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Daigneault 2000
Daigneault 2000
Daigneault 2000
To cite this article: Susan Dahlgren Daigneault (2000) Body talk: A school-based group
intervention for working with disordered eating behaviors, The Journal for Specialists in Group
Work, 25:2, 191-213, DOI: 10.1080/01933920008411461
Download by: [University of Tennessee, Knoxville] Date: 20 September 2015, At: 10:16
Body Talk
A School-BasedGroup Intervention for Working
With Disordered Eating Behaviors
Susan Dahlgren Daigneault
Dover High School
Dover, New Hampshire
This article describes a school-based group intervention designed to address issues
of body image, self-esteem, weight, and eating disturbances. Based on a narrative-
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feminist theoretical foundation, this 10-session group provides female high school
students with opportunities to explore their concerns about relationships, appear-
ance, and what it means to be female. The article provides descriptions of the narra-
tive techniques used during the group sessions, provides specific examples of activi-
ties used i n the group, and describes processing techniques.
191
192 JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2000
decisions about organizational aspects of the group are all factors that
need attention before a group begins. In this section of the article, each
ofthese considerationsis explored and guidelines are given t o help prac-
titioners form their own groups.
Because eating disturbances and body image issues involve all of the
themes that are central to both narrative and feminist therapies, these
two theoretical approaches are very appropriate for working with young
women.
Assumptions underlying a narrative approach to therapy include
these concepts:
2. People make meaning in their lives through the stones they construct
and the stones that they tell. These stories have “a profound effect on
present behavior and future possibilities” (Strand, 1997, p. 338).
3. Therapy is a life-story modification (Howard, 1991). People present for
therapy because their stones are limiting them from leading fulfilled and
satisfying lives. The therapeutic work revolves around facilitating the
creation of new stories, “life narratives that are more empowering, more
satisfying, and give hope for better futures” (Hoyt, 1994, p. 69).
4. People have the capacity to reauthor their lives. The purpose of therapy is
“to take care to discover what strengths” (Smith, 1997, p. 24) are already
present within clcents and that can be drawn on to help them lead more
fulfilled lives.
The process of helping clients develop new and more satisfying sto-
ries involves several techniques. Therapy begins with establishing a
therapeutic relationship with the client, a relationship that is aided by
getting to know the client apart from the problem through a process
called erternalization. Therapy then proceeds by asking questions to as-
sess the influence of the problem on the client’s life and listening for ex-
amples of the influence of the client on the problem. These exceptions to
the problem story are supported by encouraging a sense of personal
agency and by recruiting a wider audience, meaning involving signifi-
cant others in the client’s life to support the client in making changes
(Hoyt, 1994;White & Epston, 1990,1994).
Woven into the narrative fabric of the Body Talk group is also a femi-
nist theoretical thread. Feminist therapies focus on helping women
understand the social, political, environmental, and economic influ-
ences on women’s roles in societies. Goals common t o a feminist perspec-
tive in therapy include helping women to experience their own personal
power through assertiveness skill-building, to accept themselves physi-
cally and psychologically, and to develop their potential for leading ful-
filled lives throughout their life spans (Okun, 1997). Another focus in
the feminist model is to examine the importance of connectedness in
women’s lives. The feminist literature on human development presents
a model of female development that asserts that “women’s sense of self
is very much organized around being able t o make and then to maintain
affiliations and relationships”(Miller, 1986, p. 83).Women “definetheir
196 JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2000
community.
talked with students about their concerns and either encouraged them
to become involved with the group or suggested other strategies for cop-
ing with their issues. The school counselor also talked about the group
with a physical education teacher who was known t o have concerns
about students’issues with body image. This teacher volunteered to talk
privately with students and encourage their participation in the group.
As a result of these methods of encouragingparticipation, 7 female stu-
dents eventually became involved with the group.
Body Talk participants decided that they would like to meet weekly
for 10 sessions. Each session would last 1hour. Because the group had to
work around each student’s academic schedule, weekly meeting times
rotated throughout the daily schedule so that each student would not
jeopardize class attendance policies. Because group members would
sometimes miss academic classes, it was important to obtain their
teachers’ support in order for the students t o be able t o attend group
meetings regularly. In a confidential memo to the students’ teachers,
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Externalizing
One of the initial tasks of a therapist operating from a narrative per-
spective is to develop a safe, comfortable, conversational environment
200 JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2000
lems” (p. 9). By using this strategy, therapists are able to help relieve cli-
ents of feelings of blame and defensiveness (Freeman et al., 1997). From
a feminist perspective, externalizing conversations help women to
develop their o w n stance about how they want to relate to the problem
and provide an opportunity for women to experience their own personal
power.
This technique helps the students look at their issues around food
and body image in a different way. This technique is also used to work on
the goals of helping group members to develop a more positive attitude
toward their physical selves and t o increase their ease with self-
expression. Externalizing can be a powerful technique in helping people
change the themes of their personal stories. For example, students who
are experimenting with unhealthy eating patterns to change their
appearances are likely living a story in which they see themselves as
unattractive. By helping students to look at the culture’s influence on
how we see ourselves, these messages of unattractiveness are external-
ized. Through this process, students can be helped to replace these nega-
tive messages with more positive ones,
In the Body Talk group, the counselor invited the girls to think of a
name to call the problem they were having with food and body image.
They decided to call this problem “Ed,” short for eating disorder/eating
disturbance. During check-in time at the beginning of each session, the
girls described their relationships and encounters with Ed during the
week and talked about how Ed was affecting their lives. Through this
process of separating the problem from the clients, clients can begin to
see themselves apart from the problem, a powerful technique for devel-
oping a sense of perspective on the problem.
During one session, the girls worked on creating an illustration that
showed how Ed was affecting various aspects of their lives. They drew a
circle in the middle of a piece of newsprint and labeled the circle Ed. The
counselor asked them to think of how Ed was currently affecting their
lives and t o draw images or write words describing the influence of Ed.
They noted that Ed was affecting their physical, emotional, and social
lives. They noted that Ed was affecting their relationships with friends
and family and that Ed was constricting their activities. When friends
invited them to go out t o eat, they declined to go because they were
Daigneault / INTERVENTION FOR EATING BEHAVIORS 201
afraid of losing control over food. They were unhappy withtheir body im-
ages and depressed about being seen in swimsuits. When they did not
eat a balanced diet, they were fatigued, prone t o headaches and ill-
nesses, and sometimes missed school and extracurricular activities.
They admitted t o mood swings and t o increased arguments with family
and friends. A s the girls added words and pictures to the newsprint, the
counselor processed the activity by asking them to talk about their
drawings:
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Tell me what it is like for you to feel like you have to say “No” to friends’ in-
vitations? How is it that Ed is able to have this power over your activities?
What would you like to say to Ed when he tells you not to eat something?
How is your life now compared to how it was before you started to develop
a relationship with Ed?
What is different about days when you are able to eat well? What is hap-
pening on days when you are not thinking so much about how you look?
What used to be different for you in the days before Ed became such a
problem?
those days. I used to be around my friends a lot more before Ed came into
my life.
Sandy, who was struggling with bingeing behaviors, also talked about
how being around people helped her t o have control over her own version
of Ed:
I know that I’m much heavier than I used to be and when Ed is bugging
me, I feel terrible about my weight. But on days when I’ve been out with
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friends, I’m happy and am able to say to myselfthat I am just a whole lot of
woman and that is okay.
Sandy’s comments helped the other students t o look at their own exam-
ples of times when they felt more in control. To draw the other students
into the discussion, the counselor asked, ‘What are some stories you
each have about times when you have felt in control? How did you do
this? How could you stay in control in future situations that might be dif-
ficult for you?” This technique helped to develop assertiveness skills and
to look at ways t o stay healthy. The students left this session with many
more strategies about how to stay in charge and not let problems control
their lives.
I know that it is not good for me to be alone because that is when I am more
apt to start thinking about bingeing and more likely to do it. Then I feel
ashamed and see myself as a failure.
On days when she was surrounded by people, Sandy felt more positive
about herself and more able to keep Ed from influencing her life.
‘?’m going t o . . .”, and “I choose to . , .” help students begin to see that
they could take charge of their lives.
In the group Body Talk, the students examine unique outcomes,
exceptions t o times when Ed is in charge of their lives. Through this
examination, the girls begin to develop an awareness of their own per-
sonal power in creating a different relationship with Ed. They can then
use this power to help them devise strategies t b be more in charge of
their lives. Cathy knew, for example, that she tended t o eat more bal-
anced meals when she was in training for track and other athletic activi-
ties. She knew that when she did not eat well that her performance was
negatively affected; poor performances prompted negative self-talk and
guilt about letting her team down. Through group discussions, she
began to see the connection for herself in eating well and staying
actively involved in sports. When she was active, she felt she had more
power over controlling Ed’s influence.
Another way the group explored the issues of women’s roles and
women’s power was to examine how women are portrayed in the media.
Although no conclusive evidence exists linking the culture as a causal
factor in the development of eating disturbances, we are products of our
culture and “cometo know ourselves as a part of a culture, gender, class,
race, and age” (Madigan, 1996,p. 53). Magazine images, videos, and the
curriculum Teen Body Talk (Connolly, 1997a, 1997b), which contains
many fact sheets and handouts on body image issues and on media advo-
cacy tactics, were useful in helping t o increase students’ awareness of
the cultural foundations of eating disturbances.
in keeping the group alive for the next school year. They talked about
how difficult it is to get students to come to a group and remembered
that what encouraged them to participate was having another student
invite them personally. After discussing strategies to make other stu-
dents aware of the group, they decided to make a series of posters to
hang on the walls of the middle school. The posters advertised the group
and encouraged eighth-grade girls to come to a meeting to learn more
about the group. They also knew several eighth-grade girls whom they
thought would be interested and decided to invite them t o come to the
meeting personally. They selected a “True or False” quiz from the Body
Talk curriculum that they felt would stimulate discussion and decided
that they could facilitate the discussion themselves. They also made a
poster illustrating what the group was all about and took the poster
with them when they visited the middle school. Several eighth-grade
girls came t o the meeting and expressed interest in joining the group in
the fall.
Termination
Termination issues begin long before the last session. Ifthe group has
contracted for a set number of meetings, group members know that as
each meeting concludes, there is one fewer time that they will be
together. It is inevitable that group members will have some feelings
attached to the inevitable ending of the group. The end of a group can be
a real loss for many members and bring up prior experiences with loss
and separation. The group facilitator needs to be aware of the impor-
tance of planning for a good termination so that the end of the group does
not just happen. Mentioning the number of sessions remaining and ask-
ing group members how they want t o use their last session are ways of
bringing up the issues of termination.
Prior to the last session of their group, the Body Talk members dis-
cussed how they would like to structure their last session. They decided
that it would be helpful t o review each group member’s experience in the
group and to create a group mural.
206 JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2000
The last session felt like a celebration of what had happened in the
group. Processing questions that helped with termination were “What
will you take with you from your experience in the group? What, if any,
changes have you made in your life since you began coming to the
group?”
To memorializethe group’s existence,the students did a group mural.
The counselor asked them each to think about what the group experi-
ence meant to them and to draw a symbol of that meaning on the paper.
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Other Activities
Checklists, questionnaires, drawing, and collage are additional spe-
cific strategies that help t o deconstruct the problem story and create
alternate stories.
Drawing. Art activities are useful group tools in helping group mem-
bers express themselves in nonverbal ways. Asking students to draw
and then talk about their drawings is a powerful combination in helping
adolescents deal with affective material and gain insights into their
worlds. By encouraging the students t o provide meaning and interpret
their own drawings, the group facilitator is empowering the students to
express themselves.
For adolescents, who as a group are especially sensitive about their
bodies, asking them t o draw a picture of how they look and another one
of how they would like to look can help them talk about how they feel
about their bodies (Oaklander, 1988).Another drawing activity involves
students creating three drawings: one of Ed, one of themselves without
Ed, and another of themselves with Ed. Students could be as abstract or
Daigneault / INTERVENTION FOR EATING BEHAVIORS 207
As you talk about your drawing of Ed and of you and Ed together, talk as if
you were Ed. Ed, tell us about yourself and your relationship with -.
Ed, talk about the picture that doesn’t include you. How do you feel about
that picture?
Next, students are asked to talk to Ed: ‘Tell Ed what you think ofyour
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relationship. What is it like for you? Is there anything that you’d like to
be different?” Finally, they are to talk about themselves without Ed:
“HOW is it for you without Ed? How is your life different now without Ed?
How do you feel without Ed in your life?”This activity helped the stu-
dents t o look at their relationships with Ed and t o contemplate what
their lives could be like without Ed or with a changed relationship with
Ed.
An extension of this last drawing activity involves having students
write letters to Ed. In their letters, students are asked to deal with the
following topics: What is the statushature of the current relationship
you have with Ed? What are the positive aspects (if any) of the current
relationship? What are the negative aspects of the current relationship?
What do you want to do with the relationship at this time? What do you
need from Ed to change the current relationship? As students process
their letters, their interests in maintaining or changing their relation-
ships with Ed become public.
Think about mealtime a t your home. Visualize where you will be eating,
who will be there, what the food smells like and looks like. What feelings
are you having as you look a t and smell the food? Are there other people
around during your meal? If so, who is there and what do people talk
about? Who is talking to whom? Next, imagine taking some food and put-
ting it in your mouth. Notice the texture and taste. How are you feeling
right now? Imagine yourself finishing your meal and getting up from the
table. Where are you going next? What are you going to do now?
208 JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2000
Once the visualization was finished, processing involved going over the
various aspects of the experience and focusing particularly on the feel-
ings that came up for students. They were also asked to talk about Ed’s
presence, participation, and influence and how they felt about Ed‘s
involvement in the eating ritual. The following questions are used to
process the activity:
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Tell us about Ed’s presence at your house. What influence does Ed have in
your life? How do you feel about Ed’s involvement in your mealtimes? Are
there any changes you would like to see in Ed‘sinvolvementin your life?
Videotapes. Film is a powerful tool for helping young women see the
impact that media and the culture have on forming our images of our-
selves as women. Two videos that could be used during the group 88s-
sions were Slim Hopes (Kilbourne, 1995) and Teen Body Talk (Connolly,
1997a).Slim Hopes is an expos6 about the media’s portrayal of women.
The video provides facts about the burgeoning diet industry, about ad-
vertising’s messages to women, and about the fashion industry‘s por-
trayal of women’s bodies. Teen Body Talk features girls and boys of vari-
ous ages talking about and challenging the pressures of media messages
and their feelings about body image and self-esteem. The video also fea-
tures three young women who tell their stories of their own struggles
with anorexia, bulimia, and compulsive overeating. Some questions
that prompt discussion after the videos are (a)What thoughts and feel-
ings came up for you in watching this video? (b) How did you identify
with any of the individuals in the video? (c) What new information did
you learn from watching the video? (d)What can we do to address the is-
sues that the video introduced? To further focus group members’ atten-
tion on the issues of gender, perfectionism, power, the media’s portrayal
of women, and the culture’s press for thinness, the following questions
also can be used: (a) How does Ed use the media to gain power in
women’s lives? (b) Why is it that Ed tends t o affect primarily women of
Western culture? (c) If women wanted to protest the power of Ed in their
lives, what would you suggest that they do? (d) What messages do Ed
and the media send to women about how they should look?
ger and to recognize fullness. To regain this power, students might ex-
periment with keeping a food journal (Kratina, 1996)that incorporated
charting hungerhatiety levels in addition t o tracking types and
amounts of food eaten. In using a hungerhatiety scale, students rate
their hunger level before they eat and again when they are finished with
eating. Doing this helps students become more aware of their eating
patterns and be able to recognize not only the feeling of hunger but also
the intensity. These activities also generate discussion about what “nor-
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CONCLUSIONS
students to give and receive feedback. Group members also learned that
the issues surrounding body image, self-esteem, and eating distur-
bances have societal foundations and that societies can be changed
through advocacy and awareness. Although the purpose of the group
was not to “cure” group members of all of their problematic behaviors,
the weekly sessions did provide a valuable forum for the students t o
bring issues out into the open and to experience support and caring from
the other group members.
Despite the anecdotal evidence of the group’s success, the model pre-
sented in this article has not been empirically tested. Future research
on this approach t o working with eating disturbances in a school setting
is needed to substantiate the efficacy of using this approach.
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