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Pharmacy Links

WEIGHT LOSS: GROUP THERAPY FOR ANOREXIA NERVOSA

23rd April 2009

Anorexic patients often have trouble with the idea of group therapy. They resist relationships because they fear rejection. They use their thinness as a shield to protect them from having to deal with other people. If they feel anxious, they tend to respond by losing more weight or running way. Because their social skills aren’t as developed, they may need more support than other members.

However, group therapy can help some anorexics precisely because it shows them how to express their feelings and interact with others. Recently Pam, a former patient, called to tell me how happy she was in her new job as a receptionist. We shared a laugh, because before treatment, Pam was notoriously shy and refused to speak to anyone. Her experience in group gave her the emotional strength to reach out to others. Now here she was, greeting visitors and talking on the phone – tasks that, just a year before, would have driven her to starvation.

When the members of a group are more compatible-similar in age, level of education, length of illness, and so on-there is usually greater group cohesion. Group therapy also stands a better chance of helping if the anorexic is not severely ill, is highly motivated, and has responded to other treatments.

It sometimes works to have at least one patient in the group who has returned to a normal body weight and maintained that weight for a period of time. Such people serve as role models. Similarly, including a patient who is on her way to recovery, who can express her feelings more easily, helps shift focus away from body weight and onto other issues.

Inpatient programs: Because they are more severely ill and their treatment is more intense, inpatients are generally willing to take part in groups. The size of the group varies. Sometimes inpatient groups are larger than outpatient groups, but because each patient may take part in several group sessions a day, she has more chances to contribute.

Of course, the goal of hospitalization is to get the patient better and send her home as soon as possible. Thus inpatient groups, by definition, are short-term groups.

A challenge comes when the patient must make the transition from the hospital to the outside world. We encourage patients who respond to the group approach to continue with therapy as outpatients.

Outpatient programs: Outpatient anorexic groups work better if their numbers are small -groups of four to six patients may better address interpersonal problems than groups of seven or eight, the size of most other outpatient therapy groups.

Programs vary, but most groups meet once a week. It’s probably best if the group plans to run for at least six months, and if it is an “open” group – that is, it allows members to come and go. This policy helps replenish the membership and keep the group operating when patients drop out, as some inevitably will.