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Week 10: Middle Phase - Skills/Facilitation

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Week 10: Middle Phase - Skills/Facilitation

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B: Role of the Group Worker

Pelech (2016) suggests that facilitators are pivotal in supporting group members in the middle phase by "value(ing) emerging self-disclosures, and ... respect(ing) group members' apparent or subtle differences." p. 144. Choate (2010) enforces these skills in bulimia support groups and acknowledges that creating a trusting group environment comes with difficulties "as many clients with bulimia have long experienced a sense of alienation." (p. 354). She suggests that "Group leaders can spend time normalizing members’ discomfort and anxiety, (thus)... decreasing their shame and isolation" (p. 354). Thus, the skills of facilitators to focus on are empathy and reflective listening to fosters trust, respect, and safety.

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Week 10: Middle Phase - Skills/Facilitation 

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Week 10: Middle Phase - Skills/Facilitation 

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A: Facilitating icebreakers/group cohesion

Lyndsay (2014) encourages group icebreakers as a means to facilitate group cohesion. They suggest that "Time spent at the start of a group helping and encouraging participants to get to know each other can be invaluable in setting the tone for the whole program." (p. 103). Padfield et al. (2017) agree with Lyndsay and suggest reading therapeutic writing at the beginning of disordered eating support groups be a powerful tool to increase group cohesion, trust, and even enhance personal reflection. As such, encouraging participants to journal feelings and read their entries can offer insight and closeness between group members and is a skill to be considered by facilitators.

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C: The "Defensive Member" = "The Encouragement Ana"

Shulman (2012) described the "Defensive Member" as someone who is in the "precontemplative stage" and "in denial" (p. 523). The "Encouragement Ana" as described by Haas et al. is the member who is most in denial about anorexia being a negative and encourages others to "Embrace her (anorexia)" (p. 52). In this way the "Encouragement Ana" is challenging as they are defensive to any sort of help for disordered eating. Rather than facing a member in the group by mirroring resistance, Shulman (2012) recommends treating the "Defensive Member"/"Encouragement Ana" with respect and empathy in acknowledging how difficult the stage of precontemplative change is for them.

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B: The "Internal Leader" = The "Advising Ana":

"Pro-Ana" or Pro-anorexia websites are not formally supported or facilitated; but Hass et al. (2011) have noted that they are popular and arise as negative reinforcement for those suffering with anorexia. As there are not formal facilitators; an "Internal" or self appointed leader naturally emerges as defined by Shulman (2012) in the way of the "Advising Ana" as defined by Hass et al. (2011). The "Advising Ana" offers tips, advice, and solidarity to others struggling with anorexia and re-enforces pro-anorexic behavior.

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A: Types of Roles

Shulman (2012) identifies group roles to aid facilitators in recognizing, supporting, and guiding group dynamics. Shulman suggests examples of roles such as the "Defensive Member" and the "Internal Group Leader". Haas et al. (2011) identify specific roles within pro-anorexia support groups to help understand the impact of said roles on group dynamics. These roles include the "Advising Ana" (Ana being a colloquial term for anorexic), and "The Encouragement Ana"  By comparing Shulman's (2012) roles and the roles described by Hass et al. (2011); one can see similarities:

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B) The Methods of Negotiating Conflict

While Zastrow (2019) speaks to methods of negotiating conflict such as win-lose, no-lose, and role-reversal. Choate (2010) suggests three similar types of conflict in her analysis of bulimia support groups, these are: "negotiation (ongoing attempts to improve the relationship),
impasse (neither individual is attempting to change), or dissolution
(the relationship is beyond repair)" (p. 357).  One could argue "negotiation" fits with no-lose, and "impasse" could be addressed with role-reversal. Zastrow (2019) doesn't address or support dissolution within group relationships; But Choate (2010) recognizes that skilled facilitators may discuss exterior relationships and conflict within said relationships that might require dissolution/healthy boundaries as solutions.

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A) The Need For Conflict

Zastrow (2009) states that though conflict is often seen as destructive, it can actually spark "lively discussions." (p. 166).  Choate (2010) agrees with her analysis of bulimia support groups and states that the middle or "working phase" (p. 356) is when the use of conflict is necessary for group bonding and for members to "practice voicing their feelings towards one another, particularly as conflicts arise" (p. 356) which in turn helps them manage conflict in their personal lives. Both Zaztrow (2009) and Choate (2010) emphasize that conflict is in many ways valuable and inevitable in group work.

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Pelech (2016) speaks to the "tasks to be fulfilled in the beginning stage of a group" and notes "cultivating group cohesion" as a top three focus when forming a group (p. 118). Kosiki (2014) reaffirms this need by stating that with regards to members of eating disorder supports groups: "Collective identification impacts on a (participants) ability to sustain participation and to instil in participants a willingness to take risks on behalf of the organization. Collective action frames initiate collective identification by bringing together individuals who share a common cause." (p. 77)

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6B) Concerns around confidentiality in a TM support group

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6B) Concerns around confidentiality in a TM support group

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In a TM support group for eating disorders, Stommel (2009) states "most users do not remain anonymous for very long, using signatures or nick-names as authentic self presentations" (p. 20). This form of identification still ensures safety. There is still anonymity which allows for self-disclosure while also ensuring confidentiality. Garvin (2017) notes that this has allowed those with eating disorders to meet and feel supported when they would previously not have because "the need to disclose their identities would have precluded seeking help" (p. 588)

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Lyndsay (2014) emphasis that before a group is finalized, the type of group it will be must be clarified. Tasca et al. (2012) states that group interpersonal psychotherapy and group cognitive behavioural therapy have both been proven group treatments in their success outcomes when addressing binge eating disorder (BED). This would indicate that a therapy group my prove beneficial when considering the type of group to form.

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There are ethical considerations in any group work such as safety/risk factors and confidentiality. Technology mediated (TM) groups may require even more consideration to be paid to these ethical concerns (Garvin et al. 2017).

6A) Risk factors of TM support groups:
Stommel 2009 cites that one risk factor of hosting web based support platforms is that counter groups can form such as "“pro-ana” (pro-anorexia) and “pro-mia” (pro-bulimia) websites, blogs and forums, which contradict the dominant medical perceptions of how to treat eating disorders as they celebrate the disorders as a preferred lifestyle." (p. 12)

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Week 4 Power and Oppression with Group Work

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Week 4 Power and Oppression with Group Work

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Disordered eating can be linked to oppression and can be supported by anti-oppressive group practice. The following examples explain the correlation.

4A) Oppression as a causation of disordered eating:
Black (2003) states that "eating issues
represent a woman’s attempt to assert her identity and to gain control in a world in which she feels powerless" (128). Without oppression, women would not feel the need to gain control; oppression has caused women to feel marginalized and lacking of autonomy.

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4B) Have the facilitator represent the group dynamic 

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4B) Have the facilitator represent the group dynamic 

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In order to support anti-oppressive practices, Lyndsay (2014) suggests that the facilitator "identify and have credibility with ... members of the client group with whom (they) will be working" (112). If you are working with an all female group; as is common with disordered eating support groups, it would be ideal to have the facilitator also be female to reduce inherent levels of oppression and power. Having personal experience with disordered eating would further reduce a power imbalance that could indicate that the facilitator as "better than" the group members.

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4C) Utilize empathy and active listening to foster respect and diminish power struggles 

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4C) Utilize empathy and active listening to foster respect and diminish power struggles 

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Lyndsay (2014) suggests that AOP group work should focus on "communicating non-verbally and empathetically with individual members" (112). Black (2003) agrees that with regards to those struggling with disordered eating "reported the benefits of feeling listened to and validated regarding their experiences. Women also overwhelmingly expressed relief at knowing they were not alone or ‘weirdo’s’." p. 137.

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Planning in regards to group work requires both need and careful consideration of the target demographic in order to create ongoing, successful support groups.

5A) The planning stage of group work:
Lyndsay (2014) states that there must be "events, situations, and opportunities that make it necessary or desirable to consider organizing a group" (p. 109). According to Statistics Canada (2015), up to 1% of all Canadian women suffer from Anorexia Nervosa; which is only one type of eating disorder (ED). If we consider that in a city of 100,000 that up to 1000 women may be currently struggling with Anorexia; the need for support groups for those with ED is high.

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Black, C. (2003). Creating curative communities: Feminist group work with women with eating issues. Australian Social Work, 56(2), 127-140. doi:10.1046/j.0312-407X.2003.00061.x

Choate, L. (2010). Interpersonal group therapy for women experiencing bulimia. The Journal for Specialists in Group Work, 35(4), 349-364. doi:10.1080/01933922.2010.514977

Haas, S. M., Irr, M. E., Jennings, N. A., & Wagner, L. M. (2011). Communicating thin: A grounded model of online negative enabling support groups in the pro-anorexia movement. New Media & Society, 13(1), 40-57. doi:10.1177/1461444810363910

[Howcast]. (2012, October 25). What is Pro Ana? [video file]. Retrieved from https://www.youtube.com/watch?v=vCXtcv_UI5E

Koski, J. P. (2014). ‘I'm just a walking eating disorder’: The mobilisation and construction of a collective illness identity in eating disorder support groups. Sociology of Health & Illness, 36(1), 75-90. doi:10.1111/1467-9566.12044

Garvin, C.D., Gutierrez, L.M. & Galinsky, M.J. (2017). Handbook of social work with groups, 2nded. New York, NY: Guilford Press.

Lindsay, T. & Orton, S. (2014). Groupwork practice in social work, 3rd ed. Thousand Oaks, CA: Sage Publications.

Padfield, B., Tominey, R., & Matthews, L. (2017). Therapeutic writing groups in specialist inpatient eating disorder treatment. The Journal for Specialists in Group Work, 42(4), 316-337. doi:10.1080/01933922.2017.1372539

Pelech, W., Basso, R. , Lee, C.D. &  Gandarilla, M. (2016). Inclusive group work. New York, N.Y.: Oxford University Press.

Shulman, L. (2012). The skills of helping individuals, families, groups and communities, 7thed. Belmont, CA: Brooks Cole Publishing.

Statistics Canada. (2015). Section D - Eating Disorders. Retrieved October 22, 2019 from Statistics Canada: https://www150.statcan.gc.ca/n1/pub/82-619-m/2012004/sections/sectiond-eng.htm.

Stommel, W. (2009). Entering an online support group on eating disorders: A discourse analysis. Amsterdam: New York.

Tasca, G. A., Balfour, L., Presniak, M. D., & Bissada, H. (2012). Outcomes of specific interpersonal problems for binge eating disorder: Comparing group psychodynamic interpersonal psychotherapy and group cognitive behavioral therapy. International Journal of Group Psychotherapy, 62(2), 197-218. doi:http://dx.doi.org.ezproxy.viu.ca/10.1521/ijgp.2012.62.2.197

Zastrow, C.H. (2009). Social work with groups, 7th ed. Brooks/Cole: Belmont, CA.