unsplash-logoFlemming Fuchs

I can't stop eating

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.

 

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.