self-efficacy, more effective coping, and increased sense of hopefulness are just some of the benefits that have been shown to be associated with group therapy.

Various topics and formats of group therapy are utilized in eating disorders treatment. Some of them include:

1. Cognitive Behavioral Group Therapy: Supported by clinical data, this approach attempts to change a person's belief systems about weight and shape. Didactic components are frequently included. Can be time-limited or open-ended.
2. Psychodynamic Group Therapy: Process oriented group that serves to contain anxiety, nurture self-identity, and examine issues relating to interpersonal relationships.  Tends to be a longer-term group format.
3. Behavioral Group Therapy: Didactic in nature. Imparts skills for enhanced coping, relaxation, stress management and nutrition management. Has been shown to be effective for reducing binge eating.
4. Psycho-educational groups: Helpful for both patients and their families to gain an understanding of the symptoms and consequences of eating disorders, the biology of weight regulation, and the social-cultural context of eating disorders.
5. Nutrition Support Groups
6. Body Image Therapy Groups: Didactic and/or experiential. Helps patients to experience a realistic and healthy body image. Also used for prevention of eating disorders with some success. The Body Project and BodyImageHealth.org contain examples of successful curriculum.
7. Self-help and peer support groups: Allows patients to share information about their own recovery experiences. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) provides a listing of free support groups (professional and peer-led) in the United States.
8. DBT skills groups. The Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan, PhD (1993) and The Dialectical Behavior workbook by McKay, Wood & Brantley (2007) can be adapted for use in a group therapy format.

There are some practical considerations to keep in mind for eating disorders group therapy. First, patient screening, particularly for outpatient groups is important. Participants should show sufficient motivation for change, possess sufficient interpersonal skills and be evaluated for co-morbid psychiatric illnesses that may impeded successful group interactions.

Second, group size should not be larger than 8-10 participants in order to allow for equal shared time among members.

Third, groups should avoid inclusion of topics that may elicit or intensify feelings of envy or competition among patients. "Triggering topics" such as purging behaviors, weight loss techniques and patient weight history should be avoided, again, this is especially true for groups that take place in an outpatient setting. Some caution that mixed diagnosis groups (anorexia and bulimia, for example) tend to exacerbate competitive responses from patients, although this is less true for inpatient settings.

Finally, consider establishing "ground rules" for group participation to enhance trust, emotional "safety", and cohesion. An example of group ground-rules can be found by clicking here.

Source: Polivy, J. & Federoff, I. (1997) Group Psychotherapy. In Garner, D.M & Garfinkel, P.E. (Eds.) Handbook of Treatment for Eating Disorders. New York: The Guilford Press.

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