unsplash-logoFlemming Fuchs

How to Set Up a Therapy Group in Private Practice

My last blog post, 5 Reasons Why We Need More Group Therapy, was a plea to fellow counsellors and therapists to get more therapy groups up and running. Groups can be powerful vehicles for personal development and change. Many people wanting to access help are priced out of private individual counselling. Help through the NHS is usually time limited and waiting lists are long.

Many therapists I speak to like the thought of running groups but don’t know where to start. The logistics can get a bit complicated. Finding a group of ready clients all prepared to start at the same time, then assessing everyone and finding a suitable venue can all be a bit of a headache.

psychotherapist ealing binge eating

In this article I’m sharing what I have learned about setting up groups to help you get that group up off the ground and running.

1.     Pick a theme – Don’t get me wrong, I think general therapy groups work very well but usually it’s other therapists or trainees that seek out such groups. For the general public, joining a therapy group is scary. They want to know there will be people who they can relate to in the group. If your group is focused on a shared issue, it creates a mutual task for the group and any prospective clients will be reassured that they are more likely to connect with people. Themes could be anything from anxiety to depression to OCD. My groups are focused on people struggling with binge eating and run open ended. You may prefer to run a closed group for a specific number of sessions.

2.     Find a suitable location – I run my group from home. There are no extra overheads this way, zero traveling for me and I like the informality of the setting. However, for many therapists running a group from home just isn’t a viable option. Most counselling centres have rooms for groups but don’t be afraid to think outside the box on this one. Is there a local café that closes at 5pm who might be willing to let you use their space one evening a week? A community hall or a church? See where your local Alcoholic Anonymous meetings are held, perhaps some of those locations may rent the space to you.

3.     Pick a start date – This one is so, so important. I made the mistake of believing I should find participants and then announce the start date once I had enough people to run the group. Potential participants are likely to feel a bit unsure and ambivalent about joining a group. People are more likely to join if there is at least some certainty about when it will start. In the end I picked a start date of 29th January and started marketing in October. Nothing happened. Ten days before the first session I still had no-one signed up for the group but then, during the last week, there was a rush for spaces and the group was full! I even had to turn someone away. A deadline is crucial for people to decide to commit but it will test your nerve.

4.     Get the word out – Many therapists don’t enjoy the idea of marketing. They believe people will come for therapy when they are ready and have already decided to do so. Quite right. But marketing your group is simply finding ways to let people know about it. They need to know where you are and what you are offering and they will come and enquire if they are interested.

Some ideas to try – edit your online directory profiles to include details of the group, let local therapists know what you are offering in case they have someone to refer, put it on your website and ask your therapist friends to add a link to their websites, print out posters and display in local supermarkets and cafes, share on your social media and ask friends and colleagues to re-share on their accounts, consider a Facebook or Instagram ad campaign, write to local GP practices and include your poster and just talk about it everywhere you can without being too much of a nuisance. I personally found the printed posters (just simple ones created at home) put up locally and my Instagram posts yielded the most results.

One of my posters for the binge eating group

5.    Managing the money – Taking deposits from people before the group starts benefits everyone. It’s a demonstration of commitment and makes no shows much less likely. Nerves will build as the first session looms closer but having already paid it’s harder for clients to talk themselves out of at least coming and giving it a try. I suggest holding a deposit equivalent to two session and using this to cover the last two sessions in the group. The deposit works particularly well in open ended groups because when the client is ready to leave it encourages them to use those pre-paid sessions to process their ending and say goodbye.

It’s possible that some participants may want to use the group as a drop in service, which can have a negative impact on group cohesion. I recommend you request participants to pay for their space in the group, rather than for their attendance so, if they miss a session, they still pay because it is the seat they are paying for. This helps to encourage commitment and regular attendance.

Setting up a group in private practice really is doable. I have found there is a demand for it. People are designed to be in groups and with a mutual problem they work together, provide mirrors for each other and challenge one another. Doing group work is some of the most satisfying work I have done in my life. I don’t even like to use the word work because it doesn’t feel like work, it feels like a privilege.

 

5 Reasons Why We Need More Group Therapy

When I decided that I was going to try to set up a therapy group on my own and run it from my home, I received a few raised eyebrows from my colleagues. There appears to be a general consensus among therapists that groups are difficult to recruit for and take a lot of energy to manage.

During my training I did a placement at a private eating disorder clinic and I needed to get some group experience. The clinic approved my idea for an 8 week overeating support group and, despite high visibility and paid for marketing platforms, there was very little interest. The group ended up with three participants but I absolutely loved that little group. The way they supported and challenged one another felt like a privilege to be a part of. I came away each week feeling energised by the work and really looked forward to the next one. This was my first taste of running a group and I loved it!

Today I run therapy groups for binge eating from my home. I did my own marketing and this time the interest was there. I had always suspected there was a demand for it and through trying various different means, I managed to spread the word and the people came.

group therapy binge eating

Group therapy is something else. I would go as far as saying that I think group therapy is often more effective than one to one, at least when it comes to a shared problem, such as compulsive eating.

The power of groups cannot be overestimated in my opinion and here are some of the reasons why I believe we need more therapists willing to set up groups.

1.     “Money doesn’t bring happiness but it does bring options.” Anthony Bright

Let’s get really practical for a moment. Group therapy is so much more affordable than one-to-one therapy. Group therapy can be an opportunity for someone to access therapy who might ordinarily be unable to due to limited means. With many therapeutic services having their funding cut, group therapy is a way of getting more help to more people.

2.     “Shame dies when stories are told in safe places.” - Anonymous

In every session, at some point, someone will share a story or difficulty they are having and be met with a “me too” response. It’s so common to feel guilty and ashamed about the things we are struggling with. There is often a compassion for others that isn’t always extended to ourselves, so when we hear someone talking about their experience and it’s a similar thing we see in ourselves, it can be like looking into a mirror but the self-judgment subsides. This starts to change the way we feel about our problems, which makes it easier to make changes. No-one changes from a place of shame.

3.     “The transference phenomenon is an inevitable feature.” – Carl Jung

Groups offer so many opportunities to work through old relational hurts. What are the members projecting onto each other? With individual work, there is only the therapist as a transferential object. This could mean that a male therapist might never evoke transferential feelings about mother so that stuff doesn’t get worked through. We are born into family groups, so our sense of our place in the group is a powerful way to gain self-awareness and challenge self-beliefs or even identity.

4.     “Knowledge is of no value unless you put it into practice.” – Anton Chekhov

The group provides an opportunity to practice something new. If the struggle is conflict avoidance, the group can provide the opportunity to practice managing conflict in a contained environment. If the client finds it hard to ask for what she needs, she could start by asking for something from the group.

5.     “There is an indefinable mysterious power that pervades everything.” – Gandhi

There’s just something else that happens in a group, something I struggle to find the words for. When people gather with a shared intention, things shift and morph and create something new. Each group has it’s own identity and shared personality. Is it love? We don’t talk about love much in therapy but I have seen moments of deep connection in groups. People care for one another and sometimes that means challenging someone and dealing with difficult feelings that arise towards each other. I welcome the difficult situations because they are the biggest opportunity for growth.

 Fear and uncertainty often prevent clients from considering group therapy as an option. If group therapy becomes more popular, the idea will seem less daunting and people might be more willing to give it a go.

 This includes therapists too. Yes, I appreciate it’s not for everyone but I know a few counsellors who like the idea but don’t know where to start. Next week I’ll be posting my “Top Tips For Getting a Therapy Group Up and Running.” If it’s something you’ve thought about doing, hopefully it will give you a some ideas about how to make your group a reality.

Podcast Interview

I had a lot of fun recording a podcast episode for Better Mental Health this week. In the episode I talk about body image - the trouble with comparing yourself to others and the influence of social media.

You can find the episode at https://podcasts.apple.com/gb/podcast/better-mental-health

I also share a bit about my own story with binge eating, which isn’t something I have done a lot of online. I do think we connect through sharing our stories. I see this a lot in the binge eating therapy groups I run. When we know we aren’t the only one facing this challenge, we feel less alone. When we feel compassion for someone else’s story that’s similar to our own, we can find a bit of compassion for ourselves.

Struggling with compulsive eating and bingeing is nothing to be ashamed of. It’s confusing and scary and it can be hard to find your way out on your own. There are many places to get support, professional or otherwise, you don’t have to face this alone.

Episode 11 - Sarah Dosanjh on Body Image

Episode 11 - Sarah Dosanjh on Body Image

Why dieting isn’t the answer to overeating

I am pretty vocal about being anti-diet. Diets do not work for the majority of people. Our behaviour is driven by how we are thinking and feeling. Going on a diet usually involves trying to create a behaviour change without making any other changes. Diets will insist that you just have to be disciplined enough and if you don’t manage to stick to the diet, you must be lacking in willpower.

As Kelly McGonigal writes in her book Willpower! You only need willpower if there is a conflict of will. Diets create a conflict and no-one can thrive while living in a conflicted state. There are three things that could happen when you go on a diet.

i can't stop eating binge eating weight loss

You might lose weight and be a “success” story.

Firstly, you might lose weight and keep it off. This is very much the exception not the rule but it does happen in a tiny percentage of cases. When it does happen, these people have created a shift in identity. They develop a new attitude to how they eat and move their bodies and that attitude is integrated into their personality. Usually these are people who didn’t have a great deal of emotion around their eating or body image to begin with. They are not people who have tried dozens of diets and have had the experience of feeling like a failure around food. Because the emotions are not particularly heightened, they are not working with the same resistance that so many of us are. Not fair? Perhaps, but we can’t change our emotional history with food. We need to accept where we’re starting from.

The rebound effect of diets.

Secondly, you may stick to the diet for hours, days, weeks or months - maybe you even hit you goal weight but at some point most people will throw off the shackles and resume eating, usually more than before and usually with a sense of feeling out of control until you find yourself back at your starting weight or higher. How distressed you are by this experience will predict how disordered you could start to become around food the next time you try and exert control over your eating.

Dieting triggers eating disorders.

And lastly, you restrict and maintain your restriction through tolerating the conflict of wanting to eat but not allowing yourself to. This one can be dangerous because it’s the feeding ground of eating disorders. In anorexia tight restriction is maintained but at enormous cost. Obsession, fear, anxiety, isolation and deteriorating health all follow this type of restriction and once you’re gripped by it, it’s incredibly difficult to fully recover. Perhaps you manage to restrict but with periods of bingeing, well this is a slippery slope into binge eating disorder and once you start making “amends” for bingeing (purging, exercise, laxatives, fasting) you slide into bulimia territory.

How do I stop overeating?

You may be thinking this all sounds a bit hopeless. What are you supposed to do if dieting isn’t the answer? I think we need think about what we can learn about the first group. They changed their identity around how they were with food. Their conflict and emotionality around food isn’t as high. In order to change how we eat, we first need to reduce our own conflict and emotionality around food. I know you want to jump straight into making the changes. Of course you do, this has become so incredibly important to you but the challenge may be to make it LESS important. This is why ditching the diet mentality is crucial. It’s not just about not dieting but about shifting the mentality. This is the mentality that you carry around day-to-day and it influences every single food choice you make and turning food decisions into a minefield.

This is how so many people get stuck, the desperation to lose weight through controlling what you eat is what will keep you feeling out of control. Like a spiders web, the more you struggle, the more stuck you become. We need to end the war to find peace and then rebuild from the debris. This means surrender, not destroying ourselves through trying to win against our appetite for it is a fierce and non-compromising opponent.

 

Want to stop binge eating? STOP compensating.

First let me preface this by saying that this blog post is not going to be aimed at everyone who is struggling with overeating but if you struggle with binge eating and your weight stays within a 10lb range then read on and listen up.

Weight and binge eating

Now this may sound a bit controversial but if your weight is not climbing up then you are probably not eating more than your body needs over the long run. “No way,” I imagine you thinking, “Have you seen how much food I can put away on a binge?” I hear you, it doesn’t seem possible that you could ever need that amount of food and you know by how terrible you physically feel afterwards that it was more than you needed in the moment. But that’s the point, it might have been more than you needed in the moment but perhaps it was what you needed in the long term.

Most of my clients who come to me for help with binge eating are not in what most people would call big bodies and yet they are consuming large amounts of food and feeling utterly out of control of their eating. So what’s happening?

Compensation. From the moment the binge is over you start plotting and planning how to compensate for the excess of food. This usually involves planning exercise, promising to eat less/healthier tomorrow, skipping meals or purging, and what does this do? It ramps up cravings and the desire to binge again soon.

bingeing compulsive eating stop

Compulsive eating and caloric deficits

I often ask people to describe a bad day of eating and a good one. This invariably produces similar answers - the bad days mean bingeing on sugar and processed foods and the good days go something like, porridge for breakfast, soup for lunch and fish and vegetables for dinner. The good days are invariably days of caloric deficit, so then the compensatory behaviour to for this is a binge.

You see? Restriction compensates for bingeing but then bingeing compensates for restriction. It’s not so much of a vicious cycle, more like a pendulum swinging one way and then the other. Even thinking about compensatory behaviours can trigger more bingeing. It’s that moment mid-binge where you feel a bit sick and fleetingly consider stopping, it’s often that compensatory belief about what you’ll do later that will lead you to continue the binge. You tell yourself that tomorrow you’ll be so “good” that you don’t want this food left around anyway so you’d better just eat it all now.


binge eating stop compulsive overeating

Clients then point out to me that some people seem to be able to maintain strict and even restrictive diets. They use this as evidence that they just need to try harder and that the answer must be to find a way to control their food intake. This is a tricky one but I do think people’s brains are wired very differently when it comes to eating and appetite. We don’t all experience our hunger or our cravings in the same way. You don’t have the same brain as that fitspo model with the million+ Instagram followers and you don’t have the same biochemistry either.

Binge eating recovery

So while this post has focused on the physical side of bingeing, the psychological component is a massive factor that we can’t ignore. I think it’s important to briefly touch on identity. Often binge eating, once it becomes a regular experience, starts to integrate itself into your identity. You start to believe you are a person who is out of control with food, you are a person who cannot trust their body’s signals, you are someone who keeps failing. These beliefs start to bury themselves in your psyche and they are driven in deeper each time they are compounded by strong emotions such as guilt or shame.

This is why we cannot separate the physical (stopping the compensation) with the emotional (the way we feel about ourselves). A focus on emotional health, while stopping compensatory behaviour planning is the path or recovery.

Cleaning Up Your Instagram

It’s incredibly challenging for many of us to maintain a positive body image when we live in a world of shiny Instagram filters and images of people “living my best life”.

Ugh. Ideally I would wrench you all away from Instagram but if you insist on staying, may I suggest you become discerning about who you are following? Does that fitspo account actually inspire you into wanting chia seeds for breakfast, or does it leave you feeling dissatisfied and defeated?

Instagram works on algorithms, which means it simply feeds you more of what you are already following. If you want to feel better about yourself, why not consider following accounts whose specific aim is to make you feel better about yourself?

So I’ve done some of the hard work for you! See below for a list of accounts committed to helping you realise you are already enough. Just as you are.

@therapist_in_london @Thebirdspapaya @katewas_, @loveyourbody.babe @drsarahcairns @joyateverysize @mindbodyfood @nudenutritionrd @ownitbabe @bodyimagewithbri @body_peace_liberation @positivelypresent @thefuckitdiet @i_weigh @drclaudiafelty @bulimiafree @mindfultherapyatx @evelyntribole @nom_nomaste.llc @thephitcoach @moreloveorg @intuitive.dietitian.kosher @brokefatgirl @concentriccounselling @madeonagenerousplan @the.truthful.scoop @geneenroth @a_body_well_fed @foodandpsych @virgietovar @chr1styharrison @thecrankytherapist @aaronfloresrdn @with_this_body @bodypositivephd @kylafoxrecovery @summerinnanen @metabolism_recovery @kristamurias @jameelajamilofficial @bodyposipanda @ditchthatdiet @body_acceptance_collective @jenniferdigennaro @hopefulhorizons.ca @bodybravecanada @jennafree__ @isarobinson_ @carolynviggh @harriet_frew_therapist @mollybcounseling @kristinabruce_coach @thebodypositive @laurathomasphd @beyond_the_binge @annamarie.rd @100daysoffoodfreedom @nalgonapositivitypride @bravebodylove @intuitivelylacey @whole_embodied_therapist @thefightforbeauty @harri_rose_ @champagneandcurves @emmymbrunner @theintuitive_rd @drcolleenreichmann @fyeahmfabello @isabelfoxenduke @rebeccascritchfield @thefatedrecoverycoach @chubstr @jennifer_rollin @mittendietitian @rachelwcole @whole_embodied_therapist @gogochristie @healingcrayons @haes_studentdoctor @bopo.boy

And some hash tags to follow….

#bodyacceptance #bingeeatingrecovery #yourbodyyourrules #bingeeatinghelp #nondiet
#edrecovery #minduleating #bodypeace #makepeacewithyourplate #healthateverysize #weightneutrality #bodyneutrality #selfcare #ditchthediet #bodyrespect #youaintyourweight #bodypositive #bopo #gentlenutrition #positivebodyimage #livenownotwhen #selfacceptance #intuitiveeating #nourishnotpunish #makepeacewithfood #haes #weightneutral #bodyneutral #iweigh #selfcompassion #screwthescales #allbodiesaregoodbodies #selfloveisthebestlove #bodypositivity #bopowarrior #yourbodyyourchoice #fatpositiveprovider #foodisbeautiful #nodiet #mindfuleatingtips

A Rant About Calories

When oh when will we stop with the demonisation of calories? Products on the shelves loudly and proudly proclaim - “Only X number of calories per portion!”, “Low in calories!” or my biggest pet peeve – “Guilt free!” (implication – low in calories).

Since where are we supposed to feel guilty about needing to eat food and for that food to contain calories?! Gah! Calories are energy and energy is necessary for, well, just about everything!

People fear consuming too many calories and in today’s environment of easy-access, high energy food I recognise that this might be a legitimate fear for some but worrying about getting your calorific levels ‘right’ may simply create a lot of internal chatter that makes it difficult to really know what your body wants at this moment in time.

You have probably been there - standing in Pret or Tesco, comparing sandwiches and pre-packed salads and trying to find the fewest calories to trick your body into thinking this is enough for your lunch. Your body is smarter than you are when it comes to calorie usage.

Also, we don’t absorb all the calories we eat, did you know that? Yep, some of those calories pass right through you and there is no way of knowing how many you absorb. Did you know that if two people consume a 100kcal banana, one could absorb 95 calories and the other 85 calories? FROM EATING THE SAME THING!

You don’t know with your thinking mind how many calories you need and the body’s caloric requirements change from day to day based on numerous factors from activity levels to the weather to how many calories you consumed the previous day.

So please, let’s start appreciating those humble calories, the building blocks of our body, the unsung heroes of our life.

Ending the Nightmare of Binge Eating

First published on the Counselling Directory https://www.counselling-directory.org.uk/counsellor-articles/ending-the-nightmare-of-binge-eating.

We have never had greater access to nutritional information than we do today. We also know more about how our bodies function than ever before, but it seems that we have never had a trickier relationship with food or greater dissatisfaction about the size and shape of our bodies.

More and more clients are approaching me because they are fed up of struggling with what they perceive is their out-of-control appetite. Are our appetites more out of control these days? This is often the reported experience but all may not be as it seems...

Our relationship with food and appetite is complex. We have many cues and triggers that encourage us to consume food, and these engage all the physical senses - sight, smell, taste, touch and even sound. Ever spotted that green Starbucks sign and suddenly wanted a caramel latte? It wasn’t even on your mind until you spotted the green mermaid in her circular frame!

Experts have termed our environment as ‘obseogenic’, and this simply means we are living in a culture that continuously primes us to eat.

Here lies the cultural paradox. Thin lean taunt bodies and “clean” disciplined eating is celebrated as a sign of success and bestowed with greater social value. Soft, squishy bodies are often judged as undisciplined and an example of what we shouldn’t be. The pressure is on to sculpt your body into a more acceptable shape.

The solution to this becomes a diet. Diets these days are often masquerading as wellness programmes, or healthy clean eating. Sugar is the enemy; we should be eating low carb, keto or paleo. There are long lists of what you should or shouldn't be allowing yourself to consume, and with each new bit of research more things are added to these lists.

The problem with this solution is that it requires you to ignore your body’s signals and hand over the decisions about what and how much to eat to a prescribed set of rules. People crave freedom, it’s a basic primal need, and for many the restriction imposed by dieting triggers rebellious eating, or binge eating.

Binge eating is much more than eating “too much”. It’s a sensation of completely losing control around food. It’s very scary to experience. Unfortunately the common response when people start to binge is to try and exercise EVEN MORE control over food, which sets up the next binge and so the cycle continues. This is how people get trapped in the cycle of bingeing and dieting.

Also, dieting causes emotional eating. As soon as you restrict food you like, you increase its emotional value. Eating and deciding what to eat becomes a more emotionally-charged experience, which confuses your hunger signals even more. Food can then become a way to manage your emotional state.

So what’s the solution?

Understanding some of the emotional reasons that perpetuate your eating is a good start, and counselling will help you gain insight into this and assist you to develop tools for managing your emotions without turning to food.

The emotional work is only part of the picture though.

I like to use the analogy of Newton’s third law, which states that each action has an equal and opposite reaction. Bingeing is the natural reaction to restriction. Even restrictive thinking can trigger the binge response. Ever planned to start a diet on Monday and ended up eating your way through the weekend before?

To break free from bingeing requires a rejection of diet culture and a re-learning of how to respond to your body’s signals.

When people stop believing their bodies aren’t acceptable as they are, they can begin to reconnect with the subtle sensations and signals in their bodies, and regain their sanity around food.

If you are struggling with binge eating, you may be interested in joining a binge eating therapy group. The group meets on Tuesday evenings in Ealing. For more info, click here.

Thought of the Day

Thought of the day today is an excerpt from Ice Cream for Breakfast by Laura Jane Williams. Taking a moment to acknowledge the amazing things your body does is one of the practical steps we can take to improve body image. Our bodies are more than what they look like, they are incredible! Let’s take a moment to appreciate that!

Have you reached a turning point?

A Turning Point Session (TSP) is for anyone who has come to a point in their lives where they are fed up of struggling with overeating and body image and have reached the the point where they are ready to make a change.

If you have been caught up in a bingeing cycle for a while, I imagine you would have made many resolutions to change in the past. You’ve probably said to yourself most days that tomorrow will be different.

But then it isn’t.

And the cycle continues.

overeating binge eating treatment

In your TPS, we will have a 3 hour intensive together where we seek to get to the bottom of what may be keeping you stuck. I have many tools in my kit to help us to uncover this and make a plan to change it around. Drawing on approaches from transactional analysis, cognitive therapy, NLP, psychotherapy and coaching, we will have a session which is tailor made for you. You will have filled out a thorough assessment session prior to our session, which will enable me to have an idea before me meet of what techniques we may need to use.

This may be right for you if….

  • You are fed up of struggling with overeating/bingeing. You know it isn’t supposed to be this hard.

  • You are ready and willing to learn how to do things differently.

  • Committing to weekly sessions does not appeal to you.

You will leave the session with tools and resources you can use to turn things around and get on with living your life.

The session includes:

  • Constructing the narrative - understanding how you have become this way around food.

  • Understanding neuroscience and how this information can help restore mental sanity with food.

  • Emotional release work.

  • A tailor-made plan for you to implement over the next few weeks. Including take home resources.

  • A Skype check in 4 weeks later.

    If you’d like to find out more, please head to the contact page and I would be happy to answer any questions you may have. To purchase a Turning Point Session, please click here.