cou file · Web viewEating disorders affect millions of men and women every year; the National Eating Disorders Association (2013) states that “20 million women and 10 million men

Running head: EATING DISORDERS AND SELF-IMAGE 1

Group Proposal Plan

Eating Disorders and Self-Image in Young Women

Courtney Hollister and Lori Feiszli

Bowling Green State University

EATING DISORDERS AND SELF-IMAGE 2

Positive Self-Image for Women Struggling with Eating Disorders

Eating disorders affect millions of men and women every year; the National Eating Disorders

Association (2013) states that “20 million women and 10 million men suffer from a clinically significant eating

disorder at some time in their life”. This statistic highlights the abundance of individuals that struggle with an

eating disorder and the importance of medical and mental health resources made available to these

individuals. Not only are there physical symptoms such as muscle loss and weakness, severe dehydration,

fatigue, hair loss, reduction of bone density, tooth decay, abnormal heart rate, and low blood pressure

(National Eating Disorders Association, 2013), but there is an increase in mental health concerns as well.

According to the National Eating Disorders Association (2013), alcohol and other substance abuse disorders

are four times more common in individuals with an eating disorder and the comorbidity of depression and

other mood disorders with eating disorders occurs frequently.

Of all individuals struggling with anorexia nervosa, 90% are women (Font-Costa & Bonet-Jofre, 2013,

p.46). According to Benas, Uhrlass & Gibb (2010), “beginning in adolescence, rates of depression are

approximately twice as high for women than for men and research suggests that body dissatisfaction

contributes to elevated depression levels above and beyond other risk factors” (p.352). These statistics

emphasize the significance of assisting young women in obtaining a positive self-image and decreasing body

dissatisfaction. The media can be detrimental to this goal because “women often experience unrealistic cultural

demands for thinness” (p.47) as stated by Font-Costa et al. (2013). Women encounter unrealistic expectations

on a daily basis from TV, movies, magazines, books and the Internet. A study done by Font-Costa et al. (2013)

showed that fashion magazine reading can be associated with women having a higher preference for lower

weight and having lower confidence about their own body image (p. 47). In addition, researchers have

reported that “80% of teenage women of normal height and weight indicated a desire to weigh less and 27% of

girls aged 12-18 displayed disordered eating attitudes, with the highest prevalence among older adolescent

women” (Choma, Shove, Busseri, Sadava, Hosker, 2009, p. 700).


Not only does the media provide women with unrealistic body expectations, but they also fuel the

objectification theory, which can cause negative experiences such as body shame (Choma et al. 2009, p. 700).

According to Choma et al. (2009), “Women who self-objectify view their bodies in relation to western culture’s

idealized female body; and, when a women fails to attain this ideal, or perceive a discrepancy between their

actual self and their culturally-informed self, they experience shame” (p.700). This body shame and self-

objectification is linked to negative mental health concerns such as depression, social anxiety, low self-esteem

and impaired sexual functioning (Bhatnagar, Wisniewski, Solomon, & Heinberg, 2013, p. 1).

As shown in the above research, eating disorders are prevalent among young women and the physical

and mental health concerns are serious. It is crucial that mental health resources such as support groups and

individual and group counseling are made available so that women struggling with an eating disorder have

knowledge and support to overcome their disorder.

Leadership Style and Preferences

In order to best meet the needs of the group members, it is important that the leaders have awareness

of their own leadership style and how this can affect the therapeutic relationship in a group. According to

Jacobs, Masson, Harvill, & Schimmel (2012), leadership style can be differentiated into specific categories such

as leader-directed, group-directed, intrapersonal and interpersonal leadership styles (p.22-23). Not only does a

leader need awareness of their own personal style of leadership, he or she should know what it takes to be an

effective leader. Characteristics such as caring, openness, flexibility, warmth, honesty, strength and patience,

are crucial to being a successful group leader (Jacobs et al. 2012, p.25).

Courtney & Lori’s Leadership Style

After a discussion of our leadership styles and preferences, Lori and Courtney discovered that their

leadership styles are very similar. After leading group sessions, we feel that we closely utilize a leader-directed

approach. For the group sessions outlined in this proposal, we think a leader-directed approach will helpful

throughout the beginning sessions and a group-directed approach may be more effective in the closing


sessions. Part of our group purpose is to educate the members, so a leader-directed approach may be more

appropriate in these sessions. In addition, we believe we possess qualities of both an interpersonal and

intrapersonal oriented leader. Throughout the group sessions in this proposal, the group leader will want to

focus mostly on interpersonal connections among the group members but there may be times where the group

leader will want to focus on a certain individual using an intrapersonal approach.

Overall Focus/Goal of Group

The main goals of the group include educating the members about their eating disorders, as well as

increasing the member’s body and self-image in order to continue progressing in their recovery and maintain a

healthy weight. The group leaders will use a combination of psychoeducational and counseling group

strategies in order to help members reach their individual and group goals.

Recruiting and Screening Members

Members will be referred to the group by the agency’s psychiatrists based on their diagnosis of anorexia

nervosa or bulimia nervosa. Psychiatrists will be notified of the group’s logistical parameters, which include a

formal diagnosis, as well as the sex and age of the members.

If the group leaders receive more than eight referrals, they will conduct personal interviews to screen

the members and ensure they are ready for group counseling. The document used is screen members is shown

in Appendix A. Using the personal interview responses, the group leaders will decide which eight women are

the best fit for the group.

Additional Group Logistics

The group will consist of eight females ranging in age of 14-24, specifically girls in high school or

college. The group members may differ in their previous attempts at recovery, their time in recovery and their

specific eating disorder. The group will meet in the agency’s meeting room with the chairs arranged in a circle,

and the group will meet every Wednesday for eight weeks for two hour sessions from 7-9pm.


Group Plan Section

Session One: Opening

Purpose: The purpose of the opening session is to introduce the leaders and become acquainted with each member of the group. We want to provide a safe and trusting environment for all members, so that they will be able to feel comfortable enough to begin sharing and participating in the group. There will also be a brief discussion regarding informed consent, rules, confidentiality, the purpose of the group and the group member’s expectations of the group.

Opener: The opener will be an activity where the members begin by sitting in a circle. Bright lights in the room will be turned off and a candle will be lit by one of the leaders, who will then pass the candle to the group member directly to her right. When a member is handed the lit candle, she will tell her name, and in two or three sentences describe what her expectations for the group are and what she hopes to gain from participating in the group. When finished, that member will then pass the candle to the group member to her right, and the process will be repeated until everyone has had the opportunity to introduce themselves. The candle will be blown out by the last member after her introduction.

Main Activity: There will be two main activities that will focus on how each group member feels about her body/self-image. First, a body/self-image questionnaire will be passed out to each member (See Appendix C). On this questionnaire, there will be a wide variety of body types, ranging from extremely thin/emaciated, to heavy-set. There will be 18 images total, with 1 being the thinnest and 18 being the heaviest. Each member will circle three different silhouettes, and above each of those number them in the following order: 1) The silhouette that most accurately depicts the member’s body size as she perceives it; 2) The silhouette that most accurately depicts the body size that she would most prefer; and 3) The silhouette that represents a body size that she believes is realistic for her to maintain over a long period of time. Since this activity is fairly brief, it will be supplemented by a 10-question worksheet in which each member has to put whether she (1) Strongly Agrees; (2) Agrees; (3) Disagrees; or (4) Strongly Disagrees with each statement. The ten statements are as follows:

______1. On the whole, I am satisfied with myself.______2. At times I think I am no good at all.______3. I feel that I have a number of good qualities.______4. I am able to do things as well as most other people.______5. I feel I do not have much to be proud of.______6. I certainly feel useless at times.______7. I feel that I am a person of worth, at least on an equal plane with others______8. I wish I could have more respect for myself.______9. All in all, I am inclined to feel that I am a failure.______10. I take a positive attitude toward myself.

Once each member has completed these two items, we will process the activities together as a group. This questionnaire is a combination of questionnaires from Collings, A.S. (2005) and Conley, A.R. (2004).

Processing Questions: 1) What feelings, thoughts, or emotions came up for you while you were selecting the various silhouettes, as well as

when filling out the questionnaire?2) What was the most difficult part about these two activities?3) What do you wish was different about yourself?

Closing: We will close the opening session by giving each group member their own personal journals. They will be given enough time (approximately 5-10 minutes) at the end of each session to write their thoughts or feelings about that evening’s group, and any questions or concerns they may have. They will then be given the responsibility to take their journals home with them and write about one event that occurred from the end of each meeting to the beginning of the very next meeting. This event must be relevant to the purpose of the group, and may be used as a means for a member to bring up a topic or question for future discussion. Members will be instructed to bring their journals with them to every session.


Session Two

Purpose: The purpose of the second session is to continue providing a safe and trusting atmosphere for each member of the group. We will once again briefly cover the rules regarding confidentiality, informed consent, and continue to acquaint the members as to how the group process works. We will reiterate the purpose of the group and why members are here, which is to help them recover from their eating disorder(s) and focus on improving body/self-image. This session will be dedicated to educating group members about anorexia and bulimia, including the physical effects these diseases have on the body, statistics, and any other pertinent information. Members will also be educated about nutrition, maintaining a healthy body weight, learning relaxation techniques, challenging negative thoughts, and learning new coping skills.

Opener: We will begin with a quick round in which every member briefly states in 2-3 sentences what their thoughts were concerning the first session, as well as the toughest and/or most anxiety-provoking part for them. The members will also be given a sheet of paper on which to write between 5 and 10 negative thoughts they have about themselves in regards to their eating disorder and body/self-image. The members will then hand in the list to one of the leaders, and it will be saved, with its purpose being described during a later session.

Main Activity: The main activity will focus on the education of group members about their eating disorder(s). We will begin by playing a ‘Fact or Myth’ game with the members. The leaders will have two columns up on the Smart Board, the first labeled ‘Myth’ and the other listed ‘Fact.’ At the bottom of the screen will be a combination of 16 myths and truths in a phrase or sentence form about eating disorders. Each member will have an opportunity to come up to the Smart Board twice and drag their chosen sentence or phrase into the ‘Myth’ or ‘Fact’ columns. Before revealing if the answers are correct or not, the leaders will be showing an interesting Power Point presentation about what anorexia and bulimia are, how they affect a person’s body, the prevalence of the disease, statistics, mortality rate, treatment choices and outcomes, how family members are affected, and so forth. Visual aids (e.g. diagrams and charts) will also be incorporated in order to make the presentation more interesting for the members. It will not last for a long duration (approximately 20 minutes) in order to prevent boredom/loss of interest. When the Power Point presentation has concluded, the members will be asked to get up and stretch/move around for approximately 2-3 minutes before continuing with the next activity. This will give members a moment to refocus and collect their thoughts on all the information that was just presented. Once members return to their seats, we will begin processing the information that was learned, and go over what the correct answers were to the ‘Fact or Myth’ game. Members will then be given an opportunity to clarify any questions or concerns they may have regarding the game and/or presentation, and will be allowed approximately 3-4 minutes to vocalize their thoughts and reactions to them.

Processing Questions: 1) What did you enjoy most about the ‘Fact or Myth’ game and presentation?2) What did you enjoy least about the ‘Fact or Myth’ game and presentation?3) When viewing the presentation, what was at least one or two things mentioned that you already knew about

eating disorders?4) When viewing the presentation, what was at least one or two things mentioned that you did NOT yet know about

eating disorders?5) Were you surprised by any of the answers to the ‘Fact or Myth’ game?6) Was it difficult to learn any of the information you did today? If so, what was the most difficult part(s) to see

and/or hear?7) How has the presentation and game affected you personally? Did it bring up feelings, thoughts, or emotions that

you hadn’t anticipated you would experience?

Closing: As with the first session, and each remaining session from here on out, the members will be given the last 5-10 minutes of the group to write in their journals about their thoughts and feelings on the evening’s group, as well as any questions or concerns they might have. They will take their journals with them in order to write about one relevant issue that occurred during the following week that is relevant and pertains to the purpose of the group.


Session Three

Purpose: The purpose of the third session is to do a brief review of the material group members learned in the second session pertaining to eating disorders. They will use the information they learned to begin forming relevant goals for themselves. Members will also begin to become more aware of their negative perceptions of their own bodies, as well as the attributes they feel are positive.

Opener: We will begin by doing a round with the group members, asking them to mention one new thing that they learned the previous week. If for some reason a member did not learn anything new, she can briefly state one way in which she can apply her knowledge to her own personal struggles.

Main Activity: There will be two activities that the group will focus on during this session. The first activity will involve goal planning. Members will include goals that they wish to achieve in one week, as well as goals that they would like to achieve by the end of the eight sessions. After coming up with their goals, the members will list two obstacles that my interfere with them reaching their goals; two things they will need to do in order to achieve their goals; and one thing they can begin doing the very next day to begin working towards their goals. Each member will then take a few minutes to share and process these items with the rest of the group. The members will then be given a 10-minute break in between the two activities in order to refresh and refocus.

Upon returning from the 10-minute break, we will begin the second activity. This is an art therapy activity that the members will complete in dyads. Members will pair up with another member of their choice and will participate in an activity called “Body Tracing With Love” as explained in Appendix D. Upon completion of the activity, the group will discuss the negative and positive aspects of themselves as depicted on their traced bodies. The group will look for similarities and differences between each member’s perceptions of herself, and process why they perceive themselves in a particular way. This exercise is adapted from Schwartz (2013).

Processing Questions: 1) What was it like for you to see your body traced on the paper? What emotions surfaced?2) Was it easier to list the negative or the positive aspects of yourself? Why?3) Did you agree with other member’s negative views of themselves?4) Do you have any idea why you perceive yourself in the negative ways that you listed?5) How do you think your perceptions of yourself could become more positive?

Closing: Write in journals and wrap-up with a round on how members are feeling after completing the evening’s activities utilizing the 1-10 scale (with 1 being extremely negative and 10 being extremely positive).


Session Four

Purpose: The purpose of this session is to get the group members to try and delve deeper emotionally in order to better understand the cause of their eating disorder and negative self-image. We hope to facilitate this process by using music and video clips dealing with eating disorders and negative self-image in order to reach their innermost feelings and emotions. We would also like to enhance member’s knowledge of their disorder by providing them with numerous resources, ranging from books to other music videos and movies dealing with eating disorders and self-image.

Opener: The group will begin by sitting in a circle on the floor. The leader instructs each member to imagine that she is the person sitting to her right. The members need to essentially “put themselves in the other member’s shoes” and think about what kind of day that person had, then share their thoughts in 4-5 sentences. Each individual will share what they come up with in regards to the type of day their fellow group member had. After each person has shared, the individual concerned will then give a score for accuracy (i.e. 6 out of 10). Each member will have approximately 1-2 minutes to share what her day was like, and the accuracies or inaccuracies of how the member to her left described her day. This exercise is adapted from Leadership Development Resources (2013).

Main Activity: The activities for this session will include watching a documentary about eating disorders titled “Dying to be Thin” and listening and watching the video of Christina Aguilera’s song “Beautiful.” The group will first watch the documentary about eating disorders. After the video is finished, members will be put into dyads for approximately 5-10 minutes to share their thoughts on what they viewed, as well as discuss how they could relate to the video. Members will have to include their thoughts and reactions in their journals near the end of the session as well. Members will then be given a brief 5-10 minute break.

When the group members return, they will watch Christina Aguilera’s music video “Beautiful” while carefully observing what is occurring and listening closely to the lyrics. When the song is over, the members will take a few minutes to collect their thoughts, and then will begin writing down feelings and emotions that emerged for them while listening to the song. When the members are finished writing, they will process their thoughts on how they felt and reacted to the song. This will be done as a round so each member has the opportunity to share. The round will be followed by a group discussion.

Processing Questions:1) Which part of the documentary really stood out to you?2) In what ways were you able to relate to the things discussed in the documentary?3) When you watched the music video and listened to the lyrics, what part really resonated with you?4) What positive advice would you have for the individuals in the documentary and/or the music video? Could you

take that advice and apply it to yourself?

Closing: Write in journals, and if all members are okay with doing it, participate in a group hug to end the session and bring a sense of unity and closeness to the group.


Session Five

Purpose: The first purpose of this session will be to give each member the opportunity to bring up a topic of relevance to the whole group and begin their own discussion. The other purpose will be for members to begin identifying and addressing the root causes of their disorder, which are the emotional triggers that lead to their disordered eating.

Opener: We will open the fifth session by asking how each member is rating her self-image now, five weeks into therapy, versus how she believes she would have rated herself when the group first began. Using a round, each member will rate her self-image on a scale of 1-10 (with 1 being extremely negative and 10 being extremely positive). She will state the number that she feels most accurately depicted her view of herself when she came to the very first session, and will then state the number she feels most accurately describes where she is at now in regards to having a positive self-image. All members will have approximately 3 minutes to discuss why they believe their number has gone up or down within the past five weeks.

Main Activity: The first activity will give members the opportunity to bring up an issue or topic (of relevance to the purpose of the group) that she wishes to discuss. Approximately 20-30 minutes will be allotted for this activity. If none of the members have anything they want to bring up, the leaders will bring up a preplanned topic that they feel the group as a whole still needs to work and improve upon such as how the media influences their disorders.

The second activity will help to assist group members in recognizing what their emotional triggers are, and the members will be taught how to avoid or combat them. Each member will be given a worksheet with questions concerning what things may trigger them or how their negative thinking could affect their recovery. See Appendix F for a copy of the worksheet. Members will be given enough time to really think about these questions, and then begin answering them honestly. When each group member is finished, she will take a few minutes to discuss with the group 1 or 2 items on the worksheet that she believes may be her biggest trigger(s) and put her in jeopardy of relapsing.

Processing Questions: 1) How did it feel coming to the realization that you may need to make many significant changes in your life in order

to prevent relapsing?2) What was the most difficult part about filling out the Trigger Worksheet?3) Are you having doubts about any people, places, or things you may need to eliminate from your life in order to

remain healthy?4) How can this group use each other and/or the knowledge you each have gained so far as a source of strength in

the future should you feel you may relapse?

Closing: Write in journals. Have each member say one positive thing about the group member sitting to her left.


Session Six

Purpose: The first purpose for tonight’s group will be to track each member’s progress on the goals set in week 3. The second purpose is to teach and discuss new coping skills in order to help members deal with their particular eating disorder.

Opener: Tonight’s group will open with a round on how the previous week was for each of the members (in regards to any triggers they may have encountered). Each member will be given approximately 3 minutes to talk about what the trigger was (if any), and how she dealt with it. If a member did not encounter a trigger during the previous week, she will be asked to share 1 or 2 positive things that happened to her.

Main Activity: For the first activity, members will each take a turn reviewing and sharing with the group what the goals were that she had set forth for herself. She will then take a couple of minutes to discuss whether she has made progress, and if so, how she has done this. If she has not made progress on her goals, she will process with the group why she thinks she is not moving forward.

The second activity will require each member to brainstorm various ways in which she could cope with her underlying feelings of anger, sadness, fear, vulnerability, etc., instead of using food to cope with the painful emotions she is experiencing. For this activity, the members will form dyads in order to allow for more personal sharing and discussion of healthy coping mechanisms that they feel they could use in their own lives (instead of starving themselves or binging and purging). Members will have approximately 10 minutes to come up with as many healthy coping mechanisms as possible. When the 10 minutes are up, one member from each dyad will take a turn writing her groups’ ideas on the Smart Board for the rest of the members to see. Once a member from each of the four dyads has had the opportunity to finish writing, a discussion will follow about how each of the group’s lists compare and contrast to one another. A discussion will ensue regarding the group’s thoughts and reactions to the activity.

Processing Questions:1) What can you do to continue making progress on your goals?2) If you feel you are not making progress, what do you think you have to do in order to start working towards your

goals?3) What did you get out of the second activity that dealt with coping skills?4) Which coping skills do you feel might be the easiest for you to try, and which ones may be the most difficult?

Closing: Write in journals.


Session Seven

Purpose: The purpose of the seventh session is to make the group members aware of just how important it is to have significant people in their lives (e.g. parents/guardians, spouse/significant other, close friends, etc.) involved in their recovery. This will be a time where one or two of the most significant people in each member’s life can come in and gain more insight into eating disorders and the recovery process by listening to a guest speaker, who has been in recovery for more than 10 years, share her story.

Opener: Since tonight is very different from other sessions in which only group members were present, we are not going to do a traditional activity or round to open up with. Instead, we will give each group member a chance to introduce who they have brought in with them. This will be kept to simply the name of the person and his or her relationship to the group member. The opener will be limited to 10 minutes or less for the entire group.

Main Activity: Tonight, we will be bringing in a guest speaker who has been in recovery for more than 10 years from an eating disorder. She is going to share her experiences, and provide hope, strength, and encouragement to group members and the guests they brought with them. She will take approximately 45 minutes to tell her story, which will include why it is so imperative to have close family members or friends involved in the group members’ lives throughout their recovery.

Processing Questions: Since tonight is different from previous sessions, once the speaker has concluded her story, the remainder of the session will be devoted to answering questions that group members and their guests have for the speaker.

Closing: If time allows, members will take the last few minutes to write in their journals. Everyone will thank the speaker for sharing.


Session Eight: Closing

Purpose: The final session will serve several purposes. The first will be to review what members have learned throughout the course of the group. The second purpose will be for each member to create and take home a Safety/Prevention Plan. Members will take the body image questionnaire (the same one they took during the first session) to see how much progress they have made. We will finish with two fun activities before wrapping up and saying our goodbyes.

Opener: For the opener we will do a round and give each member the opportunity to share what she will take away most from participating in the group.

Main Activity: As a group, we will begin by having a discussion over things the members have learned throughout the past eight weeks. We will then have each member create her own Safety/Prevention Plan. This plan will include 3-5 signs that the member may relapse; 3-5 people she can call should she feel she is at risk for relapsing; and 5 things she can do to get her mind off of her eating disorder and calm the urge to return to her old ways.

Finally, members will engage in a fun activity that will remind each of them every day about some of the most positive qualities that they each possess. We will give each member a framed mirror. The frame of the mirror is white and can be written on with nail polish or permanent marker. Each group member will take turns writing something positive about each person on their individual mirrors. The intention of this activity is for every member to take their mirrors home with them, hang them up in a place where they will be seen every day, and have them look into the mirror while simultaneously saying out loud all of the positive qualities that they possess.

Processing Questions:1) What is the biggest change you notice about yourself from the first session until now?2) What emotions are you experiencing now that the group is ending?3) What was the most positive thing you will take away from participating in the group?

Closing: Members will be given the body image questionnaire to complete and turn in, showing the changes they have made from the first session until now. We will then return to the pieces of paper the members turned in with 5-10 negative things about their eating disorder and/or body image (from session 2). We will stand in a circle around a paper shredder. Each member will take turns reading her list out loud to the group, and will then walk up and shred the piece of paper, destroying those negative thoughts and perceptions she has carried around with her for her entire life. We will then say our goodbyes.


Anticipated Challenges

There are many anticipated challenges in a group counseling environment, not only during the group

sessions but also throughout the planning process. A challenge of planning the group could be finding time for

several personal interviews in order to appropriate screen members for the group. A challenge that could

occur during a group session is that members could be at different stages of recovery, i.e. a member’s first time

in recovery versus a member who has been struggling with recovery for many months. Another challenge for

the group may be negative group dynamics such as manipulative, defensive or avoidant members, personality

and value differences among members and members not willing to participate in the group or with certain

individuals. The group sessions include journal writing both in and out of the sessions, so a challenge may be

that some members may not write in their journal outside of the group or may forgot to bring their journal to

the sessions. In addition, when working with girls in high school or college, many members may have other

extracurricular activities or academic responsibilities, so members missing group sessions may be a challenge.

There are many other challenges that may come up in the group such as subgroups forming and tardiness to

the group sessions.

Evaluation of Group

In order to evaluate the group member’s progress and the overall group effectiveness, a questionnaire

(see Appendix A) will be given at the beginning and end of the group sessions. This questionnaire will show

progress made in ideas of body image, self-esteem and self-image. In addition, members will be asked to make

goals during the third group session and these goals will be assessed throughout the following sessions to

ensure that progress is being made. Other evaluation methods include an evaluation form that the group

members will fill out about the effectiveness and helpfulness of the group and a leader reflection and

evaluation of the group. Both of these will be helpful in making improvements to future groups and evaluating

leader effectiveness, strengths and weaknesses. In addition, the group leaders will encourage members to

attend a follow-up session three months later to check recovery progress of the members.


Conclusion

The rationale for this group is reinforced by the previously discussed research and statistics about

eating disorders. We hope that the group sessions described in this group proposal are detailed enough that

future mental health counselors can use these sessions in their own counseling practices. We believe the

activities outlined in the sessions are geared toward the group goals of educating the members about their

eating disorders and increasing the member’s body and self-image in order to continue progressing in their

recovery and maintain a healthy weight. Although there will be challenges, we feel that the combination of a

counseling and psychoeducational group will best meet the needs of the group members.


References

Benas, J.S., Uhrlass, D.J., & Gibb, B.E. (2010). Body dissatisfaction and weight-related teasing: A model of

cognitive vulnerability to depression among women. Journal of Behavior Therapy and Experimental

Psychiatry. 41, 352-356. doi: 10.1016/j.jbtep.2010.03.006

Bhatnagar, K., Wisniewski, L., Solomon, M., & Heinberg, L. (2013). Effectiveness and feasibility of a cognitive-

behavioral group intervention for body image disturbance in women with eating disorders. Journal of

Clinical Psychology, 69(1), 1-13. doi: 10.1002/jclp.21909

Birgegard, A., Bjorck, C., Norring, C., Sohlberg, S., & Clinton, D. (2008). Anorexic self-control and bulimic self-

hate: Differential outcome predication from initial self-image. International Journal of Eating Disorders,

42, 522-530. doi: 10.1002/eat.20642

Choma, B.L, Shove, C., Busseri, M., Sadaba, S.W., & Hosker, A. (2009). Assessing the role of body image coping

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Collings, A.S. (2005). The relationship between body image and weight maintenance in community women

enrolled in weight-loss programs (Doctoral dissertation). Available from Digital Commons at Eastern

Michigan University database.

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Jacobs, E.E., Masson, R.L., Harvill, R.L., & Schimmel, C.J. (2012). Group counseling: Strategies and skills. United

States: Brooks & Cole Cengage Learning.

Leadership Development Resources (2013, July). Get-to-know-you exercises. In Team-Builders, Energizers, Ice-

Breakers. Retrieved from http://www.drexel.edu/OCA/l/tipsheets/Teambuilders.pdf


National Eating Disorders Assocation. (2013, July). Find help & support. In National Eating Disorder

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Schwartz, D. (2013, October). Art therapy techniques: Tracings of love. In Art Therapy. Retrieved from

http://www.arttherapyblog.com/art-therapy-activities/expressive-art-therapy-technique-body-

tracings-of-love/#.Ue2R0o21F8E


Appendix A- Personal Interview QuestionsScreening Document taken from Jacobs et. al 2012, p. 72

Why do you want to be in this group?

What are your expectations of the group?

Have you ever been in a group before? If so, what was it like?

What concerns do you want help with?

Is there anyone with whom you would not want to be in group?

How do you think you can contribute to the group?

Do you have any questions about the group or leader?


Appendix B – Informed Consent

Informed Written Consent for Group Counseling Modified copy obtained from Jacqueline M. Alexander, MA, LPC, NCC

Counselor Relationship Role1. The counselor will help establish goals and objectives to be achieved during the counseling experience.2. The counselor will discuss with you the anticipated benefits as well as the possible undesirable effects of group

counseling work.3. The counselor can make no guarantees as to the outcome of your counseling experience. The counselor will, however,

monitor with you the progress of your therapy and the degree to which the treatment is meeting your needs. If at any point it is evident that you would be better served by a mental health professional other than myself, I will assist you by providing a list of referrals.

Confidentiality1. Any and all information, including your identity, will remain strictly confidential unless the counselor has your written

permission to the contrary. 2. Any and all information disclosed by other group members during a group session is confidential and may not be

discussed by group members outside of the group session. However, the counselor has no control over the other group members.

3. The counselor will, as bound by law, report all cases of child/elder abuse (actual or suspected) to the appropriate state or community agency. Further, the counselor is obligated by law to intervene, including breaking confidentiality, in situations where there is evidence that you are at risk of doing harm either to yourself or others, and/or other’s property. The counselor is also bound by law to report full and accurate information regarding the content of counseling sessions in cases where she has received a subpoena or court order to do so. In cases where the counselor is required to break the agreement of confidentiality, she will, if possible, discuss the specifics of the particular situation with you.

Client’s Relationship Role1. After discussing the objectives of the group therapy format, I am freely agreeing to take part in the therapy, and work

toward the achievement of the objectives the counselor and I will set, knowing the desirable and undesirable effects that are possible.Note: Counseling can be tremendously beneficial for some individuals. There can be no guarantee, however, that your participation in group counseling will result in a positive benefit. Counseling also carries with it some risks you should be aware of. Through the process of opening up personal issues, you may experience unwanted feelings that can include but are not limited to: sadness, anger, fear, guilt, anxiety, etc. It is important to remember that these feelings may be a normal, natural, and necessary part of the counseling process. Other risks of counseling might include: recalling unpleasant life events, facing unpleasant thoughts and beliefs, increased awareness of feelings, values and experiences; alteration of your ability or desire to deal effectively and harmoniously with others in relationship. In counseling, major life decisions are sometimes made including: separation within families, development of other relationships, changing employment, or changing lifestyles. These decisions are legitimate outcomes of counseling. Your therapist will discuss with you any questions or concerns you may have with the counseling process and/or if your desired goals should change.

2. I agree to participate, to the best of my ability, in all sessions. Should I decide that I no longer wish to continue in personal therapy, I will share my decision with the counselor and attend a final group meeting to achieve closure with the group members.

Relationship Termination1. I have been assured of my right to terminate participation in group therapy at any time, for any reason.2. I understand that the counselor may terminate our working relationship if it is her professional opinion that I can be

better served by another form of mental health service and/or agency. If that case should arise, the counselor will provide referral sources and assist me in finding adequate services.

Client ConcernsI understand that at any time I may voice concerns that may arise over the course of my work with the counselor. Further, I understand that my concerns will be taken seriously and efforts will be made to resolve my concerns.

Client Signature: _______________________________________________________ Date: _____________________

Therapist Signature:____________________________________________________Date: ____________________


Appendix C – Body/Self-Image Questionnaire

Body Image Assessment________ 1. Select the silhouette (choose a number from above) that most accurately depicts your body size as you perceive

it to be.

________ 2. Select the silhouette that most accurately depicts that body size that you would most prefer.

________ 3. Select a silhouette that represents a body size that you believe is realistic for you to maintain over a long period

of time.

Relationship of Self Esteem SurveyIndicate which response best describes how much you agree or disagree with the following statements.

1- Strongly Agree2- Agree

3- Neutral4- Disagree

5- Strongly Disagree

________1. On the whole, I am satisfied with myself.

________ 2. At times I think I am not good enough.

________ 3. I feel that I have a number of good qualities.

________ 4. I am able to do things as well as most other people.

________ 5. I feel I do not have much to be proud of.

________ 6. I certainly feel useless at times.

________ 7. I feel that I am a person of worth, at least on an equal plane with others.

________ 8. I wish I could have more respect for myself.

________ 9. All in all, I am inclined to feel that I am a failure.

________ 10. I take a positive attitude toward myself.


Appendix D – Body Tracing with Love Activity

Purpose:

- Provide opportunities for members to discuss the power that printed and visual media has over self-esteem and

body acceptance.

- Help clients remember and/or discover that her body has more value in the world than just looking a certain

way.

- Learn to nurture a true self-love for a body’s abilities rather than perceived obligations, which may be a vital step

in living a physically and emotionally healthy lifestyle.

Materials Needed:

- Magazines

- Butcher paper

- Construction paper

- Colored pencils

- Markers

- Scissors

- Glue sticks

Directions:

- Group members will participate in this activity in dyads. Members should partner up with a person on their

choice to complete the activity.

- Members will trace each other’s’ bodies on the butcher paper (if a member is uncomfortable with this process, a

generic outline of a body can be provided).

- On the other side of the paper, have the members write down the negative external messages they receive about

their bodies.

- On the front of the paper (same side as the body outline), members will put a star next to the body parts they feel

are positive and will use collage materials, colors, texts, drawings and magazine clippings to describe the positive

aspects of their body and self.

- Remind members not to focus on the judgments they or others may have about what constitutes beauty or

perfection, those thoughts and words should be written on the back of the paper.

- When the artwork is complete, have each person choose one part of their body that they struggle with the most in

regards to self-acceptance, and share the negatives first and then the positives on the art piece.

- Note the commonalities and differences among the group members.


Appendix E – Media Resources

BooksAnorexics and Bulimics Anonymous - A 12-Step Approach to Eating Disorder Treatmentby Faith Farthing

Gaining The Truth About Life After Eating Disordersby Aimee Liu

Life Without Edby Jenni Schaefer, Thom Rutledge

Overcoming Eating Disordersby Robin F. Apple, & W. Stewart Agras

The BDD Workbook: Overcome Body Dysmorphic Disorder and End Body Image Obsessionsby James Claiborn, Cherry Pedrick

The Body Image Workbook: An 8-Step Program for Learning to Like Your Looksby Thomas F. Cash, Ph.D.

Anorexia Nervosa: A Guide to Recoveryby Lindsey Hall, Monika Ostroff

Bulimia: A Guide to Recoveryby Lindsey Hall & Leigh Cohn

Eating in the Light of the Moonby Anita Johnson, Ph.D.

Surviving an Eating Disorder: Strategies for Family & Friendsby Michelle Siegel, Judith Brisman, Margot Weinshel

The Body Image Workbookby Thomas E. Cash, Ph.D.

Dear Ashley: A Father's Reflections and Letters to His Daughter on Life, Love and Hopeby Don Blackwell

Movies/Video ClipsDove Body Sketches: http://www.youtube.com/watch?v=litXW91UauEDove Real Beauty: http://www.youtube.com/watch?v=pEEAZKbul4wPositive Body Image: http://www.youtube.com/watch?v=BpujGW1PkRI

Music“Just The Way You Are” – Bruno Mars“Beautiful” – Christina Aguilera“Perfect”- Pink“What Makes You Beautiful” – One Direction“Who Says”- Selena Gomez “Loser Like Me” – Glee cast“The Climb” – Miley Cyrus“The Voice Within”- Christina Aguilera“Listen”- Beyonce“The Beauty in Ugly”- Jason Mraz


Appendix F- Triggers Worksheet

Take a look at the following questions about your life. While you are completing this assignment, be completely honest. Honesty is the best way to reveal your negative thought and behavior patterns so that you can proceed to make healthy changes in your life and remain free from your eating disorder!

People:

Is there any person in your life that triggers your eating disorder? ________________________________________________________________________________________________________

If you answered “Yes” to the first question, who is that person, and why do you believe he or she triggers you? ________________________________________________________________________________________________________

Who in your life would you like to get closer to? ________________________________________________________________________________________________________

Where could you find other individuals who are in recovery from an eating disorder? ________________________________________________________________________________________________________

Places:

List the places that you need to stay away from because they trigger your disorder: ________________________________________________________________________________________________________

Why do you need to stay away from these places? ________________________________________________________________________________________________________

What are some healthy places you could visit? ________________________________________________________________________________________________________

Why is it important to change the places in your life that trigger you? ________________________________________________________________________________________________________

Things:

Do you have any item(s) that you need to get rid of? (Ex: a huge stash of food hidden somewhere that would tempt you to binge.) ________________________________________________________________________________________________________

Is there anything that you have that would be a constant reminder of your disorder? (Ex: a collection of magazines or posters with extremely thin models.) ________________________________________________________________________________________________________

List the things that you will have to change in order to reduce the triggers that you will face: ________________________________________________________________________________________________________


Continuation of Appendix F

Why is it important to change the things related to your disorder? ________________________________________________________________________________________________________

Thinking:

List your negative attitudes and thoughts related to recovery: ________________________________________________________________________________________________________

How can your thinking trigger you into relapsing? ________________________________________________________________________________________________________

Why is it important to change the way you think? ________________________________________________________________________________________________________

Client Name: _________________________________ Completion Date: _________

Therapist Name: _____________________________ Review Date: ____________

Documents

cou file · Web viewEating disorders affect millions of men and women every year; the National Eating Disorders Association (2013) states that “20 million women and 10 million men