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Pharmacy Links

WEIGHT LOSS: STRUCTURE OF THERAPY GROUPS

April 23, 2009

How many patients should there be in a therapy group? Between four and eight patients seems ideal-small enough so each can relate to the others, large enough to bring together people with a range of experiences. Many groups are made up entirely of women because there are relatively few males with eating disorders.

Most outpatient groups meet once a week, with sessions lasting from one and a quarter to two hours. Some shorter-term programs meet twice a week. Meeting more frequently provides additional support to very symptomatic patients.

Inpatient groups are more varied. I have found it helpful to combine daily group psychotherapy with other groups, such as psychodrama, art, movement, nutrition, relaxation, women’s issues, and body image groups.

Outpatient groups can meet for a limited number of weeks or they may be open-ended. Short-term groups are generally more structured. They may have a preset agenda with different specific topics each week. In addition, members continue to monitor their symptomatic behavior and work to change it.

Group leaders should make sure all members know when and where meetings will be and how to get there. An eating-disordered patient has enough trouble dealing with her insecurities. She doesn’t need to wander the halls of some huge building, anxious and alone, looking for the meeting room. Lack of clear instructions can cause a patient to quit the group before she has even started.

Groups are usually more effective if they are made up of patients with similar problems. Like oil and water, bulimics in the same group may not easily mix. An anorexic may feel “bullied” by a bulimic, while the bulimic may feel frustrated that the anorexic won’t open up and share what’s going on inside. Higher-weight patients may feel angry or envious in the presence of emaciated ones.