Support Groups: Moving Treatment Beyond the Dress Rehearsal

Contributor:  Candice Hershman, MA., LMFT, New Dawn’s Eating Disorder Recovery Center

Therapists aim to provide clients with an authentic experience: not a dress rehearsal, but rather the actuality of relationship.  This experience includes support and positive regard, and also disagreements, misunderstandings, and the necessity to remain engaged in a relationship when inevitable conflict arises.  

Although these challenges and amazing learning opportunities can come up during an authentic encounter between a client and therapist, a support group widens the circle of interactions, helping a client move beyond intrapersonal development and more intimate interpersonal encounter, to many personalities and styles of interaction.  People connect in support groups and learn to communicate with themselves and each other.

Support Groups For Eating Disorder Recovery

People with eating disorders may develop a tendency to become either isolated from others due to shame, guilt, and protectiveness of their habits, or become distracted by the recovery of others.  Support groups provide clients in eating disorder recovery a wonderful opportunity – bringing them out of isolation and into contact.  This connection provides the opportunity to hear the challenges of their peers and realize that they are not totally unique in their painful emotional experiences.  

As compassion is developed for others, they may identify the compassion for themselves that so desperately needs to be developed for recovery.  Additionally, by acknowledging the suffering of others, individuals suffering from eating disorders, with co-occurring disorders like depression, learn to move beyond the inertia that can occur from losing contact with others.  The stories may all be different, but the pain is often quite similar.

Improving Communication Effectiveness

Individuals learn to communicate effectively by listening to others and gauging the amount of space they take in order to make space for others.  They learn to speak from their own experience and take responsibility for their own treatment rather than comparing themselves to others and their progress.

Friends giving each other support like Support GroupsEating disorder sufferers may need to learn to ask for help from others, and experience the benefit of offering support for others based on their own painful experiences.  When these kinds of interactions are consistent, individuals become empowered as they integrate social-relational skills through active process rather than mere psycho-education.

Most importantly, group members are given the opportunity to feel themselves be successful in a social way.  

Whether it be co-occurring substance abuse, para-suicidal behaviors such as cutting or risk taking, or basic isolation, many eating disordered people have experienced tremendous social anxiety and need new, positive social experiences in order to actively recognize that they have something valuable to offer a group.  In fact, many members of the group realize that they are not just acceptable: they are valuable and lovable to others.

Structure of Support Groups

Support groups can occur in many forms.  People usually meet in person, although with contemporary technological advances, people often meet through Skype, or even conference calls.  There are advantages and disadvantages with this.  In person is ideal because it gives people direct contact.  

Having access to a positive support group trumps whether or not it appears in person or via phone or Skype.  Research has shown that online group therapy can be as effective as face-to-face treatment, although the pace of recovery may be slower [1].

One particular research study found that Internet support groups, when combined with Internet-based psychotherapy training programs, showed significantly greater reduction in depressive symptoms at six and twelve months of treatment, compared to that of a control group [2].  

Combining an Internet support group with psychotherapy training may be a more effective option for treatment, rather than opting for an online-based support group alone.  These are important options for individuals who are hoping to maintain consistent support, connection and treatment, though may be limited due to time allotment, location, accessibility, resources, and more.  

In the past a busy work schedule or long commute could have been the barrier standing between themselves and receiving support, but technology is allowing the therapy to transcend distance. Additionally, some people who experience an exceptional amount of social anxiety may want to begin with an online or conference call support group because it gives them an extra buffer between actual contact.  It may be a good place for people to begin.

Regular attendance of a support group allows members to move beyond the natural inhibitions that most people have when initially meeting others.  It is perfectly normal for people to take time to warm up with a new group.  Over time people become more comfortable and may be more inclined to share personal insights, emotions, or experiences that benefit both themselves and the group.  People may begin to rely on each other both inside and outside of the group.  

Frienships supporting each otherAs long as members are thoughtful about group confidentiality and do not talk about other people’s issues outside of group, they can be just a phone call away in a crisis.  

Even better, people who have discovered shared interests can spend casually fun time together.

Learning to have a good time without focusing on recovery is an important skill.  It helps people open their worlds up beyond their pain, and can build resiliency.  

Either way, long lasting relationships built on the positive principles of communication and respect inherent in the group format are developed, and this is often critical to eating disorder recovery.  

Especially for an individual in recovery who may have found it challenging to connect with others or develop meaningful friendships, support groups can help foster healthy relationships in a safe setting that is therapeutic for ongoing healing and recovery.  

Readiness For Eating Disorder Support Groups

Sometimes people are not ready for support groups.  If a person is too early in their recovery, they may trigger uncomfortable feelings in other members.  Group members may begin to either caretake, feel a stronger urge to relapse back into eating disorder behaviors, or resent new clients for not being as “committed” to their ED recovery.  

Special care needs to be taken with these situations, and members could remind each other to stay focused on their own treatment and use their internal reactions as opportunities to explore what is at the root of bad feelings.

Sometimes people are not ready for support groups because they are too inter-personally aggressive and not yet able to behave in ways that help keep the group safe.  Depending on the type of support group, people ideally would be screened for appropriateness for the group.  Clinicians typically screen for this, although some support groups are not run by clinicians.  

A designated leader, group rules, and protocol for handling these delicate situations would best help provide boundaries and safety for the group.  However, some people may build rapport first and then act out towards other members.  Witnessing this could be painful for group members for a variety of reasons, but nevertheless cannot be tolerated.  Group safety is critical to every member’s recovery.

Support Group for Family of Eating Disorder Sufferers

Support groups are not just available to people with eating disorders.  Often times, family members need a space to work out feelings that result from witnessing a loved one with an eating disorder.  Most people in the community at large do not understand the nuances of eating disorders: the ripple effect that it has, and what the underlying issues may be.  

Families can feel isolated, judged, and misunderstood.  A support group may provide a space for family members to connect with other family members, helping them identify, feel more normal, and develop relationships that they can rely on outside of group (given, once again, that group confidentiality is honored).  Being lonely is not only something that eating disorder clients experience.  Family members can feel lonely too.  Support groups can help assuage that loneliness.

Group of friends spending time together

Family support groups can also offer much needed encouragement along the eating disorder recovery journey, giving guidance to family members who often feel discouraged, hopeless, and/or helpless as they watch their loved one struggle.  

Family support groups may be generalized, or there may be options tailored to more specific needs.  For example, there are support groups especially for parents of a child with an eating disorder, spouses of eating disorder sufferers, siblings, caregivers, and more.  Connecting with a group in a safe environment can be an invaluable resource for any family members involved.

Participating in support groups is not always easy, but neither is recovery if you try to do it alone.  Groups provide a contained, safe space that integrates validation of feelings and identification with people who understand the idiosyncrasies of an eating disorder.  Support Groups also provide interpersonal challenges that help people stretch and reach their growing edge.  

This is how people learn, and the success of either working through group conflict or finding a pleasant connection can be extremely empowering for clients.  Groups, just like life, are no dress rehearsal.  They are learning by living.

If you or your loved one has been recovering from an eating disorder, consider the option of integrating support groups for your ongoing treatment.  Check out the online Directory of Support Groups on the Eating Disorder Hope website to find a group near you, or check in with your treatment team providers for any recommendations based on your individualized needs.  

The process of recovering from an eating disorder is an ongoing journey, and developing relationships with others who support your efforts will be a crucial part of maintaining recovery for the long term.  



[1]:  University of North Carolina Health Care System. “Online group therapy may be effective treatment for bulimia nervosa.” ScienceDaily. ScienceDaily, 30 November 2016. <>.
[2]: Griffiths KM, Mackinnon AJ, Crisp DA, Christensen H, Bennett K, Farrer L (2012) The Effectiveness of an Online Support Group for Members of the Community with Depression: A Randomised Controlled Trial. PLoS ONE 7(12): e53244.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Edited And Updated By: Crystal Karges, MS, RDN, IBCLC on June 28, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on June 28, 2017.
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