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A Guide for Support Groups

A Guide for Support Groups

Throughout the United States and Canada, ongoing support groups can often be located by contacting local treatment facilities, hospitals, therapists, women’s centers, or college health or counseling centers. Overeaters Anonymous serves this function for many people. Additionally, the eating disorder organizations listed in the “Resources” section of this book may be able to help you find a group. Finally, there are eating disorders support groups on the Internet.

However, there is a chance that you will not be able to find a group in your area. So, we offer this guide which takes a group from conception through six meetings, with a framework for future sessions. We strongly encourage you to find a professional to facilitate your group at some point, but you can get started without one while you look for someone you like.

Note: These guidelines have been adopted for use by many professional therapists and self-led bulimia groups.

Forming the Group

As we said before, if no professionally-led groups are available in your area, use the guidelines in this section to start your own. This means gathering your courage and taking the initiative to search out members. Classified advertising in a college or local newspaper might get enough responses to fill a group. Here’s how you might word the ad:

“Stop your binge/vomiting. Join a free bulimia support group. Forming now to start (the date). Confidential! Call (Your phone number).”

An advertisement such as this costs less than a binge, and the group can share the expense once it gets going. Run the ad a few times to get between 5 and 10 people. Another good way to advertise for members is to place leaflets on bulletin boards in office buildings or on college campuses. Neatly present the same basic information as above on a sheet which may be photocopied. You may want to include your phone number on tear-off tabs at the bottom.

Arrange for the first meeting to be held at a public facility, and after that, your responsibilities as leader are over.

Rules of the Group

The following is a basic framework for support groups, which is intended to maintain a balance of order and positive reinforcement for the participants. Professionally-led groups can dispense with most of these structural technicalities, but can still use the basic ideas and activities that follow in the six agendas.

At the first meeting, review the following rules:

1. Any of these rules may be changed by consensus of the group. Consensus means that everyone agrees or agrees not to stop the mutual decision of the others.
2. The underlying issue for most bulimics is not food; therefore, the following subjects should not monopolize the discussions: diets, food, bingeing, weight control, etc.
3. Each group will follow the same basic format: introduction and goals, discussion, exercises, and summary. The topics and exercises will be provided here.
4. At each meeting, different people must be appointed to the following jobs, which may be rotated:
• facilitator (group leader to introduce each topic and call on people to speak)
• time-keeper (to keep on schedule)
• gripe-control monitor (to interrupt anyone who is monopolizing the focus)
5. At the beginning of each meeting, the agenda will be reviewed and anyone who wants to add an item may do so.
6. One requirement of all group members is complete honesty.
7. No meeting shall end on a pessimistic or depressed note. If these conditions exist at the scheduled close, then a discussion or activity must be enacted to uplift the spirit of the group.

First Meeting Agenda

1. Review the rules of the group.
2. Appoint facilitator, time-keeper, and gripe-control monitor. These positions might not be necessary in professionally-led groups.
3. The facilitator reviews this agenda with the group, and agenda items are added. Approximate times are allocated for each item.
4. Introduction: Everyone in the group introduces themselves and explains why they have joined the group. Keep these introductions to a couple of minutes each.
5. Discussion: This meeting’s topic is about the nature of support. To begin the discussion, each member of the group takes turns answering some of the following questions:
• Who has been supportive of your recovery, and what have they done that has been helpful?
• If anyone else knows about your bulimia, how did they react when they found out, and how did that make you feel?
• What are a few do’s and don’ts you would recommend to someone in order to help you recover from bulimia?
• What will you offer to other members of the group to support them?
• After the circle is complete, the group can have an open discussion about some of the things that came out in the exercise. This is not to psychoanalyze each other, but to gain insight through each other’s disclosures. (20-40 minutes).

6. Exercise: Relaxation! (15-20 minutes)
Everyone gets into a comfortable position, either sitting or lying down. One person talks the others through the exercise in a soothing, monotone voice, while the others relax with their eyes closed. Here is the exercise:
Take three deep breaths, inhaling, holding the breath, and exhaling, each to the count of ten (one-two-three…to ten inhaling, one-two-three…to ten holding, one-two-three…to ten exhaling). Afterwards, breathe normally. As you inhale, feel as though you are being filled with light; and as you exhale, empty yourself of stress. Feel your body relax. Concentrate on your toes, relax them. Continue this, relaxing your feet, ankles, calves, knees, etc., until every part of the body is mentioned. Feel yourself filled with light and health, goodness, purity, contentment, power, etc. Remain in this state for several minutes before slowly reviving.

7. Summary: The group needs to set a time and place for the next meeting. It can be as soon as tomorrow! Because this is a support group, a commitment needs to be made by the members to come to at least the next meeting, with the intention of coming to all six. Exchange phone numbers so that individuals can use each other for support outside of the group.

A Few Words About Your Progress: This first meeting may have been difficult for you. Opening up may not have been easy or even possible. Give yourself some time; it will get easier. Individual or group therapy, medical examinations, and other steps towards self-help that are suggested in this book need to be made in addition to the support group. In any case, stick to your commitment to getting better and remember that you make your own choices.

Second Meeting Agenda

1. If appropriate, appoint a new facilitator, time-keeper, and gripe-control monitor.
2. Review the guidelines of the group and agenda.
3. Introduction: “I wish…,” “I want…,” and “I am…”
Everyone takes a few minutes to think about their answers to the above sentences within the context of recovery issues. Then, they take turns giving answers for “I wish . . .” until everyone has had a chance to answer two or three times (For example: “I wish I had better communication with my father.”) The same is done for “I want . . .” and “I am . . .” 
Important: Try to be positive with your language. (For example, instead of “I am a binger,” say, “I am curing myself of binge eating.”)
4. Discussion: This meeting’s topic is “Family Relations.” Each group member takes three uninterrupted minutes to describe their family. It may be helpful to address how your family relates, your parents’ and siblings’ characters, and the atmosphere at family get-togethers. After everyone has had a chance to speak, open the floor to discussion and questions. Listen carefully! Try to understand some of the reasons for your eating behavior.
5. Exercise: Assertiveness to Mom or Dad!
For the first part of this exercise, everyone writes some things that they dislike about one parent (living or dead, past or present). Then, take turns sharing answers, and continue until everyone has spoken two or three times. Go around again stressing their  likable traits. Continue this until everyone has spoken at least three times. (Example: “I dislike how financially dependent my mother acts,” and “I like that my mom listens when I talk to her.”)
The second part of this exercise is a gripe session with mother or father. Get in pairs or triads and take turns spending about ten minutes in role-playing that allows you to assert yourself to your parent(s). You may bring up old wounds that have never healed, you may scream, or you may try to explain your feelings. Express your true self in a way that you have always wished you could. Even though this is only a role-play, try to be serious and avoid hiding your feelings. When playing the parent role, try to put yourself fully into that person’s character.
6. Relaxation: Take five minutes for group relaxation, led by a volunteer. This can be as simple sitting quietly with your eyes closed, repeating an affirmation, or using another technique described in this book.
7. Set a time and place for the next meeting.
8. Share a few words about commitment to the group. Discuss if any members want to rely on each other for support outside of the meetings.
Note: Do not procrastinate working on your individual steps towards getting better. If you need to seek professional therapy, have a medical examination, tell more people about your bulimia, or whatever—do it!

Third Meeting Agenda

1. If appropriate, appoint a new facilitator, time-keeper, and gripe-control monitor.
2. Review the guidelines of the group and agenda.
3. Introduction: Each person spends a few minutes sharing a success story about how they stopped themselves from bingeing. If you don’t have a success story, say so, and suggest something you might try to do instead of bingeing in the future. It’s important to be honest!
4. Discussion: This meeting’s topics are “rituals” and “secrecy.” Most bulimics are secretive about their food obsessions and engage in private rituals involving scales, mirrors, clothing, or food. They may even compulsively lie and steal. Each person reveals some of their secrets and answers questions. (For example: “Every time I close the bathroom door, I automatically check myself in the mirror,” or “I shoplift cosmetics.”) Disclosing secrets takes away some of the importance and power you have given them.
5. Exercise: Visualization
Repeat the progressive relaxation technique from the first meeting. Then, the narrator tells the group to imagine themselves in front of a mirror, and to think about how they would look as a different race, a child, an old person, very ugly, the opposite sex, fat, thin, very beautiful, and finally, as light without form. (The narrator might suggest these possibilities one at a time, pausing for reflection before continuing to the next description.) Then, instruct the group to visualize themselves stepping through the mirror and feeling absorbed by that light, filled with health, purity, love, and contentment. Remain in this state for a few minutes before slowly reviving.
6. Summary: Discuss the effectiveness of the group. How can it be improved? What are everyone’s feelings about the group? Are people willing to commit to attend through the next three guided meetings? Does the group then want to: continue, disband, enlist a therapist (if there is not one already), etc. Start making plans now.
7. Set a time and place for the next meeting.

Fourth Meeting Agenda

1. If appropriate, appoint a new facilitator, time-keeper, and gripe-control monitor.
2. Review the guidelines and agenda.
3. Introduction: Each person shares a brief story about a positive step towards their recovery they have taken or experienced since starting the support group. This may be an action, thought, or feeling.
4. Discussion: “The Media, Feminism, and Food.”
This is an open-ended discussion. Try to keep comments related to personal experiences. Consider these questions:
• Why are bulimics mainly women?
• How does the media affect your body image?
• Why is there competition between women over their appearance? Does it have to be this way?
•What role do men play in perpetuating negative stereotypes about women?
5. Exercise: Equality
Every person takes turns bringing up positive and negative characterizations of women on television shows. Point out stereotypes that promote thinness as desirable, fat women as unappealing, and good role models. How would the shows be different if these actresses reversed roles?
6. Discuss the future of the group. There are still two more meeting agendas provided. What are everyone’s feelings about the group? Are people willing to attend those guided meetings? What direction is the group going to take? Is the group open to new members? A decision should be reached by the next meeting. Set a time and place.
7. Close with some suggestions: What can we do as individuals on a daily basis to improve our self-image?

Fifth Meeting Agenda

1. If appropriate, appoint a new facilitator, time-keeper, and gripe-control monitor.
2. Review the guidelines and agenda.
3. Introduction: Each person shares a positive experience with self-help ideas or professional therapy.
4. Discussion: “Feelings are not good or bad, they just are.”
Bulimics are often “people pleasers” who tend to keep their real feelings hidden. They are said to “swallow their feelings” instead of being honest about them. To get this discussion started, take turns naming types of feelings (happiness, fear, excitement, etc.). Then, discuss the following topics or others that develop.
• How can we identify feelings as they happen rather than hiding from them?
• What are different ways of coping with difficult feelings?
• What is so scary about expressing feelings?
5. Exercise: The Bulimic Cycle.
Bulimics follow a pattern of feelings and behaviors that make up the binge/purge cycle. Sit a circle taking turns describing consecutive parts of the cycle. For example: “I feel anxious,” might be followed by “I start thinking about food,” all the way until, “I throw up,” and “I feel guilty.” Go into as much detail as the individuals want, and keep going until the cycle starts to be replayed. When you reach this point, the next person should interrupt the bulimic cycle by saying, “I recognize I must do something else instead of bingeing.” Then, take turns with suggestions for how to proceed in a healthier direction.
6. Summary: Resolve the group’s future. This is a good time to consider inviting a trained therapist to the next meeting, if that has not already been done.
7. Set a time and place for the next meeting.
8. Share your feelings about the group’s effectiveness.

Sixth Meeting Agenda

1. Appoint a new facilitator, time-keeper, and gripe-control monitor.
2. Review the agenda.
3. Introduction: In what positive ways have you changed since joining the group? New members can answer the introductory questions from the first meeting’s agenda. Everyone takes a turn.
4. The Future of the Group: If your group’s future is uncertain at this time, make it a top priority. Spend as much time as needed to finish up this matter. Work together to develop discussion topics and exercises if there are going to be more meetings. You might find some good ideas in Chapter Nine of this book.
5. Discussion: Intimacy
Most bulimics have withdrawn from normal social interaction and lost touch with what it means to be in open, mutually rewarding relationships. They are afraid to express opinions and feel that they might inconvenience others with their needs. They think everyone disapproves of them. Take turns answering the following questions, and discuss the answers:
• What good qualities can you bring to a friendship?
• What kind of first impression do you think you make?
• Is there anyone with whom you can be completely yourself?
• Do you want to get closer to any group members in or out of meetings?
6. Exercise: Feeling Connected
Everyone gets in a circle and holds hands. One person squeezes their left hand (their partner’s right), and the squeeze is passed around the circle from person to person. At random, reverse the direction. Continue this playful exchange for a couple of minutes. Then, while still remaining connected, take turns thanking the group and members for their support.



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