Dear Stella,
Sorry for the delay in responding.
I have not had an experience with BN groups per se. For the last 3 years I have
been working individually with clients with a variety of eating disorders on an
outpatient basis. I was hoping to start some groups but had not had a chance
yet. Here is what I can answer based on my experience:
1) We are wondering how behaviorally focused your groups are, in
terms of targeting and changing the binge purging behaviors?- ie.
do you focus on reducing binge eating and purging as the
predetermined, main goal of the group or do you have a general goal
of helping them to identify and accept their values and live a vital
life, with the idea that the ED behaviours will change in the process
of them taking active steps towards pursuing their values?
I usually start off with the values and then any behavior change is done in the
context of these values. I invite clients that if they are willing and if it is
important to them to make changes then to commit to change and proceed to do
that. So I do not outright try to change their binge eating behavior, I want
them to see that this is something that prevents them from their valued life and
become willing to commit to making a change and then help them do that.
2) Ambivalence is a feature of Bulimia and we often have EDNOS clients
with extremely restrictive food intakes and they are pre-
contemplative towards making changes in this area. Do you meet with
the group clients separately beforehand to do some pre-commitment
work with those who are ambivalent and to work on engagement before
the group commences?
As I have not done such groups yet, I can speak from my experience with other
groups (e.g. panic and social anxiety). I think though that this is an empirical
question that needs to be examined. I would say that ambivalence should be a
topic of the group that can be addressed as such. I presume that group members
will help each other as well with the ambivalence expressed so I would use this
in the groups.
3) Do you target each session based on where the majority of the group
are at, or are the sessions structured in a predetermined order? ie.
We're wondering how early to bring in values...?
Based on other ACT groups I run, we had a predetermined agenda (manual) and we
went by that. Again this is an empirical question that needs to be addressed.
Regarding values, I have started to include them at the very beginning. I find
the start of treatment to be much smoother with values than with creative
hopelessness- just my preference. Again, the order of the treatment components
needs to be examined further.
4) if you have come up with a content outline, are you willing to
share it with us?
Unfortunately, I do not have something written up. Basically, I follow the ACT
treatment as outlined in the book, except that I introduce values at the
beginning. Most metaphors can be adapted to this population and I do so as I go
on. I hope to find some time to write some of this up.
5) Measures- I also use a daily monitoring form of binge eating, food diary and
mood monitoring.
6) In my other groups we had done a 6 and 12 month follow-ups. With individual
clients I try to do such follow-ups as well. It would be great if you have the
resources to include longer follow-ups as well.
Sorry that a lot of this is is not as specific. Hopefully with more of us doing
this work, things will become much more specific in the near future.
Please let me know if I can be of more help.
Maria


Maria Karekla, Ph.D.
Licensed Clinical Psychologist and Director of Clinical Practical Training,
Assistant Professor,
Intercollege and The Center for Therapy, Training, and Research (KESY),
Nicosia,
Cyprus
(357)22795100 or (357)22351274

________________________________

Από: eatingconcernsandcontextualpsychology@yahoogroups.com εκ μέρους Stella Dyer
Αποστολή: Παρ 17/8/2007 9:02 πμ
Προς: eatingconcernsandcontextualpsychology@yahoogroups.com
Θέμα: [eatingconcernsandcontextualpsychology] Bulimia group questions



Hi Alix and Maria (and all!),

I'm not sure if I sent this correctly, so here it is again:

Thanks for kindly offering to share your experience in running ACT
for BN groups. As you will see, we have heaps of questions to ask
you! (Sorry in advance!). I've sent this to everyone, in case they
are also interested in these issues. P.S If anyone else wants to
comment on their experiences, feel free!

Here they are:

* Do you have a mix of presentations in the one group? (ie. BN + BED
or AN). We were wondering whether there is a problem in putting both
BN and Binge Eating Disorder in the same group-ie. is there a
likelihood of BED clients learning purging as a new unhealthy
behaviours?
* We are wondering how behaviourally focused your groups are, in
terms of targetting and changing the binge purging behaviours?- ie.
do you focus on reducing binge eating and purging as the
predetermined, main goal of the group or do you have a general goal
of helping them to identify and accept their values and live a vital
life, with the idea that the ED behaviours will change in the process
of them taking active steps towards pursuing their values?
* Ambivalence is a feature of Bulimia and we often have EDNOS clients
with extremely restrictive food intakes and they are pre-
contemplative towards making changes in this area. Do you meet with
the group clients separately beforehand to do some pre-commitment
work with those who are ambivalent and to work on engagement before
the group commences?
* Do you target each session based on where the majority of the group
are at, or are the sessions structured in a predetermined order? ie.
We're wondering how early to bring in values...?
* if you have come up with a content outline, are you willing to
share it with us?
* We are already familiar with ED measures, but were wondering
whether you are aware of other outcome measures that pick up on ACT
consistent outcomes, besides the AAQ?
* How many weeks did you run your groups for?
* What kinds of outcomes have you had?
* Are you doing any longer term follow ups?

Well I did warn you that there were a lot of questions here, didn't
I! We're hungry for answers, but don't feel obligued to answer
everything, anything you can share will be great food for thought
(pardon the pun!)
Thanks very much in advance,
Stella ;)

---------------------------------------------------------
Stella Dyer
Clinical Psychologist
Centre for Psychotherapy
James Fletcher Hospital
Watt Street, Newcastle NSW 2300
Ph. (02) 49246820
Fax: (02) 49246801
---------------------------------------------------------

>>> "C. Alix Timko" <catimko@...> 9/07/2007 11:53 pm >>>
Hello Stella,
I use ACT with this group as well and had success with it. I second
Maria - is there anything specific you were wondering about?
Alix

--
C. Alix Timko, Ph.D.
Department of Psychology
University of Pennsylvania
3720 Walnut St.
Philadelphia, PA 19104
Telephone: 215-746-4260
Fax: 215-898-7301
E-mail: catimko@...