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.

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STIMULATE YOUR DETERMINATION: NEVER TOO OLD TO LOSE

Connie Bissonnette had all but given up on slimming down. At age 50 and 172 pounds, the full-time university instructor from Stillwater, Minnesota, believed that weight gain was a normal part of the aging process.

Lucky for her, her son Jeff knew better. And as a result of his persistence, Connie is 41 pounds thinner.

In 1992, Jeff was a student at the University of Wisconsin, majoring in human performance. When he came home for Christmas break that year, he had a mission: to persuade his mom to start exercising. “I was his first project,” Connie jokes.

She responded with her usual litany of excuses—she didn’t have time, she didn’t have the energy, her knees bothered her. But Jeff persisted. “He said, ‘Just give me 10 minutes, three times a week,’” Connie recalls. “He devised a workout that I could do at home, with what I had on hand. I started out by sitting in a chair and doing leg lifts. Then I added other exercises, like doing pushups against the wall.”

Despite her initial protests, Connie found herself enjoying her workout. Within a few months, she noticed that her knees felt better. So she asked Jeff to add some more exercises to her routine. Her 10-minute exercise sessions stretched to as long as 30 minutes.Plus, she started walking for 30 minutes, 2 or 3 days a week. One year later, she was 20 pounds lighter.

But Jeff wasn’t done. His next challenge was to transform his mother’s longtime meat-and-potatoes diet. Again, he advised Connie to start small. She substituted jam for butter on her morning toast, fresh fruit for her snack time potato chips and candy bars. Eventually, she traded frying for baking as her cooking method of choice.

It took some time, but all those little changes added up. Four years after she began exercising, Connie had lost a total of 41 pounds. Now, at age 58, she has maintained her weight at about 131 pounds since 1996.

Connie was so grateful to her son for helping her slim down that she decided to return the favor. In May 1997, she became a certified personal trainer. Now, she works in her son’s gym. “It’s great to be able to encourage the clients I train by telling them about my own weight-loss experience,” she reports. “I don’t let anyone say, ‘I can’t.’”

WINNING ACTION

Stop believing the myth of middle-age spread. Yes, most of us do gain weight as the birthdays roll by. But this accumulation of extra pounds isn’t written in our genes, our hormones, or the laws of nature. We gain weight, quite simply, because we become less active. According to William Evans, Ph.D., director of the Noll Physiological Research Center at Pennsylvania State University in University Park, about 80 percent of overweight is caused by a sedentary lifestyle. So keep moving, no matter what your age. You’ll look slimmer and you’ll feel younger.

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