I’ve been in an outpatient eating disorders group for awhile now. There’s nothing special about it — it’s just a weekly / bi-weekly group at a treatment center, with women of all ages and ED diagnoses Everyone either has to be in outpatient therapy at the center or have done some kind of intense treatment there. The latter is definitely the norm — most patients have stepped done from day treatment or IOP.
What’s weird right now is the make-up of the group: 5 restricting-anorexics and 2 binge eaters. I don’t know where all the patients in between these two groups are. I guess most of the women struggling with AN-R technically fall into the EDNOS-AN-R category, but you know what I mean. There are no bulimics, and way more restricting anorexics than there should be–statistically.
There are three issues that I have with this:
- There are too many anorexics in one room.
- Since there really isn’t any middle-ground, the group feels very divided by diagnosis.
- One of the girls is really really really underweight. Really.
Issue #1: betta fish
I think that anorexics are like betta fish — you’re not supposed to put several of them in the same bowl. I could expand this to all individuals with eating disorders, but I think that there is something especially competitive about anorexia. Even when they are doing well in their recovery, putting too many of them in a group is just not a good idea.
Issue #2: no grey
I definitely believe that eating disorders are on a continuum and that we all have similar struggles despite the different diagnoses. However… we seem to be missing all the people in the middle of that continuum. It sucks to have BED and be in a group with all anorexics. Heck, I think it’s triggering for anyone to be in that group (see issue #1). With such a polarity, it feels a little them vs. us.
Issue #3: too sick
I don’t care how great you’re doing mentally — if you’re that underweight, you shouldn’t be in outpatient group. You could be drinking boost like it’s water, and I still wouldn’t be okay with it. It’s just too triggering. I think it’s an especially bad combination in the current group, because the majority of girls have gone through refeeding in the last year and are struggling with body image now that they are at healthy weights. Plus, personally, my whole “I don’t need to be here because I’m not that sick” complex starts creeping up on me.
Issues #2 and #3 are definitely elephants in the room. Everyone feels weird about the divide and triggered by said sick patient. No one will say anything (myself included).
I think you have to be so careful when putting together outpatient eating disorder groups… and I think that a certain level of physical health is necessary — even if someone is 100% gung-ho, yay-recovery-is-awesome.
5 comments
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Cammy says:
Sep 5, 2010
The fish analogy is a very good one, never thought of it like that before. This post describes the main concerns that have always made me shy away from group programs. I know they can be helpful, but it seems like it takes just the right recipe. My psychologist in college ran a group, but it was “invitation only” from among clients in her practice that she thought were ready and able to handle it.
greythinking says:
Sep 6, 2010
Cammy,
The OP group I was in during college was like that, too — and it definitely weeded out any potentially triggering individuals. What’s kind of funny, though, is that in my freshman year I was NOT allowed in the group because I was struggling. I was really annoyed at the time, thinking “no kidding I’m struggling — that’s why I’m trying to get more help and support! What is this, a group of healthy people?”
During my sophomore year, I was invited to join the group… and actually I didn’t feel like I could relate the many of the girls because it was their first time in any kind of therapy. Some of them I think just struggled with bad body image. I almost never talked about myself because I felt so out of place.
Anyway, it sounds like your psychologist found a good recipe for group
Tiptoe says:
Sep 6, 2010
I agree, you have to be careful with putting together ED groups. This was probably one reason why I did not do them as well. This, and the fact that I’d likely completely ignore my own issues and focus on everyone else’s.
Good analogy with the Betta fish. We say similar thing about dog trainers, especially ones with opposing views.
greythinking says:
Sep 6, 2010
Tiptoe,
Funny — I never thought that about dog trainers before. I guess the analogy could probably used in a lot of situations, actually….