What is group therapy?
Group therapy is a foundational part of eating disorder treatment. It is an opportunity for individuals to come together to honestly discuss issues they are struggling with, and to focus on specific topics related to their eating disorder and recovery issues. Clinicians are present to guide the interactions, and group members are encouraged to participate by questioning, encouraging, and challenging one another. Often groups include education on a topic related to recovery, followed by discussion.
What are the benefits of this approach?
The benefits of group therapy are multi-faceted. Social support research finds a buffering effect from peer support towards positive mental health. The group process allows individuals struggling with eating disorders to find a place where they can open up and be honest and real about their struggles, and receive much needed support. They learn they are not alone and often find points of identification in their life stories, helping diminish shame that is a core emotion upholding eating disorder behaviors. They also learn that they have value in being able to offer support to others. Isolating is a debilitating behavior with those who have eating disorders. Group therapy offers isolation’s antidote. While this may cause a person to feel uncomfortable at first, they quickly realize the group can be a source of support and encouragement. Group provides a safe place to practice new and challenging skills and behaviors - from simply speaking up and sharing to practicing boundaries with another group member. The group also allows the person to move beyond themselves and their own problems, reach out to peers, and learn to encourage, challenge, and support others.
How can this form of treatment fit into my overall treatment plan?
Group therapy is highly recommended at all levels of care (inpatient, residential, and outpatient levels). No matter what stage of recovery someone is in, groups provide much needed connection and consistent clinical and peer support. The relationships that are built enable the person to have the social support needed to progress in recovery. Finding a group that is a safe place for continual honesty, accountability, and support is extremely beneficial.
How does this approach facilitate recovery from an eating disorder?
Group therapy allows the person a safe place to share their life story and current struggles, where emotions can be expressed and validated. With an eating disorder, emotions are shut down, and shame permeates the individual suffering. The shame and isolation work hand in hand to keep individuals dependent on the eating disorder to cope. The group process helps one learn that they can rely on others for support. Ideally, the group dynamic can take the person from isolation to connection, from emotional shutdown to validation, and from minimal coping skills to skill development.
What can you gain from a group that you can’t gain any other way?
Due to the isolative nature of a person using an eating disorder, group therapy is necessary to gain interpersonal effectiveness skills in order to function in life. The task given to each group member is to speak, to share, and to use their voice versus turning to the eating disorder to deal with emotions. Foundationally, the group helps the person learn they are not alone in their struggles. In addition, they learn to give and receive feedback, and to learn to listen to others. They will also learn new coping and life skills and have the opportunity to discuss how to use these new practices in everyday life. The ultimate goal of the group therapy setting is that these interpersonal/coping/life skills become transferable to real life.
What fears do people have about group therapy that often go away once you start a group?
The person starting group therapy fears rejection. They fear judgment of their life story and behaviors and feeling like nobody will understand them and what they do. They fear having to talk and share their feelings. The person fears a lack of acceptance by their peers, confrontation, and connection with others. Since this is the usual consensus of every person entering group therapy, group members and the clinicians are sensitive to and aware of this. They are able to invite the new person in, supporting them through this initial introduction stage. This is what helps their fears dissipate more than anything else.
How long do groups run for and what is the ideal size?
Groups may run for different lengths of time depending on the level of care of the patient. A group size may vary from 3 to 4 people and up to 12 to 15 people. Groups can be effective whether they meet daily for a 4 to 6 week period of time at the inpatient level, or a few times a week at the residential or outpatient levels of care. At the outpatient level, the group may continue for 6 months to a year, or longer. When joining a group, it is important to find out the main group structure, timeline for starting and finishing, number of days it meets per week, and whether it is an open or closed group. The goal of the group is to build trust, and to set clear guidelines for confidentiality, so it is a safe environment for the person to open up and share.
What is the difference between a ‘closed’ and ‘open’ group? What are the advantages to each approach?
A “closed group” is designed for a specific time period with a specific group of people. Once the group starts, no new people are allowed to join the group. The benefit of this type of group is that you will have the same consistent people; this helps to build strong bonds and a safe environment to be open and share. Group guidelines will be shared with all group members.
The “open group” is continually open to new members joining at any time. The benefit of this type of group is that you continue to meet new people, and build confidence in connecting, communicating, and opening up with other individuals who may have similar struggles. It is important that the clinician reinforces group guidelines and expectations when a new member joins the group, with the goal of continuing to reinforce a safe environment for open sharing.
How long should people be in group therapy?
In groups that are ongoing, the clinician leading the group and/or the primary therapist will make recommendations for the amount of time an individual needs to be in group therapy. Some groups are time limited. And some people remain part of groups for years. The initial recommendation for an individual transitioning from inpatient level of care to outpatient is to participate in group therapy for a minimum of one year. The ability to develop long-term safety, accountability and strong social support while the person is moving towards recovery takes time. The same would be true for someone leaving residential treatment.
What are some signs that a group isn’t helpful, ‘safe’ or a good fit?
There are some very clear signs that should be discussed with the clinician leading the group prior to stopping attendance. The signs of an “unsafe” group will usually revolve around how well the group follows the strong guideline of confidentiality and conduct. A safe group is a group where confidentiality can be reinforced among the peers. If there are concerns for one another outside of group, they should be talking directly to that person or their therapist, but not to other group members. Breaching confidentiality makes the group therapy experience an unsafe place to learn to be honest.
In an eating disorder group, it is important to be aware of peers that may still be practicing behaviors, and to make sure these individuals are being open and honest about their struggles. If they brag about behaviors or pressure group members to participate in eating disordered behaviors outside of the group, this may make the group unsafe. Of course, these issues can be worked on within the group therapeutic process, which is another benefit to group therapy. In order to maintain a safe group, clinicians and peers need to continue to challenge group members towards honesty and accountability.
Common Group Guidelines:
- Honesty about feelings and behaviors
- Effort towards recovery
- Sharing in group
There are online groups and groups over the phone - do those have the same benefits?
These groups can be of some help if the person has no access to a live group therapy experience. The human connection is always recommended, but if the person lives in a rural area, town, or city that doesn’t have eating disorder groups, then this can be helpful and supportive. These types of groups are less risky for someone who has social phobia, or extreme relationship anxiety. It is better to have some connection and support even if it is on-line or by phone. It would be recommended for the clinician to be monitoring the length of time and types of relationships developed in these groups. If one were avoiding human contact, then therapeutic interventions would be necessary to challenge the person to step out and connect with a live group.
How do I find a group in my area?
Check with your outpatient therapist, as they may have specific group information. You can also contact NEDA (National Eating Disorders Association) at 1-800-931-2237 for group contacts, or IAEDP (International Association of Eating Disorder Professionals) at 1-800-800-8126. Overeaters Anonymous also offers many online and telephone groups referred to as ‘meetings.’
Amy E. Wasserbauer, Ph.D.
Remuda Ranch Treatment Programs
Programs for Eating and Obsessive Compulsive Disorders