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Watch for Karen’s upcoming book on eating disorders co-authored with Linda Ciotola, M.Ed., TEP

By Karen Carnabucci MSS, LCSW, TEP

T he use of psychodrama is especially helpful

with the treatment of traditional eating disorders as well as “dieting disorders” and a range of difficulties with body image. The psychodramatic group is another plus, as men and women with eating disorders are often isolated from others and tend to use food or the misuse of food to avoid relationships with people. A number of psychodrama trainers, including Monica Callahan, Kate Hudgins, Kathy Metcalf , Colleen Baratka and Linda Ciotola have devoted some or all of their professional work to eating disorders. Recent modifications, including the Therapeutic Spiral Model developed for survivors of trauma, are applicable for safety and containment as treatment continues. The sociometric and the experiential nature of the psycho-drama method help eating disorder patients in a number of ways. Sociometrically, the understanding of roles the patient plays — including the self-destructive roles — is a first step in enhancing new roles that are healthy and self-caring. The eating disorder patient is able

to experience her relationship with the eating disorder as well learn more about its role in her life. Experientially, patients are able to move out of their heads and into a fuller experience at which time they can experience problems and rehearse solutions in a new way. As patients employ creativity — with role play, art, movement, choice-making and imagery — they expand their sense of self and replace compulsion with creativity and internal safety. With eating disorder clients, the client may be asked to make a special kind of social atom by charting foods that are “OK” and foods that are “forbidden” according to his or her rule system. The client can then observe more about his or her relationship with certain foods and may identify the origins of such rules. A similar exercise involves having the client complete a social atom

showing significant people in her life and then circling or marking the people who enable or reinforce that person’s binge eating, restricting, purging or dieting. Identifying and role reversing with cultural icons (such as the Barbie doll) that support women’s obsession with unrealistic body images can raise consciousness about the silent but insidious messages of the culture. Role reversing with one’s food plan or self-help group can assess and strengthen the internalized strength of these supports. Action approaches are varied as individual approaches or styles. Key is to allow the exploration of the roles that may have contributed to the role of the “eating disordered person” while also offering opportunities for healing the role the eating disorder serves. Role training offers the client opportunities to practice and integrate behaviors of true self care that substitutes for the coping value of the eating disorder. Sharing at the conclusion of a drama should never involve analyzing, criticizing or judgment: instead participants should be encouraged to speak from personal experience so the protagonist can be “fed” after his or her disclosure of personal material. Neglecting full sharing, especially before breaks or meals, may cause the patient to act out on feelings by binge eating, purging or restricting.

The use of psychodrama with eating disorders

Both the sociometric and the experiential nature of the

method help eating disorder patients in a number of ways.