- Slides: 27
Eating Disorders GROUP PROPOSAL
• Eating disorders are a significant problem for adolescents. Prevalence rates for bulimia nervosa are approximately 1% for females and 0. 4% for males. Anorexia nervosa is estimated to affect 0. 3% of females and 0. 2% of males, and eating disorders not otherwise specified or partial syndrome rates are reported to be as high as 15% for females and 5% for males (includes binge eating). • Recent increased interest in eating disorders among female adolescents who are the primary target population affected by these illnesses- social media/ “pro-ana” tumblrs, Pinterest, etc • Often impacts cheerleaders, drill team members, gymnasts, wrestlers, runners, or a students actively involved in the performing arts. Such highly competitive environments create stress factors and failure experiences (at times), which when combined with perfectionistic tendencies may take on special significance for the student with a predisposition to the formation of an eating disorder
Potential benefits of group therapy: • greater potential for self-insight • opportunities for personal growth that might not occur in individual therapy • ability to explore characteristics common to those with eating disorders, including: • feelings of isolation • ineffective communication skills • poor self esteem • trouble identifying feelings. • many people with eating disorders struggle with interpersonal relationships, so group therapy allows members to change the way they relate to others. -Wanlass, et al. (2005)
Therapeutic factors to be addressed in group counseling: • • universality cohesion development of socialization techniques reenactment of issues from their families of origin, thus allowing for personal growth beyond just the treatment of the eating disorder. • allows members to change the way they relate to others. -Wanlass, et al. (2005)
Cultural Considerations • Anorexia nervosa and bulimia most commonly occur in Caucasian female adolescents living in affluent societies. The incidence of these two eating disorders among male adolescents is estimated to range from 5% to 10% of all cases (Omizo & Omizo, 1992) • African American young women are more likely to experience binge eating than anorexia or bulimia, perhaps due to different cultural standards of beauty coupled with the intersection of racial and sex discrimination. • Latinas and Asian experience body dissatisfaction at the same rate as European women, though they are less likely to engage in anorexic or bulimic behaviors. (Talleyrand, 2012)
IT’S NOT ABOUT FOOD I learned that it’s really not about food, that all of the issues we discussed in the groups: self esteem, self image, relaxation, healthy eating, etc. are issues that are tried by everyone, and are usually the underlying factors to our problems with food. I learned that these sorts of things can happen to anyone. We need to help each other out and promote good healthy habits to help prevent some of these problems.
STATEMENT OF PURPOSE
The overall goal of this program would be three pronged. 1. We would seek to educate group members about how to identify and prevent harmful eating behaviors. 2. We would work with the members to develop lifelong healthful attitudes and behaviors related to food, body weight, self-esteem, and physical activity. 3. WE would work to establish cooperation with the family or outside resources to provide more clinical one-on-one therapy and medical attention. This last piece is critical to the success of the group.
• • • Limited to 10 -12 members Group membership would be open- potential need to bring new members “up to speed” Potential for one-on-one counseling including school nurse for nutritional information Meetings would be held in a classroom or large counseling office, in a circle formation. Meetings are gender-specific Meetings are held weekly for the duration of the school year
LEGAL AND ETHICAL CONCNERNS
• • Parental notification and permission is key Membership is not mandatory, as it could cause more harm than good if students do not want to be there Confidentiality is mandatory for all members and guest speakers Group leaders would do well to seek additional training in working with eating disorders
• Advertising would include: • Flyers and posters • Announcements • Parent mailings • Psychoeducational group presentations on various support groups offered through the school
Questioning your relationship with food? Finding yourself binging? Eating your feelings? Purging? Denying yourself food? Unhappy with your body? It’s not about the food! See Mrs. Mangino or Mrs. Cornelius for a new group about learning to manage your relationship with food
SCREENING AND PREPARATION
• • We would use the EAT-26, a 26 question screening tool about relationships with food The test would be administered to all students, perhaps through a PE or Health class
TWO SCHOOLS OF THOUGHT
COUNSELOR AS PART OF TEAM WITH OUTSIDE COUNSELING The student with anorexia nervosa or bulimia must be educated about healthy eating habits, including the necessity of having adequate nutrition and eating a minimum of three balanced meals a day consisting of at least 1, 200 calories. A discussion of nutritional requirements (i. e. , the four basic food groups) serves as a foundation for planning a healthy diet and can help the anorexic or bulimic student structure eating in a healthy way
COUNSELOR DIRECTLY ADDRESSES ISSUES OF EATING DISORDER • Food diaries monitor eating habits. • include what is eaten • when it is eaten, where it is eaten • if the food is a meal or snack • if the food is eaten with someone, • what thoughts and feelings occur while eating • can be used to identify patterns and generate options • Thought diaries • identify irrational or unrealistic thoughts • provide a link between thoughts, feelings, and behaviors
Sessions • 1 – Introductions/Icebreaker/Norms/Confidenitality • 2, 3, &4 – Education/Share and discussion/task (journal) celebrations • 5 – Check in Journals/share/ support/ coping strategies, build self esteem, connections etc…
When considering the group model for therapy there are both practical and emotive reasons for selecting such a model. The practical reasoning focuses on the limited resources, namely that of time, afforded the school counselor. With in the group model, the counselor can maximize contact with those in need. Within a thirty-minute time frame he or she may see 6 individuals as opposed to a single student. The emotive rationale for the group is emotional and experiential support. Noting that the majority of those suffering from eating disorders are female, it would be best to maintain gender specific groups for this issue. When discussing body image and eating, it stands to reason that adolescent girls would be more uncomfortable sharing details of their struggles with males in the room. With regard to culture, research may state that the majority of girls suffering form eating disorders are affluent Caucasians, but this disease does travel across racial boundaries, and as such would be open to girls of all cultures. Within the group there may be different techniques, activities and expectations for initial participation due to cultural differences, but culture would not preclude membership.
Evaluation of Procedures • Monitor disordered behavior through journals and Google Docs • Monitor feelings through journaling • Seek to reduce frequency of binging, purging, obsessive exercise, and depressive thoughts