Cognitive Behavior Therapy for Eating Disorders

Cognitive Behavior Therapy for Eating Disorders

When any relationship ends, including a counseling relationship, there are many emotions experienced by the participants. The termination stage forms the last stage of counseling and is equally important as the other phases. This stage allows the members to reflect on their experiences and decide how they will use the knowledge gained to improve on their future occurrences. Ending a group therapy is very difficult because of the strong attachments created and requires some skills from the group leader to effectively terminate the therapy. For instance, the elderly population may find it difficult to terminate group sessions because of the established sense of belonging. It is recommended that the group leader plan early on how to terminate the group to prevent issues like pulling back or disengagement due to emotions surrounding termination.

Effective Termination of Group Therapy

Termination should be among the first topics discussed with the client or group to ensure that individuals are able to function without the therapist upon recovery. The therapist should communicate to the group how long they will be available and how the end of the sessions will look like. The first measure that can ensure the effective conclusion of a therapy session involves reminding the group that the time for termination is approaching. It is recommended that communication about termination should be made about 2 to 3 sessions prior to the final one. Timely communication allows the client to open up on how they feel about the end and provides the therapist an opportunity to address any issues raised. This strategy gives the group members a chance to picture how their lives will be without the sessions.

All groups are progressive and very unique. Some groups may turn to be effective in changing the lives of the participants while others may leave the clients empty-handed. The therapist should assess the group members before termination to ensure they have benefited to some degree from the sessions. While every group may have fixed timing, adjustments can be made to incorporate a few more sessions to help the group members according to the perceived needs. Another strategy that can ensure effective termination is spacing out the last few meetings with the group. Spacing out is a good way to wean the clients from the relationship and foster a sense of responsibility and confidence. The strategy allows the clients to learn how to work alone and how to handle difficult situations without the group.

Reviewing the progress made during group therapy is an important aspect of termination. The members should highlight the positives that resulted from the therapy with assistance from the group leader. The leader should allow the clients to talk about their feelings, how they feel about termination, and any emotional attachments present. Additionally, the group leader must be aware of their feelings and spend time acknowledging and processing them. If possible, an open door policy should be used during termination. This means that the clients may want to return after some time to get clarification about some issues.

Interventions During Termination

The approach of termination of group therapy is a psychic shock that members react to differently. Most commonly observed is avoidance or denying the reality that the group is coming to an end. Various interventions by the group leader may help the members cope with this challenging phase. The first intervention should focus on addressing any remaining tasks and drawing attention to important activities that could otherwise prolong the sessions. Sometimes group members may be overly enthusiastic to tackle any remaining tasks making it difficult to conclude the sessions.            Secondly, the group leader must refrain from introducing new activities in the final stages. Activities that promote interaction, rewards, and perhaps those that may strengthen the bonds of group members should be avoided. Any assignments should be individualized to promote independence while limiting interaction.

Examining the strategies and skills learned in the group sessions is a good way to reflect on what members can take with them and use in their daily lives. The group leader is responsible for showing members what they have learned and how it can be useful in the real world. The leader should review the tools and skills that clients have acquired through the counseling process. Additionally, reflective practices should be used to ensure the teachings are well-understood. Lastly, the group leader should openly address the fears of the members and allow them to express their feelings.

Functions or Problems During Termination

Termination of sessions may see group members experience certain problems that may affect the effectiveness of the group therapy. Most commonly observed is denial whereby the members may express surprise or claim to have forgotten that the group would end. Sometimes unsatisfied members may plan to continue with the sessions on their own or look towards reunions. The second challenge that group members may experience is a lack of satisfaction or some members may fail to completely benefit from the sessions. Every individual responds differently to therapy and not all sessions can be fruitful. The group leader may find it difficult to end the session when indeed some members have little insight on how to solve their problems. Another problem that may exist is regression where members tend to backslide into earlier group experiences and relationship patterns. Some members may provoke the initiation of the needs that led to the group being set up originally. Actions like aggression and destructive behavior directed towards the group might be observed during the final stage.

Apart from the group members, the group leader might experience some challenges during the final stage of interaction. The leader may have too much attachment to the group leading to delayed termination. Sometimes the leader might develop a new role of a protector instead of a counselor leading to long-lasting relationships with clients. Actions like regression and reviewing of group experiences may be observed in the group leader indicating problems with letting go. As the group moves towards the end, the main function of the leader is to help the members let go of the group and move away. The leader should remind the members that clear boundaries and limits exist professionally to promote a smooth termination process. While making these points, interventions like allowing clients to talk about their feelings, giving timely feedback, allowing reflective practices, and referral when appropriate can help solve these challenges.

Evaluation and Follow-Up

Group leaders evaluate their groups to determine whether group goals and objectives have been met. Group evaluation helps the leader to determine the success of the group and important aspects like referral that may proceed to the termination stage. Effective group evaluation involves both formative and summative evaluations. Formative evaluations are conducted as the group evolves and involve giving feedback to improve on the aspects that are poorly performed. Summative evaluations are conducted to determine whether the group has met its goals. To effectively evaluate my group’s performance, I will develop an eating disorder diagnostic scale that will be rated according to each patient’s response. A one-month follow-up session will be set after the termination of the group to evaluate the impact changes made had on the lives of the members. Each group member will be required to give feedback and the group leader will address any challenges observed.

Evaluation Tool

The tool selected for the evaluation is the eating disorder diagnostic scale (EDDS). The designed tool contains four parts that assess the attitudinal symptoms of eating disorders, frequency of uncontrolled food consumption, compensatory behaviors to the disorder, and aspects of weight that determine the BMI of the individual. The tool will be administered at the beginning of the group therapy and also at the end. The results will be compared to determine the effectiveness of group therapy in minimizing symptoms. I will present the tool in one of the sessions by explaining the importance of assessing the identified parts, interpretation of the scores, and how to determine progress. Printed copies of the tool will be available during the presentation to ensure the members understand what is expected upon completion of the therapy.

 

 

Appendix

Eating Disorder Diagnostic Tool

Please carefully complete all questions

Part 1

Over the past three months..	Not at all 0	Moderately 1	Extremely 2
Have you felt fat or gained weight?
Did you fear that you might gain weight?
Has your weight influenced how you think about yourself?

Part 2

1. During the past six months, have you eaten what other people would term as ‘a large amount of food?’……….. NO YES
2. Have there been instances you are able to control the amount of food taken?… ……………….. .NO YES
3. During the past three months, on average, how many days per week have you eaten excessively? 0 1 2          3          4          5          6          7

Part 3

During the episodes of eating excessively did you…

1. Eat until you felt uncomfortably full?………………. NO YES
2. Feel embarrassed by how much you were eating?……NO YES
3. Feel guilty or disgusted with yourself?………………..NO YES

Part 4

1. What is your current weight? If uncertain give an estimate……….Lbs
2. What is your current height? ……………Inches
3. What is your current BMI?………….

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