Creating curative communities: feminist group work with women with eating issues

Keywordseating disorders, feminist therapy, group work.

IntroductionIn Australia, in 2001, over five per cent ofyoung women are identified as having an eating issue (Mulkerrins 2001).2 Thedominant form of treatment for these women will take a bio-medical approach.The focus of such intervention has been totreat the eating ‘behaviour’ thereby viewingthe eating issue in terms of individualpsychopathology (Malson 1999).

The medical conceptualisation of eating issues as forms of individualpsychopathology, and the correspondingbio-medical treatment approach, has beenchallenged by feminist critiques ofpractitioners in the fields of social work,psychology and psychiatry (Orbach 1988;Fallon et al. 1994). These critiques have not been homogenous as many variants offeminism exist (Humm 1995). Variants offeminism inform different theoretical andtherapeutic approaches to working withwomen with eating issues. Early secondwave feminist therapeutic interventions with women with eating issues typicallyadopted radical feminist perspectives(Orbach 1988). In more recent years, these approaches have been challengedby post-modern and post-structuralistperspectives in work undertaken by

Australian Social Work/June 2003, Vol. 56, No. 2 127

Creating curative communities:feminist group work with women with eating issuesCatherine Black

The purpose of this study is to explore the efficacy of feminist group work forwomen with eating issues. Data for the study is drawn from participants involved infive therapeutic groups at the community based organisation, ISIS Centre forWomen’s Action on Eating Issues1. Participants in this study completed the EatingDisorder Inventory (EDI) before and after group work and also responded to a post-group questionnaire which elicited their experiences of group work.Background information about ISIS and the model of group work at ISIS is provided.Following this, the EDI completed by participants and the post-group questionnaireare examined. The data reveals that feminist group work is a valuable therapeuticintervention for women with eating issues. The key to the effectiveness of groupwork is that it provides a curative culture.

Catherine Black is in private practice and consults to ISISCentre for Women’s Action on Eating Issues in Brisbane.Email: [email protected]

writers such as Bordo (1988) andRobertson (1992). This turn to culture hasemphasised women’s multiple subjectivities,the pluralistic and localised nature of powerand the potential for power to be resisted(Brooks 1997). Illustrative of this type ofwork is a study undertaken by Rieger et al.(2001) that examined women’s eatingissues by focusing on women’s culturalidentities as well as their gender identities.

Feminist group work at ISIS has beenformed by the early second wave feministapproaches described above (Orbach1988). The group work model was one that was developed largely in response tothe bio-medical approach. Instead of a‘medical interventionist’ approach, theapproach has been labelled ‘women-centred’ (Black 2000). In adopting thisapproach, ISIS workers have drawn not only on earlier feminist studies of eatingissues, but also more recent work whichhas suggested that, regardless of otherdifferences between women, there arecommon themes underlying women’srelationships with food and their bodies(Bloom et al. 1994; Katzman & Lee 1997).

One of the central themes is therecognition that eating behaviour may be away women have developed to cope withthe internal conflicts and underlying traumathey experience in the course of their lives(Lawrence 1987). Thus, eating issuesrepresent a woman’s attempt to assert heridentity and to gain control in a world inwhich she feels powerless (Lawrence 1987;Orbach 1988). Eating issues characterisewomen’s experiences as they move socialclasses, countries or gender boundaries oras they attempt to straddle the private andpublic domains of society. Thus, eatingissues may be conceptualised as ‘problems

of disconnection, transition and oppressionrather than dieting, weight and fat phobia’(Katzman & Lee 1997; p. 392).

To address this disconnection feministshave advocated the use of group work toprovide women with a ‘mini-community’which may create an alternative place todwell and to enact their struggles other than through food and their bodies(Katzman & Lee 1997; p. 392). This model of group work, which addresseswomen’s isolation and disconnection insociety, is one that has been adopted atISIS. It is embedded in four assumptions(Black 2000). The first is that relationshipsare central to the therapeutic process.Thus, the feminist group work model at ISIS is characterised by an approach thatvalues women’s differing input, emphasisesnon-hierarchical relationships and placesemphasis on support and care. The second is that the process is as importantas the product. That is, the processadopted in the group work is integral to and cannot be separated from thebehavioural changes women may beseeking. The third is that women’sexperiences and expertise are recognisedas valuable and that these can be used as an integral aspect of women’s recovery.It is important therefore that the processesand practices of group work give voice andspace to these experiences and expertise.The fourth is that the personal is political.The model thus recognises that eatingissues are triggered by broader societalcauses, rather than individualpsychopathology or ‘fat phobic’ Westerncultures. Women in groups are encouragedto make connections between theirindividual experiences and the broaderposition of women within society

128 Australian Social Work/June 2003, Vol. 56, No. 2

(Dana & Lawrence 1987; Jasper &Maddocks 1992).

Despite the large number of academicpapers published on using group work withwomen who have eating issues, only asmall number have focused on feministgroup work and of this small number, veryfew have considered the clinical utility of afeminist group work approach (Moreno1998). Perhaps one explanation for the lackof academic studies evaluating the efficacyof feminist group work is that feminists havefound the traditional tools used to evaluateeating issues as limiting (Streigel-Moore1994). For example, the Eating DisorderInventory (EDI), one of the most widelyused evaluation instruments for themeasurement of treatment effectivenesswith women with eating issues, has beencriticised by feminist practitioners whosuggest that such ‘fat and food focused’instruments may not measure the coremotivations underlying women’s disorderedrelationship with food and their bodies(Katzman & Lee 1997; p. 390). Despite the possible limitations of the EDI, its use at ISIS chosen based upon three factors.First, the ISIS staff and ManagementCommittee were acutely aware of theimportance given to numerical data by the funding body and other professionalsworking within the field of eating issues.Furthermore, the EDI, despite its limitationsin terms of a feminist perspective, is still one of the most widely recognisedevaluation tools used in assessing theeffectiveness of intervention with womenwho have eating issues. Finally, there arecurrently no alternative measures thataddress the limitations previously outlined.

The purpose of this study is to seek toaddress the gap in the literature by

examining the efficacy of a feminist groupwork approach with women who haveeating issues. This study focuses on thegroup work undertaken at the communitybased centre, ISIS.

The Feminist Group WorkModel at ISISISIS Centre for Women’s Action on EatingIssues was established in 1996 with fundingfrom the Queensland Government. ISIS is acommunity based service providingtherapeutic group work and counselling towomen with serious eating issues. Arecently published resource manualdocuments the model of group workpractice at ISIS (Black 20003). The model ofgroup work is based on women’sparticipation and feedback, andincorporates a review of the literaturepertaining to radical feminist group workwith women with eating issues (Wooley &Kearney-Cooke 1986; Dana & Lawrence1987; Orbach 1988; Jasper & Maddocks1992).The group work model consists offour distinct developmental stages. Theseare: group building; disclosure; challenge;and closure. These stages address thegoals of group work. The first is to have apositive influence on an individual’sknowledge and attitudes that areassociated with their development of aneating issue. A second is to work towardsalleviating eating behaviours by beginningto address the underlying issues that giverise to women’s eating issues (Black 2000).

To meet these goals, groups at ISISconsist of a maximum of 12 women and a3 hour weekly session co-facilitated over an18–20 week period. Both the length of the


sessions and the period of the group workreflect both feminist practice andtherapeutic approaches to eating issuesmore generally, which emphasise long-termtherapeutic intervention as necessary torespond effectively to women with eatingissues (Dana & Lawrence 1987; Garneret al. 1997; McKisack & Waller 1997;Mohamed & Smith 1997). Typically sessionscomprise of a check-in, group buildingexercises, focus topics, a woman’s storyand a wind down. Creative arts processesare a regular feature of group work,enabling women an alternative means ofexpression other than cognitive expression,through transference or their relationshipwith food and their body. Non-hierarchicalrelationships and collaborative processesare essential features of group work offeringflexibility and control to individual womenparticipants.

Between 1997 and 2001, 14 therapeuticgroups involving 124 women participantshave been undertaken at ISIS. It is datafrom five of the more recent groups formsthe basis of discussion for this study.

Research MethodologySixty women participated across the fivegroups which ran over the period July 1998to June 2000. Women participants rangedin ages from 17–42 years. Of the 60 womenwho initially participated, 24 withdrew fromthe groups. Women indicated a range ofreasons for non-completion including:illness (six), work commitments (five);distance including travel overseas orrelocation (three); the group being toochallenging (three); the group was notmeeting needs (two); and other reasons

(five) including: inadequate childcare;transport difficulties; incompatibility withother group members; agoraphobia and no specified reason.

Of the 36 women completing group workat ISIS, 32 completed the EDI developed by Garner (1991), which measurespsychological factors associated withanorexia and bulimia, and 31 completed astandardised questionnaire developed atISIS. The EDI is a self-report questionnairewith eight subscales including: drive forthinness (indicating restrictive behaviour);bulimia (measuring the level of bulimicbehaviour); body dissatisfaction (assessingbody image); ineffectiveness (measuringfeelings of inadequacy); perfectionism(desiring high levels of achievement);interpersonal distrust (feeling alienated from others and difficulty in formingrelationships); interoceptive awareness(mistrusting feelings and an inability torespond to emotions); and maturity fears(assessing a desire to return to childhood).Higher scores on the EDI reflect higherlevels of disordered eating and adisordered relationship with one’s body(Garner et al. 1993).

Of these 32 women from the five groupswho completed the EDI prior to joining thegroup, and again in the final week of thegroup, seven women from group onecompleted an additional EDI during a 12-month follow-up evaluation. Of the32 women, nine identified as havinganorexia, five with bulimia, 10 withcompulsive eating and eight gave no clear indication about their type of eatingissue.

The second data source is the ISISsurvey, a standardised questionnairecompleted by 31 participants in the final


group session. These questionnaires weredesigned to elicit qualitative feedbackabout the impact of group work. The ISISsurvey asked women to provide generalimpressions of the overall experience ofgroup work as well as more specificreactions to particular aspects of the group. The standardised questionnairesenable some comparisons of the women’sexperiences of group work and their scores on the EDI. Further, as the feministcriticism of the EDI has pointed out, the qualitative data enables a morecomprehensive account of women’sexperiences of group work (Streigel-Moore1994; Katzman & Lee 1997).

Results of the eatingdisorder inventory Overall results of the EDI across allparticipants in groups 1–5 (Table 1)revealed a downward trend on allsubscales, with body dissatisfaction,interpersonal distrust and bulimia scores

displaying the most change and the scores for ineffectiveness and interoceptiveawareness changing the least.4 To assist in providing a context for the pre-group and post-group mean scores, they arerepresented graphically in Fig. 1, along with the scores from a sample population of women with eating disorders and asample population from a female universitycollege (presumed to represent a ‘normal’population).

The 12-month post-group follow-up withseven women from group one producedsome very positive results (Table 1). Scoreson all eight subscales of the EDI showed astrong downward trend, with improvementson the interoceptive awareness, maturityfears, drive for thinness, perfectionism andbody dissatisfaction scales beingsignificant.

Of the pre-group scores for the differenteating issues (Table 2), women whoidentified as having bulimia had noticeablyhigher levels of drive for thinness andineffectiveness than the other two groups,while women with anorexia had higher


Table 1. Eating Disorder Inventory mean scores and standard deviations pre-group formation,2 months post group formation and 12 months post-group formation

EDI Subscale Pre-group 2 months 12 months formation (n = 32) post-group post-group

formation (n = 32) formation (n = 7)mean scores SD mean scores SD mean scores SD

Drive for thinness 13.290 7.650 10.875 6.095 6.29 7.87Bulimia 7.781 5.863 5.781 4.405 4.14 6.99Body dissatisfaction 17.438 8.546 14.750 8.164 10.14 10.64Ineffectiveness 12.281 7.651 11.313 8.345 6.29 8.22Perfectionism 9.656 4.783 8.406 4.970 6.43 3.82Interpersonal distrust 6.875 4.995 5.281 4.517 4.57 4.12Interoceptive awareness 13.250 7.362 12.344 8.256 6.29 7.76Maturity fears 5.250 4.964 4.156 4.304 2.14 4.41

EDI: Eating Disorder Inventory.

levels of interpersonal distrust and lowerlevels of body dissatisfaction.

The post-group scores (Table 3) suggestthat women with bulimia benefited mostfrom their participation in the group. Theirscores on all EDI subscales improved, with particularly strong reductions on themeasures for body dissatisfaction, bulimia,perfectionism, drive for thinness andmaturity fears. Women with anorexia andcompulsive eating showed improvement on some subscales but not as much asthose with bulimia. Participation in

counselling in conjunction with group work appears to be advantageous, with EDI scores (Table 3) for this group ofwomen showing greater reduction than for women who participated only in groupwork.

Results of post-groupquestionnaires: women’sgroup work experiencesIn responding to a question about how theybenefited from the group work process,


Fig. 1. Overall mean Eating Disorder Inventory (EDI) scores (�) and female college studentmean EDI scores (�) compared with 2 month post-group formation mean scores (•––•) and pre-group formation mean scores (�– – –�).

participants emphasised the importance ofsimply sharing their experiences and storywith others. The significance of this wasevident in a majority of responses in whichwomen used words such as ‘hide’, ‘shame’,‘guilt’ and ‘secrets’. The following typifiesthese responses:

This is the first time I have ever spokenopenly about my eating issue. It has helpedme make progress and understand myselfmore than I had hoped for.

. . . I don’t feel that I am a shameful secretthat would be rejected and ridiculed if only people knew (Julie, aged 20 years,bulimia).5

Women felt able to share their experience,because, as one stated, there was ‘an open and safe place in which to come out’(Kate, aged 22 years, compulsive eating).Participants explained that this positivespace had been created through the skillsof the facilitators, who the women variouslydescribed as being ‘genuine’, ‘impartial’,‘flexible’, ‘trustworthy’, ‘sensitive yet astute’,‘compassionate’ and ‘challenging, gentleand non-shaming’.

Data indicates that a majority of womenalso stated it was important that theyexperienced being accepted and validatedwhen their stories were shared. One womanstated:


Table 2. Eating Disorder Inventory mean scores pre-group formation and 2 months post-groupformation for women who identified with the eating issues labels of anorexia, bulimia andcompulsive eating

Eating Disorder Anorexia (n = 9) Bulimia (n = 5) Compulsive Inventory subscales Eating (n = 10)

Drive for thinnessPre 8.78 18.2 11.5Post 10.00 12.4 9.9

BulimiaPre 2.22 12.8 9.7Post 2.78 5.2 9.1

Body DissatisfactionPre 11.56 19.8 19.7Post 11.44 10.6 17.7

IneffectivenessPre 10.00 13.8 10.3Post 12.22 7.4 11.2

PerfectionismPre 9.89 10.6 9.5Post 8.89 6.8 8.3

Interpersonal DistrustPre 7.56 3.4 5.9Post 5.67 2.6 5.1

Interoceptive awarenessPre 12.11 11.6 13.7Post 12.11 7.8 12.8

Maturity fearsPre 6.67 5.8 3.5Post 5.78 1.8 3.3

I am still lost for what it is that wasparticularly helpful about my involvement inthis particular group. The genuineness and integrity, the honesty and openness of group members perhaps. I justconstantly felt okay and valued . . . andperfect as I am (Lucy, aged 38 years,bulimia).

A further factor, which women foundbeneficial, was being in a space where they met others they considered to be likethemselves. Some commented on the

benefits this provided in terms of learning from others. For example, one woman stated that, ‘It was helpful to gain coping strategies from other women’ (Joanne, aged 19 years, bulimia), while another wrote that ‘It waswonderful, exciting and encouraging towork with so many brave and beautifulwomen’ (Julie, aged 20 years, bulimia). The strength gained by women from theexperiences of others in the group wasevident in comments, such as:


Table 3. Eating Disorder Inventory pre-group formation mean scores and 2 months post-groupformation mean scores for women who had counselling with group work and women who hadgroup work only

EDI subscales Mean scores for women Mean scores for women who had counselling who had group work

with group work (n = 14) only (n = 18)

Drive for thinnessPre 11.72 14.77Post 8.67 14.15

BulimiaPre 8.33 7.54Post 5.5 6.46

Body dissatisfactionPre 15.22 20.54Post 11.61 19.31

IneffectivenessPre 13.17 11.92Post 10.11 13.77

PerfectionismPre 8.06 11.92Post 5.78 11.37

Interpersonal distrustPre 7.17 6.92Post 5.28 5.69

Interoceptive awarenessPre 14.28 12.69Post 11.33 14.54

Maturity fearsPre 4.83 5.92Post 3.5 5.31

EDI, Eating Disorder Inventory.

Hearing the words spoken by other womenand seeing and feeling the strength of theiremotions . . . realising how real and painfultheir experiences were, made me respectmy own experiences more (Julie, aged 20 years, bulimia).

For others, this identification meant theemergence of friendships. Commenting onher involvement, one participant wrote:

I have friends and a support system whom I can call, share things with and listen toand won’t judge me or think I’m weird (Ruth, aged 22 years, bulimia).

As well as the element of friendship, theabove statement also points to group workas providing a non-judgemental context in which women can share similarexperiences without feeling strange ordifferent. One woman gave the responsethat she now felt ‘not so freaky realising that many women just like me are lurkingunder rocks’ (Sue, aged 24 years,anorexia). Another woman offered a similarreflection, saying that her involvement withothers made her feel that ‘I am not a weirdoor bad person’ (Maria, aged 19 years,bulimia). For these women, there was areduction in the isolation they hadexperienced and a lessening of self-blame.One woman said that she was ‘amazed bythe similarities between women regardingtheir issues and behaviours’ (Madeline,aged 24 years, anorexia). Another stated ‘I found the commonality and identityliberating’ (Judy, aged 26 years,compulsive eating). Nineteen of the 31 women described feeling an increasedlevel of self-acceptance. For example, one stated:

The experience of sharing my story, feelingsand life and owning and accepting my

experiences was of benefit (Joan, aged 29 years, compulsive eating).

Other participants agreed with this type of comment, reflecting that throughdeveloping relationships with others andtalking about similar experiences, theycame to know themselves in a more in-depth way. This is exemplified in thecomment by a woman who said that,through group work, she was able to have more ‘rational and supportiveconversations’ with herself (Judy, aged 26 years, compulsive eating). Othersdescribed increased feelings of self-acceptance as they learned moreabout their eating issue. One woman stated that she found it beneficial to be able to ‘clarify and understand themultiplicity of issues associated with eatingdisorders’ (Beth, aged 23 years, bulimia). A similar level of learning was expressed by the participant who explained that shecould now decode the language of fat:

. . . when I feel ‘fat’ I am actually feelingupset, angry, scared and I have the powerto change those feelings (Sally, aged 25 years, bulimia).

While identification with others in the groupwas considered beneficial by most of thewomen, data also indicates that womenfound group difference beneficial. This wasparticularly the case when women withdifferent eating issues were in a group. Acommon sentiment was expressed by aparticipant who wrote, ‘The diversity madecommon issues beneath the differentbehaviours much clearer’ (Emma, aged 27 years, compulsive eating). Alsoreflecting on the benefits of working with a diverse group of women, was theparticipant who stated that this was useful


to her own growth, as it ‘helped meunderstand how everyone is different but just as valid ’ (Clare, aged 23 years,anorexia).

While making positive comments,women also typically described difficultiesthey encountered in participating in thegroup. A common sentiment expressed bya number of participants was that ‘noticingand bringing up’ their feelings was at timesoverwhelming and painful. One woman’sresponse highlights the contradictionsinherent in therapeutic group work. Theparticipant wrote:

The group was difficult, fantastic, amazing,enlightening, confronting, challenging, sadand emotionally draining (Clare, aged 23 years, anorexia).

What this participant experienced was notuncommon. In their qualitative responses,women described the many challengesthey faced in being a member of atherapeutic support group. Four themeswere evident. First, women detailed whatone called the ‘hard and confronting’ workof sharing experiences with others. Anotherwoman stated, ‘It’s difficult having to shareand tell other people stuff I have kept tomyself for a very long time’ (Helen, aged 20 years, anorexia/bulimia/and compulsiveeating). Second, women expresseddifficulties they experienced in finding thelanguage to communicate with others in the group setting, as one woman stated itwas hard, ‘to put words to the mess in mymind ’ (Ruth, aged 22 years, bulimia). Third,women described a challenge in managingconflict when it arose in some groups.However, this was also positive in somerespects as one woman described nowbeing ‘more assertive and having healthier

boundaries around others’ (Chloe, aged 27 years, bulimia, anorexia and compulsiveeating). Finally, women found themanagement of some of the relationships inthe group as difficult and challenging. Forexample, one woman commented that shefound the process of relating to others inthe group difficult such as ‘shutting up, nottrying to rescue others and not comparingmyself and coming out unfavourably’ (Lucy, aged 38 years, bulimia).

DiscussionThe data from this paper has demonstratedthat a feminist approach to group work withwomen with eating issues used at ISIS isbeneficial. The EDI results indicatedimprovements in psychological factorsassociated with anorexia and bulimia. Thepositive impact of group work, as measuredby the EDI, appears more influential forwomen practising bulimic behaviours thanfor women with compulsive eating oranorexia. These results are consistent withother studies which have demonstrated that‘group psychotherapy is effective in thetreatment of bulimia nervosa’ (McKisack &Waller 1997; p.2). To date little attention hasbeen given to researching the effectivenessof treatments for women with anorexia(McIntosh et al. 2000). It has beensuggested that women with anorexiaexperience impaired interpersonalfunctioning, leading to the establishment ofrigid boundaries, which may hinder thedevelopment of therapeutic relationships oralliances (Dana & Lawrence 1989). Thesesuggestions warrant further investigation. Ofparticular interest is the notion that womenwith anorexia may be unable to avail


themselves of the potential therapeuticbenefits of group work in the same way that women with bulimia are able to (Dana & Lawrence 1989).

The improvements in EDI results appearmore substantive for women who accessindividual counselling alongside of theirparticipation in group work. These resultsare consistent with other studies (e.g.Wooley & Kearney-Cooke 1986; Moreno1998). The 12-month follow-up EDI resultsindicated a strong improvement, consistentwith women’s qualitative feedback at thistime, about the continuing positive impactof the ISIS group work experience in theirlives. It is important to note that this dataneeds to be interpreted with caution as the sample size is small.

In recognition of the limitations of theEDI as a measurement instrument, thispaper has also utilised post-groupqualitative questionnaires to assess theefficacy of feminist group work. Qualitativeresponses from these questionnairessupport the benefits of group workdemonstrated by the EDI results.Importantly, they also provide indicators as to why women have experienced group work so positively at ISIS. Four key benefits can be identified.

First, group work at ISIS provided aspace in which women could identify with others and that normalised andvalidated their experiences. Rather thanfeeling odd and different, womenexperienced themselves as beinginteresting and accepted. They reported the benefits of feeling listened to andvalidated regarding their experiences.Women also overwhelmingly expressedrelief at knowing they were not alone or‘weirdo’s’.

Like the process of identification ofsameness, the identification of differencealso had important therapeutic benefits for women. This was a second beneficialfeature of group work expressed by womenin the self-report questionnaires. Theobservations of their own sense of beingdifferent and unique enabled them toembrace their autonomy. As Katzman andLee (1997; p. 392) argue, the relationshipsin group work are not just important inproviding support but ‘as interactions whichrecreate struggles with peers coworkersand family ’. According to Katzman and Lee(1997), women in group work may use newrelationships to examine past ones and toheal in the process, creating new images of self and body. This was evident in thequalitative responses from women at ISISwho, while reporting that group conflict was difficult, they still claimed that thisassisted them in understanding more about themselves and other experiences in their lives.

Third, women found it beneficial thattheir true selves were no longer hidden.Through discarding the shame and secrecysurrounding their eating issue, they wereable to achieve greater self-acceptance.Jasper and Maddocks (1992) suggest thatthe shame and secrecy surrounding eatingissues are crucial factors to address ingroup work. Within the feminist groupcontext at ISIS, women felt safe enough to speak of their experiences.

Finally, some women praised thefriendships they formed within the groupsand spoke of the support and acceptancethey derived from such relationships. This isconsistent with other evaluations of feministgroup work which have pointed to the flowon effects of the process such as finding


new networks to address isolation (Rice &Faulkner 1992).

The four benefits of group workidentified by participants in this study aredescribed in the feminist literature asforming a ‘curative culture’ (Jasper &Maddocks 1992). Such a culture has anumber of features – it instils hope,provides cohesion, is altruistic, modelsbehaviour, promotes interpersonal learningand offers support (Hotelling 1987).Feminists posit that such a curative cultureis necessary because of the oppressivesocietal culture that is a primary factor incontributing to women’s eating issues(Orbach 1988; Dana & Lawrence 1989).Indeed, the women’s qualitative responsesin this study highlight their experience ofthis oppressive culture – their sense ofisolation, separation, powerlessness andalienation. Given women’s experiences ofoppression in the broader culture, it is clear that treatment approaches which draw largely on ‘fat phobic’ and medicaldiscourses of eating issues are limited.

ConclusionThe literature emphasises that no onetheoretical orientation has proven to bemore effective than others in treatingwomen with eating issues (McKisack &Waller 1997). Indeed, there is nosuggestion in the data from this study that a ‘one size fits all approach’ is effective. Incontrast, women reported benefiting from a number of interventions – for example,group work in combination with visits to asocial worker, psychologist, psychiatristand/or general practitioner. However, thereis evidence which suggests that feministgroup work offers real benefits to women.

Groups enable the creation of a ‘counter-culture’ and an experience of a ‘mini-community’, where women may be able toexamine and recreate their relationshipswith others, food and their body.

If the potential of feminist group work is to be fully realised, more work needs to be undertaken in evaluating it as anintervention with women with eating issues.However, there is a need to designalternative instruments for evaluating theeffectiveness of treatments given thatexisting measures such as the EDI may not measure core motivations associatedwith eating issues. Further, there is a needto understand more about the process ofgroup work, the women who present togroups and in particular, the women whowithdraw from groups. A critical limitation of this paper is that little is known aboutthose women who withdrew fromparticipation in group work. Thus, additional 12-month follow-ups of othergroup participants are required to assesswhether the benefits for participants arereplicated in a larger sample. It is with such concentrated research and analysisthat the feminist group work model at ISISmay be refined and the effectiveness andpotential innovation of feminist group workas an intervention for women with eatingissues may be enhanced and recognised.

Acknowledgements

Special thanks to Barbara Pini for her timeand input in editing this paper and toElizabeth Gwynne who provided analysis ofthe EDI data.

Footnotes 1 ISIS Centre for Women’s Action on Eating Issues isbased in Brisbane. ISIS is funded through QueenslandHealth (Mental Health) and provides a range of eating


issues specific services including: information andreferral; individual counselling; therapeutic group work;social action initiatives; community education; andtraining.

2 The terminology ‘eating issue’ is used at ISIS inplace of eating disorder and will be referred tothroughout this paper. This terminology moreaccurately reflects a feminist perspective whichconsiders eating issues as socially constructedproblems rather than forms of individualpsychopathology.

3 This comprehensive manual details the goalsstructure and content of group work at ISIS. It isavailable from ISIS at www.isis.org.au.

4 Findings from population sizes as small as thoseunder discussion should be interpreted more broadlyin terms of trends rather than being considered highlysignificant.

5 The eating issue women identified as having isincluded in parenthesis in all data extracts to providesome context for the reader. However, this is not todeny other identities inhabited by women with eatingissues or indeed intended to locate women within afixed and absolute category attached only to theireating behaviour.

References

BLACK C (2000), Setting the Table Straight, aResource Manual for Working with Women with EatingIssues. ISIS Centre for Women’s Action on EatingIssues, Brisbane.

BLOOM C, GITTER A, GUTWILL S, KOGEL L &ZAPHIROPOULOS L (1994), Eating Problems: aFeminist Psychoanalytic Treatment Model. BasicBooks, New York.

BORDO S (1988), Anorexia nervosa: Psychopathologyas crystalization of culture. In: Diamond I & Quinby L(eds), Feminism and Foucault. Northeastern UniversityPress, Boston.

BROOKS A (1997), Postfeminisms: Feminism, CulturalTheory and Cultural Forms. Routledge, London.

DANA M & LAWRENCE M (1987), Poison is theNourishment that Makes One Ill: The Metaphor ofBulimia. In: Lawrence M (ed), Fed up and Hungry:Women, Oppression and Food. The Women’s Press,London, pp. 193–206.

DANA M & LAWRENCE M (1989), Women’s SecretDisorder: a New Understanding of Bulimia. Grafton,London.

FALLON P, KATZMAN MA & WOOLEY SC (eds) (1994),Feminist Perspectives on Eating Disorders. TheGuilford Press, New York.

GARNER DM (1991), Eating Disorder Inventory – 2:Professional Manual. Psychological AssessmentResources, Florida.

GARNER DM, MARION P, OLMSTEAD MA & POLIVY J(1993), Development and Validation of aMultidimensional Eating Disorder Inventory forAnorexia Nervosa and Bulimia. International Journal of Eating Disorders, 2 (2), 15–34.

GARNER DM, VITOUSEK KM & PIKE KM (1997),Cognitive-Behavioural Therapy for Anorexia Nervosa.In: Garner DM & Garfinkel PE (eds), Handbook ofTreatment for Eating Disorders. The Guilford Press,New York, pp. 94–144.

HOTELLING K (1987), Curative Factors in Groups for Women with Bulimia. In: Brody CM (ed), Women’s Therapy Groups: Paradigms of FeministTreatment. Springer Publishing, New York, pp. 241–251.

HUMM M (1995), The Dictionary of Feminist Theory.Simon and Schuster, Hertfordshire.

JASPER K & MADDOCKS SE (1992), Body ImageGroups. In: Harper-Giuffre, H & Roy Mackenzie K(eds), Group Psychotherapy for Eating Disorders.American Psychiatric Press, Washington, pp. 181–199.

KATZMAN MA & LEE S (1997), Beyond Body Image:The Integration of Feminist and Transcultural Theoriesin the Understanding of Self Starvation. InternationalJournal of Eating Disorders, 22, 385–394.

LAWRENCE M (ed) (1987), Fed Up and Hungry:Women, Oppression and Food. The Women’s Press,London.

MALSON H (1999), Women under Erasure: Anorexic Bodies in Postmodern Context. Journal of Community and Applied Social Psychology, 9, 137–153.

MCINTOSH VV, BULIK CM, MCKENZIE JM, LUTY SE &JORDAN J (2000), Interpersonal Psychotherapy forAnorexia Nervosa. International Journal of EatingDisorders, 27, 125–139.

MCKISACK C & WALLER G (1997), Factors Influencingthe Outcome of Group Psychotherapy for BulimiaNervosa. International Journal of Eating Disorders, 22, 1–13.

MOHAMED C & SMITH R (1997), Time limitedpsychotherapy. In: Lawrence M & Maguire M (eds),Psychotherapy with Women Feminist Perspectives.MacMillan Press, London, pp. 103–132.

MORENO JK (1998), Long-Term PsychodynamicGroup Psychotherapy for Eating Disorders: A


Descriptive Case Report. Journal for Specialists inGroup Work, 23 (3), 269–284.

MULKERRINS J (2001), Ex-sufferers Inspire EatingDisorders. The Australian, Thursday 9th August, p. 6.

ORBACH S (1988), Fat Is a Feminist Issue. ArrowBooks, London.

RICE C & FAULKNER J (1992), Support and Self-Help Groups. In: Harper-Giuffre H & Roy Mackenzie K(eds), Group Psychotherapy for Eating Disorders.American Psychiatric Press, Washington, pp. 245–258.

RIEGER E, TOUYZ SW, SWAIN T & BEUMONT PJV(2001), Cross-Cultural Research on Anorexia Nervosa: Assumptions Regarding the Role of BodyWeight. International Journal of Eating Disorders, 29, 205–215.

ROBERTSON M (1992), Starving in the Silence: an Exploration of Anorexia Nervosa. Allen & Unwin, North Sydney.

STREIGEL-MOORE R (1994), A feminist agenda forpsychological research on eating disorders. In: FallonP, Katzman M & Wooley S (eds), Feminist Perspectivesin Eating Disorders. Guilford Press, New York, pp. 438–454.

WOOLEY SC & KEARNEY-COOKE A (1986), IntensiveTreatment of Bulimia and Body-Image Disturbance. In: Brownell K & Foreyt J (eds), Handbook of EatingDisorders: Physiology, Psychology and Treatment ofObesity, Anorexia and Bulimia. Basic Books, New York,pp. 476–502.

Article accepted for publication November 2002.


Documents

Creating curative communities: feminist group work with women with eating issues