Dear Therapist:

Our daughter unfortunately suffers from an eating disorder. One of the things the doctor is recommending is “group therapy”. We have a number of concerns regarding this. First off, the people in the group will, presumably, be just as sick or worse than she is. We don’t want her to get any ideas that she doesn’t have already. Secondly, we are worried that she will meet people there and people will find out about her condition. Why do a bunch of strangers need to hear all about her issues? Wouldn’t she do better spending extra time with her individual therapist? Is there a benefit of group therapy that she wouldn’t get with someone privately? We are taking this very seriously and want to do the right thing. Can you please explain if this is the best thing and/or necessary? Thank you.

Response:

Eating disorders are extremely serious.  Over time, they can lead to numerous health issues, including osteoporosis, heart problems, brain damage, organ failure, and infertility.  There is a high mortality rate associated with eating disorders.  Eating disorders are typically associated with negative body image.  People with anorexia, for instance, generally feel fat and identify areas of fat on their bodies regardless of evidence to the contrary.

Your question is a common one.  People are often wary of groups and meeting for the reasons that you discussed.  The response will depend on your daughter’s needs.  You mentioned that your daughter’s doctor recommended group therapy.  You should ask the doctor for his/her reasoning.  Is the recommendation based on the very general notion that group therapy can be helpful for people dealing with emotional issues?  Is it less generally based on the understanding that people with eating disorders tend to benefit from groups?  Is it more specific to your daughter’s particular issue and her presentation, and to the doctor’s experience is this area? 

There are a number of factors that should be considered with regard to type of treatment and the timing of such.  One factor is your daughter’s understanding and acceptance of the fact that she has a problem.  Though group therapy may be an essential part of her treatment, your daughter’s particular needs and readiness should be assessed by her therapist and discussed with her (and you if appropriate).

You spoke of your daughter’s eating disorder, but didn’t specify the type.  Although there are a number of eating disorders, the most commonly discussed are anorexia, bulimia and binge-eating.  Group therapy appears to be very helpful for those with bulimia and binge-eating, and is generally recommended.  For anorexia, however, the opinions on group therapy are mixed.  On the one hand, many of the advantages of groups—feeling understood, accepted, and not alone, recognizing personal triggers, and being more comfortable discussing feelings—can be an integral part of treatment.  On the other hand, it’s been pointed out that people with anorexia are often distrustful and that groups can become competitive rather than accepting.

There are also different types of groups.  Psychoeducational and cognitive-behavioral groups seem to be the most prevalent and, when properly run, are likely less prone to issues of competitiveness.  That being said, each person has her individual issues that should be taken into account.  If your daughter is cognizant of the fact that she has a problem, but appears unclear as to the specifics—and you sense that she feels alone in her struggle and has trouble discussing her feelings—group therapy can be a great asset.  However, this is something that her therapist can help her to decide.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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