Counseling group proposal and implementation framework

¶ … aesthetics norms of beauty and the social definition of normality vs. abnormality vary from one epoch to another, and their influence over self-perception and over our own psyche cannot be neglected. The contemporary definition of a beautiful female body imposes a certain weight limit and the Rubensian model of female beauty is long gone. These standards and the new times brought to surface multiple new forms of eating disorders, from anorexia nervosa to bulimia. In their quest for beauty and for social acceptance, younger or elder females engage in unhealthy eating practices and develop compulsive attitudes towards eating, many times accompanied by variations in weight or resulting in the condition of under or overweight.

Physical characteristics may affect psychological well-being by way of the [...] social evaluations of the others [...] or through processes within the individual" (Hayes & Ross, 1986; 387). Being overweight represents a certain source of distress for those suffering from it, producing a distortion in the creation and shape of self-image and having a durable influence over self-perception and self-esteem. The studies analyzing the issue of obesity dwell onto multiple aspects, such as - the connection between overweight and psychological well-being (Hayes & Ross, 1986; Ross, 1994), the "risk factors," namely the role of culture and family over eating disorders (Howarth-Hoeppner, 2000), the social constraints in eating patterns (Maykovitch, 1978), management and therapy of obesity (Stewart, 1987).

The present study intends to focus on finding efficient treatment for obesity among female college students, starting from the findings of previous studies showing "that being overweight has no direct effect on depression in any social group except among the well-educated" (Ross, 1994; 63). The suggested therapeutical approach is group therapy, for reasons which will be detailed in the following pages and the selection of the population will be made on a voluntary basis, through class announcements and bulletin boards. The reasoning for selecting voluntary participants lies in the fact that the subjects willing to take part in these therapeutic groups were not only diagnosed as being overweight, based on the height vs. weight measurement scale, but also that they identify this issue as a problem, which needs to be cured, and they manifest interest in finding a solution for their weight disorder.

In the following paragraphs I will focus on the aspects of: group therapy (theoretical debates and importance), selection of the participants and group method, starting assumption and expected results. Moreover, the methodological theoretical framework of constituting the groups and the work with the patients will be presented and detailed below.

To begin with, group therapy is not designed to replace completely the individual counselling and therapy, but "is construed as group methods employed to assist individuals who present maladjustment problems in personality and interpersonal relationships which call for corrective and remedial action" (Dreese, 1957; 219). As it was pointed out before, obesity affects the self-esteem and the self-worth, both because of the social perspective (as I see myself through the eyes of the others) and because of internal factors. Moreover, obesity does not only stand as an obstacle for the development of a social identity and social networks, but also represents a serious health risk (Dwyer et. al, 1970; Ferraro & Kelley-Moore, 2003).

The cultural contraints brought by the normative description of the perfect woman make women associate thinnes and bodily perfection with succes, love and happiness (Wolf, 1990). More important, the influence that these social definitions have over the self-esteem and self-perception are not to be neglected. The fact that the study will take place in an educational institution will guarantee the cultural diversity of the participants, which can bring a new perspective over the importance of cultural factors in perceiving obesity. Some studies have shown, for example, that "African-American women appear to be more satisfied with their weight and appearance than are white women, and they are less likely to engage in unhealthy weight control practices, yet they are more likely to have high rates of obesity" (Lovejoy, 2001). The volunteers who manifest their interest in this group therapy program will bring additional light on this topic, given their different cultural backgrounds.

The fact that the persons involved in this therapeutical project are exclusively women can be supported by several theoretical arguments. First of all, women are more concerned with and more affected by the aesthetic norms than men, which is basically a reflection of a socially manufactured division of roles and of a certain definition of feminity (Hopwood, 1995). Second, the cultural factors are corroborated with the family environment, particulalrly a stress placed on the importance of appearance for future success in the discourse of the adults, when socializing the female child for her future social and family life (Boskind-Lodahl, 1976). The combination of all these factors - cultural patterns and constrains, family environment, media and the stereotype of beauty - make women more susceptible to be affected by eating disorders than men. Even if obesity is not an exclusively feminine attribute, but it is almost as common between men, they do not perceive it as an obstacle for their social existence or for their self-esteem, correlating it rather with health issues.

The idea of a group of persons having similar difficulties to cope with and similar obstacles to face and overcome can be of great support to a person who felt isolated from her peers because of the weight difference. In order for therapy to start bringing results, the members of the group "must not only feel secure within the situation, but also must experience some anxiety about a problem which they wish to resolve" (Lifton, 1954, 156). That is why group therapy, I believe, will constitute a promising start in an efficient treatment for obesity. As argued before, the group therapy is not the sole instrument to be used, but it can constitute, in these circumstances, a very effective approach. The group sessions can provide the acceptance, understanding and social interaction that obese persons might lack in their daily life. Besides sharing information, the participants share a common set of problems and the feeling of belonging, of being integrated in a group can provide additional elements to make therapy efficient and the patients more able to cope with their issues (Allon, 1975).

The internal dynamics of the group should not be neglected and the interactions between patients, on one hand and between patients ant the therapeut, on the other, should play an important role in constituting the groups. Based on the area of problems identified at the primary indepth interview, the groups should be consisting of patients having a common set of problems. In order to assess the way in which each patient will respond to group therapy, a few personality factors should be considered, such as - the attitude towards authority and peers, the ability and desire to reveal one's weakness towards the other members of the group etc. (Powdermaker & Frank, 1953)

The importance of the group for the effectiveness of the therapeutic program consists also in the fact that there is a leader of the group, who will control and focus the discussion, encouraging the patients to express their emotions and helping them find solutions for their problems, cope with the difficult issues they encounter, develop their social skills and etc. In the particular case analyzed here, the issues to be confronted and solved are the unhealthy eating habits, perceived as forms of compulsive behaviour or as addictive consumption (Faber et.al., 1995). Moreover, not only consumtion patterns or eating habits are to be approached by therapy, but they should be perceived as just one side of the coin, the other being represented by personality disfunctions (low or decreasing self-esteem and self-value) and social inadaptation (diminished social skills).

Compulsive consumption (of commodities or of food) is, some might say, a characteristic of the late modern society, where the protestant ethic of production has been replaced by the hedonistic ethics of consumption (Illouz, 1997). In a world invaded by the media signs and definitions of well-being and of happines, the only guarantee for and proof of success is continuous consumption of all kinds of goods - material or cultural products, food or lifestyles. The participants to the therapy group are all young and, supposedly, they are the ones who will be the most affected by the syndrom of modernity and compulsive consumption, since they were born and raised into this type of society.

Moreover, young female students live in an environment where the competition is higher and there is an increased openess towards the presence and the appearence to pop-culture stars, almost all close to the prototype of beauty (meaning slim and fitted, healthy and athletic) brought and reinforced by the visual media. (Hopwood, 1995; 66-8). Researchers have shown that, in this world, being overweight is less acceptable, since the person is considered solely responsible for her condition (Hayes & Ross, 1986)

On the other hand, all participants have a high level of education and, according to the research so far, this group seems to be a favourable environment for the development of eating disorders:

between 4 and 9% of female college students meet the criteria for the clinical eating disorders of anorexia nervosa and bulimia [...]. Furthermore, studies indicate that between 60 and 80% of college women engage in regular binge eating and other abnormal behaviours that fall short of the criteria set by clinical scales. Many college women who are at normal weights continue to express a strong desire to be thinner and to hold beliefs about food and body image that are similar to those of women who have actual eating disorders" (Hesse-Biber et.al., 1999; 385-6)

One possible explanation for the increased presence of eating disorders among young college students is given by the amount of stress, in terms of having to face some important challenges and take some major decisions (or at least perceived as such) and there might be a negative correlation between the level of self-satisfaction (as academic performance and as correct decisions) and the occurence of eating disorders, as some studies suggest (Hesse-Biber et.al., 1999)

The therapy will be continued for a duration of six months to one year, because behavioural and attitudinal change is a process that requires time. The sessions will be held once or twice per weeks, in groups of 5 to 10 persons, depending on the sample selected. The size of the group depends on the individual and therapeutical needs of the patients - and here the indepth interviews will bring light, and the high level of education is a plus, assuming that it is associated with a higher level of self-awarness and an increased ability to express and communicate the problems. Before the therapy program begins, the subjects will be interviewed and, during the sessions, they will be given a self-monitoring program, in order to fully assess the efficiency of the therapy and the development of the patients

Here, some additional comments have to be made. First, the therapy is focused on overweight women and not on eating disorders, therefore it might address to patients who suffer from obesity from medical causes. Nonetheless, these patients are in the same need of support as those suffering from an eating disorder, particularly in terms of self-conceptualization, self-acceptance and social integration. The women suffering from obesity from medical causes will have to face the same problems of adaptation as those suffering from eating disorders, but the two categories should not be reduced to only one.

The self-concept is constructed through a permanent negotiation between a sense of relationship with the others and a sense of autonomy from them (Hesse-Biber et.al, 1999; 387). Similalrly, the self-esteem is given by the measure of appreciation one has for his or her self-concept, by the closeness to the standards one desires to reach in terms of personal and social development. Accordingly, "theorists [...] claim the psychological experience of self is intimately connected to sense of one's own body; and researchers find that physical appearance is related to emotional well-being, happiness and self-esteem" (Hayes & Ross, 1986; 387). In this apparently closed circle of social aesthetics norms / appearance / self-esteem obesity can create a disruption and interfere in the social and personal dimensions of one's life.

The importance of this therapeutical project lies in several aspects. First, it can enrich the theoretical framework, exposing the risks a certain category is subject to, through providing answers to a few questions: are female students a risk group for obesity and/or eating disorders? If so, then what are the factors that predispose them towards such disorders and do they lie primarily in the socio-cultural determinants, or in the personal dimension?