Daigneault 2000

The Journal for Specialists in Group Work
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Body talk: A school-based group intervention for

working with disordered eating behaviors
Susan Dahlgren Daigneault
To cite this article: Susan Dahlgren Daigneault (2000) Body talk: A school-based group
intervention for working with disordered eating behaviors, The Journal for Specialists in Group
Work, 25:2, 191-213, DOI: 10.1080/01933920008411461
To link to this article: http://dx.doi.org/10.1080/01933920008411461
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Body Talk
A School-BasedGroup Intervention for Working
With Disordered Eating Behaviors
Susan Dahlgren Daigneault
Dover High School
Dover, New Hampshire
This article describes a school-based group intervention designed to address issues
of body image, self-esteem, weight, and eating disturbances. Based on a narrative-
Downloaded by [University of Tennessee, Knoxville] at 10:16 20 September 2015
feminist theoretical foundation, this 10-session group provides female high school
students with opportunities to explore their concerns about relationships, appear-
ance, and what it means to be female. The article provides descriptions of the narra-
tive techniques used during the group sessions, provides specific examples of activi-
ties used i n the group, and describes processing techniques.
Among the female adolescent population, the prevalence of eating

disturbances and eating disorders has been increasing in recent years
(Nassar, Hodges, & Ollendick, 19921,with many of the first signs of an
eating disorder occurring in early adolescence. Fosson, Knibbs, Bryan-
Waugh, and Lask (1987)found that the first signs of disordered eating
occur, on average, at 11.7 years of age for adolescent girls. According to
Fisher, Golden, and Katzman (1995),50% of adolescent girls see them-
selves as overweight and engage in dieting behaviors, despite the fact
that 90%to 98%of them will regain their lost weight within 2 to 5 years
(Burgard & Lyons, 1994). Wadden, Foster, Stunkard, and Linowitz
(1989)reported that in 77% of average-weight girls and in 32% of very
underweight girls, dissatisfaction with weight was accompanied by
dieting behavior. Not only do large numbers of young adolescent girls
diet, but many also lack information about healthy weight and nutri-
tion. Moore (1988) reported that among girls who did diet, more than
one third did not have a realistic idea of how much to lose.
Kalodner and Scarano (1992) suggested that eating disorders be
viewed along a continuum ranging from normal eating t o bulimia. Their
research found evidence that self-esteem was lower for individuals who
were on the more disordered end of the continuum. Fabian and Thomp-
Susan Dahlgren Daigneault, a former assistant professor o f counselor education at Appa-

lachian State University, Boone, NC,is a high school counselor at Dover H i g h School, 25
Alumni Drive, Dover, NH 03820.Dr. Daigneault may be reached at (603)740-4812;e-mail:
daig@ttlc.net.
JOURNAL FOR SPECIALISTS IN GROUP WORK,Val. 25 No.2,June 2000,191-213

Q 2000 Sage Publications, Inc.
191
192 JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2000
son (1989) found significant correlations between eating disturbance,

teasing history, depression, self-esteem, and body image. Other studies
have linked excessive dieting, preoccupation with weight, and dissatis-
faction with body image as being precursors in the development of more
severe eating disorders and eating disturbances (Emmons, 1994; Gar-
ner, Rockert, & Olmsted, 1985; Nassar et al., 1992; Polivy & Herman,
1985) and with lower levels of self-esteem and dissatisfaction with fam-
ily relationships (Button, Loan, Davies, & Sonuga-Barke, 1997).
Other studies have demonstrated that sociological factors, such as

the culture’s prevailing standards, also affect the way women view
themselves. Silverstein, Peterson, and Perdue (1986) presented data
that provide support to the contention that the popularity of a thin stan-
dard of bodily attractiveness for women may contribute to the develop-
ment of eating disorders. Those who internalize these cultural values
emphasizing thinness are particularly at risk for developing a severe
eating disorder (Shisslack, Crago, & Neal, 1990).
The potentially harmful effects of dieting and the high prevalence of
this behavior among the female adolescent population support the need
for educational programs aimed a t prevention and intervention.
Because the individuals most at risk for developing eating disturbances
are school-age young people, school interventions provide the best
opportunity to reach this population. In schools, school counselors can
play a vital role in developing comprehensive prevention programs and
also can be instrumental in providing individual and group counseling
interventions for students who may be struggling with eating distur-
bances (Omizo & Omizo, 1992). Group counseling can help students
struggling with eating disturbances to feel less isolated and t o explore
values, beliefs, and relationship issues that may contribute to the eating
disturbance behaviors. They also can teach assertiveness skills t o help
students deal with “peer, parental, and societal pressures” (Omizo &
Omizo, 1992, p. 221).
Current research on eating disturbances supports the use of group
interventions as an effective treatment modality (Laube, 1990; Mitchell
et al., 1990; Riess & Rutan, 1992; Roth & Ross, 1988; Tobin &Johnson,
1991).These studies point t o groups’ effectiveness in decreasing feelings
of isolation and in increasing interpersonal learning. Group discussions
can be effective in challenging thinking about female and male role
model behavior and can provide an opportunity for students to receive
feedback and support from peers who are also struggling with eating
issues (Omizo & Omizo, 1992). In their study on the efficacy of group
interventions, Wright and Forsyth (1997) found a connection between
students’ sense of self-worth and membership in a satisfylng group
Daigneault / INTERVENTION FOR EATING BEHAVIORS 193
experience. In their meta-analysis of 40 studies on group treatment

interventions for bulimia, Fettes and Peters (1992) concluded that, on
average, 25% of participants who participated in at least 9 hours of
group treatment were abstinent from bulimic symptoms for up t o a year
following the intervention.
The narrative approach t o therapy emphasizes the importance of the
person’s reality in providing meaning in their lives. The narrative
approach, like a feminist approach, emphasizes the importance of vali-
dating the client’s reality‘and encouraging a sense of personal agency

and personal power. Many examples of the use of a narrative approach
in individual treatment with young women experiencing eating distur-
bances exist in the professional literature (Lipchik, 1993; Madigan,
1997; Zimmerman & Dickerson, 1994). Group therapy from a narrative
perspective provides participants with an opportunity to invent new
stories and to have these emerging stories validated through being told
and heard in a group setting. As Laube and Trefz (1994)wrote, “Groups
contain undeniable movement and momentum, an inevitability of
change” (p. 30),therefore making this modality a most suitable one for
helping clients t o potentially change their relationships to eating
disturbances.
Although the narrative-feminist approach t o group therapy has been
used successfully in treating depression (Johnson, 1994; Laube & Trefz,
1994), the use of this theoretical approach in treating eating distur-
bances in a group setting has not yet been described. This article con-
tributes to the literature by describing a school-based group
intervention based on a narrative-feminist theoretical model. The
group, Body Talk,was designed as a combined psychoeducational and
insight-oriented approach to helping high school girls talk about their
concerns about body image, weight, self-esteem, and eating distur-
bances. This article discusses the issues that needed to be addressed in
designing this school-based intervention, provides a rationale for using
a narrative-feminist orientation, and describes specific examples of the
narrative techniques and activities used.
DESIGNING A SCHOOL-BASED GROUP INTERVENTION

GUIDELINES FOR PRACTITIONERS
In developing a school-based group intervention, there are several

issues that the group leader needs to consider. For example, defining the
purpose of the group, articulating group goals, establishing a theoretical
framework, recruiting prospective group members, and making
194 JOURNAL FOR SPECIALISTS IN GROUP WORK/ June 2000
decisions about organizational aspects of the group are all factors that
need attention before a group begins. In this section of the article, each
ofthese considerationsis explored and guidelines are given t o help prac-
titioners form their own groups.
Purpose and Goals of the Group

The primary purpose of Body Talk is early intervention for girls who
are showing some indication of problems around healthy eating, body

image, and self-esteembut who do not necessarily have an eating disor-
der. As a school-basedintervention, Body Talk is designed to provide an
opportunity for students to discuss issues of self-esteem, body image,
and eating disturbances in a confidential setting that could be easily
accessed by being school-based.The group focuses on providing support,
increasing awareness of identified issues, and developing self-advocacy
skills. As a school-based group, this program is not designed to substi-
tute for clinical counseling,nutrition counseling, or crisis management.
During the first session of Body Talk, the group leader encourages
students t o develop their own goals for the group experience.Through a
brainstorming activity, students identify key issues and topics that are
then linked to the following group goals: (a) to develop more positive
attitudes toward their physical selves; (b) t o become more aware of the
culture’s role in defining what it means t o be female; (c) to develop
healthier eating and exercisinghabits; (d)to increase ease in expressing
feelings and opinions to peers, family members, and significant others;
(e)t o develop healthier strategies for dealing with stress and pressures;
and Q to increase their knowledge of and experience in using assertive-
ness skills. These goals are addressed through group discussions sup-
plemented with the use of videos, artwork, fact sheets, articles from
popular magazines, checklists, and guided imagery.
Theoretical Foundations for the Group

Narrative and feminist therapies provided the theoretical foundation
for Body Talk. Narrative and feminist therapies are about helping peo-
ple t o give voice to their own stories. The narrative approach to therapy
addresses “issuesrelated to power, culture, context, and gender in ways
that other frameworks do not” (Johnson, 1994, p. 88).Like the narrative
approach, a feminist approach to therapy focuses on empowerment, on
cultural expectations for women, on the importance of women having a
voice, and on “political resistance” (Taylor, Gilligan, & Sullivan, 1995).
Because eating disturbances and body image issues involve all of the
themes that are central to both narrative and feminist therapies, these
two theoretical approaches are very appropriate for working with young
women.
Assumptions underlying a narrative approach to therapy include
these concepts:
1. “Knowledge is socially constructed (Smith, 1997, p. 3).

2. People make meaning in their lives through the stones they construct
and the stones that they tell. These stories have “a profound effect on
present behavior and future possibilities” (Strand, 1997, p. 338).
3. Therapy is a life-story modification (Howard, 1991). People present for
therapy because their stones are limiting them from leading fulfilled and
satisfying lives. The therapeutic work revolves around facilitating the
creation of new stories, “life narratives that are more empowering, more
satisfying, and give hope for better futures” (Hoyt, 1994, p. 69).
4. People have the capacity to reauthor their lives. The purpose of therapy is
“to take care to discover what strengths” (Smith, 1997, p. 24) are already
present within clcents and that can be drawn on to help them lead more
fulfilled lives.
The process of helping clients develop new and more satisfying sto-
ries involves several techniques. Therapy begins with establishing a
therapeutic relationship with the client, a relationship that is aided by
getting to know the client apart from the problem through a process
called erternalization. Therapy then proceeds by asking questions to as-
sess the influence of the problem on the client’s life and listening for ex-
amples of the influence of the client on the problem. These exceptions to
the problem story are supported by encouraging a sense of personal
agency and by recruiting a wider audience, meaning involving signifi-
cant others in the client’s life to support the client in making changes
(Hoyt, 1994;White & Epston, 1990,1994).
Woven into the narrative fabric of the Body Talk group is also a femi-
nist theoretical thread. Feminist therapies focus on helping women
understand the social, political, environmental, and economic influ-
ences on women’s roles in societies. Goals common t o a feminist perspec-
tive in therapy include helping women to experience their own personal
power through assertiveness skill-building, to accept themselves physi-
cally and psychologically, and to develop their potential for leading ful-
filled lives throughout their life spans (Okun, 1997). Another focus in
the feminist model is to examine the importance of connectedness in
women’s lives. The feminist literature on human development presents
a model of female development that asserts that “women’s sense of self
is very much organized around being able t o make and then to maintain
affiliations and relationships”(Miller, 1986, p. 83).Women “definetheir
identity through relationships of intimacy and care” (Gilligan, 1982, p.

164). It is through caring about others that women express their funda-
mental wish to remain connected (Noddings, 1984). For female adoles-
cents, “being individual and being in relation represents two sides of a
single whole” (Apter, 1990, p. 61). This literature on girls’ development
that asserts the importance of connection throughout women’s lives
strongly supports the use of a group modality in helping girls to address
personal issues and concerns within the framework of a supportive
community.
Recruiting Group Participants:

Screening and Selection
The complicated nature of eating disturbances contributes to the dif-
ficulty in recruiting group participants at the high school level. For
example, issues associated with anorexia and bulimia, such as perfec-
tionism, negative comparison, feelings of not measuring up, isolation,
self-hate, guilt, and shame (Vancouver Anti-Anorexia, Anti-Bulimia
League, 1996),make it difficult for young women to address their eating
disturbances publicly. Care and caution must be taken i n how prospec-
tive students are invited to participate in a group experience. It is often
helpful if the group leader has one key student who is interested in a
group experience and who is willing to personally invite others to join.
Sometimes teachers and coaches can tactfully approach students and
privately encourage them to consider being involved in a group.
School counselors can be instrumental in identifying prospective
group members and inviting students to participate in the group. Coun-
selors can develop brochures and posters that advertise the group. They
can look at their caseloads and identify students who have talked about
concerns about weight and appearance. They can speak to health
classes about the prevalence of eating disturbances and distribute infor-
mation about the group.
The original Body Talk group grew from a conversation between a
student who was recovering from an eating disorder and her school
counselor. Emily (a pseudonym) approached her counselor and asked
about the possibility of forming a school-basedgroup t o talk about issues
such as self-esteem, body acceptance, and eating disorders. The school
counselor was very willing to be involved with such a group and sug-
gested that Emily think of ways to encourage other students to become
involved. Both Emily and the counselor knew particular students whom
they wanted to invite t o participate in the group, and each agreed to
approach these students.
Emily also produced a flier and posted it on mirrors in the girls’

restrooms, on hallway bulletin boards, and in the guidance office. This
flier was simply worded with colorful graphics. It asked a series of sim-
ple questions (“Are you concerned about your appearance?” “DOyou
worry about your weight?” ‘Would you like t o feel better about your-
self?”) and provided students with information on where to get more
information about the discussion group that was soon to begin. Inter-
ested students were directed to see the school counselor, who then
talked with students about their concerns and either encouraged them
to become involved with the group or suggested other strategies for cop-
ing with their issues. The school counselor also talked about the group
with a physical education teacher who was known t o have concerns
about students’issues with body image. This teacher volunteered to talk
privately with students and encourage their participation in the group.
As a result of these methods of encouragingparticipation, 7 female stu-
dents eventually became involved with the group.
Organizational Aspects of Group Meetings

During the initial meeting of a group, group members and the facili-
tator need t o make decisions about meeting times and frequencies,
group guidelines, topics to be discussed, and the format of group meet-
ings. For a group focusing on disordered eating behavior, power and con-
trol are important issues. If the facilitator wants the students t o be
heard and to experience power by making decisions, students need to be
involved in making decisions about how the group will work.
Naming. Naming the group is an important initial decision,Students

may be reluctant to be involved in a “support group,” especially if they
feel they can handle their eating issues on their own. Students also may
feel uncomfortable participating in a group that has “eating disorder”in
its name, because the term disorder implies that something is wrong.
Giving students the opportunity to name their own group helps stu-
dents feel attached t o the group.
During the first meeting of this group, the students decided their
group would be known as Body Talk. This name implies that all topics
related to bodies will be appropriate for group discussion.
Scheduling. Group facilitators who work within a school setting must

face the challenge of schedulingthe group meetings around classes. Fa-
cilitators need t o be aware of constraints on meeting times and will need
t o work with the school staff to avoid conflicts.
Body Talk participants decided that they would like to meet weekly
for 10 sessions. Each session would last 1hour. Because the group had to
work around each student’s academic schedule, weekly meeting times
rotated throughout the daily schedule so that each student would not
jeopardize class attendance policies. Because group members would
sometimes miss academic classes, it was important to obtain their
teachers’ support in order for the students t o be able t o attend group
meetings regularly. In a confidential memo to the students’ teachers,
the counselor informed teachers of the group’s purpose and meeting

schedule. As a result, teachers were very supportive of the group and
appreciated having information so that they could anticipate students’
absences from classes.
Group guidelines. For trust to develop, all groups need t o establish

operating guidelines.These guidelines can be generated during the first
meeting of the group.
During the initial meeting of the group, the students established the
following guidelines: (a)t o treat all conversations within the group in a
confidential manner, (b)to respect others’rights t o express opinions, (c)
to offer honest feedback, and (d) to support each other. They decided
that they would be more comfortable discussing personal issues in a
females-only group and were willing to keep the group open to other
girls who wanted to talk about body image issues.
Confidentiality. During the development of ground rules, issues of

confidentiality and of the meaning of informed consent need to be ad-
dressed. These are professional standards that students are not likely t o
know fully but need to be informed about.
The counselor facilitating Body Talk spoke with the students about
her ethical guidelinesregarding Confidentialityand described the situa-
tions in which she would be obligated t o break confidentiality. The
group discussed how they wanted t o handle breaches of confidentiality
among themselves. The counselor also informed the students of the
school’s policy regarding parent consent. School policy dictated that all
students need to have signed parental permission to meet in counseling
groups during school. Students talked about their feelings regarding
this policy and discussed how they would each talk with their parents
about being involved with the group.
This policy helped to establish a link with parents and fostered more
open communication with the parents. On at least one occasion during
the group’s tenure, the school counselor did need t o discuss a critical
issue with a parent. After discussing her concern with the student, the
counselor called the parent and strongly suggested that an assessment

needed to be scheduled.
Stucturing meetings. The students in Body Talk wanted group meet-

ings t o include opportunities for sharing and for informing and decided
that group meetings would follow the following structure: (a) check-in
time, (b) discussion of articles, (c) activities, and (d) wrap-up time.
Check-in time provided each member a chance t o talk about her current
relationship with body image issues, t o request additional time during

the session to explore concerns, and to hear feedback from the other
members. Each week at least one of the students brought in an article,
advertisement, story, or poem from newspapers, popular magazines,
and books. Articles were selected that addressed the topics that the girls
wanted to discuss. The students who brought the material led the dis-
cussion.These contributions and the ensuing discussions increased stu-
dents’ awareness of how women are portrayed in the media and of the
media’s emphasis on diet, exercise, and slimness. Poems and stories en-
couraged discussion of feelings, of relationship issues, and of women’s
roles. During wrap-up time, processing questions helped focus group
members on what happened during the session and on what insights
they will take with them. Processing questions such as the following
were useful during wrap-up time: (a) How are you feeling about what
happened in the group today? (b)What will you take with you from your
experience in today’s session? (c) Whom did you connect with today?
and (d) What parting comments would you like to make about today’s
session?
TECHNIQUES AND ACTMTIES

Body Talk uses many of the techniques from narrative therapy and
many of the focal points from feminist thought. Activities and discus-
sions focus on helping the students externalize the problem, develop
alternative and healthier relationships with food, examine the cultural
foundations of body image problems, experience a supportive commu-
nity, and advocate for increasing their own and others’ awareness of the
multifaceted nature of eating disturbances. This next section describes
many of the activities used in the group and also illustrates the use of a
variety of narrative techniques.
Externalizing
One of the initial tasks of a therapist operating from a narrative per-
spective is to develop a safe, comfortable, conversational environment
(Smith & Nylund, 1997).To establish such an environment, it is impor-

tant from a narrative stance t o separate the problem from the person
through a ’linguistic practice called externalization” (Freeman, Epston,
& Lobovits, 1997, p. w ) .Through this process, clients can come t o think
of themselves as having a relationship with the problem rather than
looking at themselves as being the problem. As Freeman et al. (1997)
wrote, “The focus in an externalizing conversation is on expanding
choice and possibility in the relationship between persons and prob-
lems” (p. 9). By using this strategy, therapists are able to help relieve cli-
ents of feelings of blame and defensiveness (Freeman et al., 1997). From
a feminist perspective, externalizing conversations help women to
develop their o w n stance about how they want to relate to the problem
and provide an opportunity for women to experience their own personal
power.
This technique helps the students look at their issues around food
and body image in a different way. This technique is also used to work on
the goals of helping group members to develop a more positive attitude
toward their physical selves and t o increase their ease with self-
expression. Externalizing can be a powerful technique in helping people
change the themes of their personal stories. For example, students who
are experimenting with unhealthy eating patterns to change their
appearances are likely living a story in which they see themselves as
unattractive. By helping students to look at the culture’s influence on
how we see ourselves, these messages of unattractiveness are external-
ized. Through this process, students can be helped to replace these nega-
tive messages with more positive ones,
In the Body Talk group, the counselor invited the girls to think of a
name to call the problem they were having with food and body image.
They decided to call this problem “Ed,” short for eating disorder/eating
disturbance. During check-in time at the beginning of each session, the
girls described their relationships and encounters with Ed during the
week and talked about how Ed was affecting their lives. Through this
process of separating the problem from the clients, clients can begin to
see themselves apart from the problem, a powerful technique for devel-
oping a sense of perspective on the problem.
During one session, the girls worked on creating an illustration that
showed how Ed was affecting various aspects of their lives. They drew a
circle in the middle of a piece of newsprint and labeled the circle Ed. The
counselor asked them to think of how Ed was currently affecting their
lives and t o draw images or write words describing the influence of Ed.
They noted that Ed was affecting their physical, emotional, and social
lives. They noted that Ed was affecting their relationships with friends
and family and that Ed was constricting their activities. When friends
invited them to go out t o eat, they declined to go because they were
afraid of losing control over food. They were unhappy withtheir body im-
ages and depressed about being seen in swimsuits. When they did not
eat a balanced diet, they were fatigued, prone t o headaches and ill-
nesses, and sometimes missed school and extracurricular activities.
They admitted t o mood swings and t o increased arguments with family
and friends. A s the girls added words and pictures to the newsprint, the
counselor processed the activity by asking them to talk about their
drawings:
Tell me what it is like for you to feel like you have to say “No” to friends’ in-
vitations? How is it that Ed is able to have this power over your activities?
What would you like to say to Ed when he tells you not to eat something?
How is your life now compared to how it was before you started to develop
a relationship with Ed?
By participating in this activity, the girls increased their insight about

how Ed was influencing their lives and began to develop an understand-
ing of how he was able to have such power.
Other discussions in the group focused on helping the students t o
know themselves better and to value their own experiences and opin-
ions. The following questions helped t o focus these discussions: (a)What
are my own thoughts, ideas, values and feelings? (b) What are my own
wants and needs? (c) What scares, saddens, angers, pleases me? (d)
What can I do when I feel anger, sorrow, joy-other than eat or deny
myself food? (el What are some of my obsessive thoughts about food and
how can I stop these thoughts? (0 What makes me tens-pushes me
over the edge? (g)How can I ask for what I need and want? (h)How can I
learn t o not abandon myself all the time for others? (Levite, 1998).This
group of questions allowed students to hear their own voices and to be
validated for having the courage to share their opinions and experi-
ences. The questions encouraged each student to take center stage
instead of ‘living in the corner” and “beingfor others” (White & Epston,
1990).
Deconstructing the Problem Story and

Developing an Alternate Story
During the deconstructing phase of narrative therapy, the therapist
asks many questionsin an attempt t o get toknow the history of the prob-
lem story and t o listen for unique outcomes, times when the client has
had success in taming the problem (Parry & Doan, 1994).These unique
outcomes provide a basis for building and strengthening an alternate
story, a story in which the client is the author of her life and is no longer
troubled by the problem. Other narrative techniques used during this

part of the therapeutic process include creating therapeutic metaphors
and asking the miracle question (Parry& Doan, 19941,discussed subse-
quently. From a feminist perspective, this work assists women to take
charge of their lives by creating solutions to problematic aspects of their
lives.
The miracle question. The technique of asking a miracle question en-

courages clients to look at possibilities and helps t o build a rationale for

creating an alternate story, one in which the problems are tamed and
clients are in charge of their lives. What follows is an example of the
miracle question used by the counselor in Body Talk:
Suppose a miracle happened and Ed was not affecting your life as he is

now. What would make you know that a miracle had happened? What
would it be like for you without Ed having such an influence in your life?
As they contemplated these possibilities, the students talked about how

they expected that they might feel more free and less constricted. They
would have more energy and more options. They would be less con-
cerned about their body images and have more time to think about other
aspects of their lives. As they discussed these possibilities, the students
began to see how much more fulfilling their lives could be if they could
develop different relationships with Ed. This technique was used t o
work on the goals of helping the students t o express their feelings and
opinions more freely and t o develop assertiveness skills.
Unique outcomes. Miracle questions also help clients look at times

when the miracle has already happened, times when clients have been
able to stay in charge and not let problems control their lives. In probing
for examples of these unique outcomes, exceptions to the problem-
saturated story, the counselor asked the group t o think about times
when Ed has been less of a problem:
What is different about days when you are able to eat well? What is hap-
pening on days when you are not thinking so much about how you look?
What used to be different for you in the days before Ed became such a
problem?
In response to these questions, Emily said,

I am more apt to eat well on days when I feel happy. What makes me
happy? Being around my friends, acting foolish, just having fun. I miss
those days. I used to be around my friends a lot more before Ed came into
my life.
Sandy, who was struggling with bingeing behaviors, also talked about
how being around people helped her t o have control over her own version
of Ed:
I know that I’m much heavier than I used to be and when Ed is bugging
me, I feel terrible about my weight. But on days when I’ve been out with
friends, I’m happy and am able to say to myselfthat I am just a whole lot of
woman and that is okay.
Sandy’s comments helped the other students t o look at their own exam-
ples of times when they felt more in control. To draw the other students
into the discussion, the counselor asked, ‘What are some stories you
each have about times when you have felt in control? How did you do
this? How could you stay in control in future situations that might be dif-
ficult for you?” This technique helped to develop assertiveness skills and
to look at ways t o stay healthy. The students left this session with many
more strategies about how to stay in charge and not let problems control
their lives.
Therapeutic metaphors. Metaphor is another powerful tool for gain-

ing insight, for fitting new ideas together, and for creating the possibil-
ity of change (Lyness & Thomas, 1995).By using their own creative lan-
guage to talk about their experiences, students are empowered to make
their own meaning from their lived experiences. Thinking of their issues
with body image and eating disturbance as a separate entity named Ed
is one example of the use of metaphor and creative thinking. Another ex-
ample of a vivid metaphor came from Sandy, who talked about how be-
ing around people made her feel as if “Christmas lights are glowing all
over the world.” In contrast, her days with Ed were more like days “full
of darkness and heaviness . . . days that are sort of like lead balloon
days.” She went on to say,
I know that it is not good for me to be alone because that is when I am more
apt to start thinking about bingeing and more likely to do it. Then I feel
ashamed and see myself as a failure.
On days when she was surrounded by people, Sandy felt more positive
about herself and more able to keep Ed from influencing her life.
Developing a Sense of Personal Agency

One goal of a narrative approach to therapy is t o empower clients to
develop alternate stories that are more satisfying. The term personal
agency is used in narrative therapy to refer to clients’ strengths and

abilities (St. James OConnor, Meakes, Pickering, & Schuman, 1997)
that can be recruited to help them to “re-story” (Hoyt, 1994, p. 68) their
relationship with the problem. From a feminist perspective, the concept
of personal agency can be seen as focusing on helping women to take
charge of their lives. Discussions that focus on uncovering where in their
lives they have power and how they can increase their own power help
students explore these issues. Unfinished sentences such as “Iwill. . .”,
‘?’m going t o . . .”, and “I choose to . , .” help students begin to see that
they could take charge of their lives.
In the group Body Talk, the students examine unique outcomes,
exceptions t o times when Ed is in charge of their lives. Through this
examination, the girls begin to develop an awareness of their own per-
sonal power in creating a different relationship with Ed. They can then
use this power to help them devise strategies t b be more in charge of
their lives. Cathy knew, for example, that she tended t o eat more bal-
anced meals when she was in training for track and other athletic activi-
ties. She knew that when she did not eat well that her performance was
negatively affected; poor performances prompted negative self-talk and
guilt about letting her team down. Through group discussions, she
began to see the connection for herself in eating well and staying
actively involved in sports. When she was active, she felt she had more
power over controlling Ed’s influence.
Another way the group explored the issues of women’s roles and
women’s power was to examine how women are portrayed in the media.
Although no conclusive evidence exists linking the culture as a causal
factor in the development of eating disturbances, we are products of our
culture and “cometo know ourselves as a part of a culture, gender, class,
race, and age” (Madigan, 1996,p. 53). Magazine images, videos, and the
curriculum Teen Body Talk (Connolly, 1997a, 1997b), which contains
many fact sheets and handouts on body image issues and on media advo-
cacy tactics, were useful in helping t o increase students’ awareness of
the cultural foundations of eating disturbances.
Recruiting a Wider Audience

Another central tenet in narrative therapy is the importance of bring-
ing in significant others in the client’s life to support the client in mak-
ing changes and in practicing these changes. Involving significant
others in the client’s therapy also serves to foster more open communica-
tion,enriches problem-solving, and provides additional support for the
emerging alternate story (Hoyt, 1994). Participating in groups such as
Body Talk can provide students with support for tackling difficult prob-
lems and can build a sense of community, focal points in feminist
therapy.
Recruiting a wider audience also has aspects of advocacy attached t o

it. By focusing on advocacy, group members explore ways that the
efforts of the group can be disseminated to others and how the group can
continue in the future.
For Body Talk, advocacy helped to extend the group beyond the cur-
rent school year and also provided a forum for dealing with termination.
As the final session for the group approached, the students talked about
how they valued the group experience and also expressed their interest
in keeping the group alive for the next school year. They talked about
how difficult it is to get students to come to a group and remembered
that what encouraged them to participate was having another student
invite them personally. After discussing strategies to make other stu-
dents aware of the group, they decided to make a series of posters to
hang on the walls of the middle school. The posters advertised the group
and encouraged eighth-grade girls to come to a meeting to learn more
about the group. They also knew several eighth-grade girls whom they
thought would be interested and decided to invite them t o come to the
meeting personally. They selected a “True or False” quiz from the Body
Talk curriculum that they felt would stimulate discussion and decided
that they could facilitate the discussion themselves. They also made a
poster illustrating what the group was all about and took the poster
with them when they visited the middle school. Several eighth-grade
girls came t o the meeting and expressed interest in joining the group in
the fall.
Termination
Termination issues begin long before the last session. Ifthe group has
contracted for a set number of meetings, group members know that as
each meeting concludes, there is one fewer time that they will be
together. It is inevitable that group members will have some feelings
attached to the inevitable ending of the group. The end of a group can be
a real loss for many members and bring up prior experiences with loss
and separation. The group facilitator needs to be aware of the impor-
tance of planning for a good termination so that the end of the group does
not just happen. Mentioning the number of sessions remaining and ask-
ing group members how they want t o use their last session are ways of
bringing up the issues of termination.
Prior to the last session of their group, the Body Talk members dis-
cussed how they would like to structure their last session. They decided
that it would be helpful t o review each group member’s experience in the
group and to create a group mural.
The last session felt like a celebration of what had happened in the
group. Processing questions that helped with termination were “What
will you take with you from your experience in the group? What, if any,
changes have you made in your life since you began coming to the
group?”
To memorializethe group’s existence,the students did a group mural.
The counselor asked them each to think about what the group experi-
ence meant to them and to draw a symbol of that meaning on the paper.
Processing of the group drawing occurred spontaneously as students

began to talk and draw at the same time, remembering experiences and
sharing them with the group. Although sadness was present because
somethingvalued was ending, there was also a sense ofjoy and anticipa-
tion for the coming year when new members would join.
Other Activities
Checklists, questionnaires, drawing, and collage are additional spe-
cific strategies that help t o deconstruct the problem story and create
alternate stories.
Assessment. Group facilitators might consider using a structured as-

sessment instrument, such as the Eating Disorders Inventory (Garner,
Olmstead, & Polivy, 1993),as a tool t o help group members explore the
many issues associated with disordered eating. Such instruments might
provide clues to underlying issues such as depression and family dys-
function. A feelings and opinions checklist of 25 statements developed
from the Eating Disorders Inventory (Garner et al., 1993)was used dur-
ing several of the group meetings of Body Talk. The checklist generated
insight and facilitated trust within the group.
Drawing. Art activities are useful group tools in helping group mem-
bers express themselves in nonverbal ways. Asking students to draw
and then talk about their drawings is a powerful combination in helping
adolescents deal with affective material and gain insights into their
worlds. By encouraging the students t o provide meaning and interpret
their own drawings, the group facilitator is empowering the students to
express themselves.
For adolescents, who as a group are especially sensitive about their
bodies, asking them t o draw a picture of how they look and another one
of how they would like to look can help them talk about how they feel
about their bodies (Oaklander, 1988).Another drawing activity involves
students creating three drawings: one of Ed, one of themselves without
Ed, and another of themselves with Ed. Students could be as abstract or
as concrete as they wanted to be in constructing their pictures. In proc-

essing the activity, the counselor begins with the following directions:
As you talk about your drawing of Ed and of you and Ed together, talk as if
you were Ed. Ed, tell us about yourself and your relationship with -.
Ed, talk about the picture that doesn’t include you. How do you feel about
that picture?
Next, students are asked to talk to Ed: ‘Tell Ed what you think ofyour
relationship. What is it like for you? Is there anything that you’d like to
be different?” Finally, they are to talk about themselves without Ed:
“HOW is it for you without Ed? How is your life different now without Ed?
How do you feel without Ed in your life?”This activity helped the stu-
dents t o look at their relationships with Ed and t o contemplate what
their lives could be like without Ed or with a changed relationship with
Ed.
An extension of this last drawing activity involves having students
write letters to Ed. In their letters, students are asked to deal with the
following topics: What is the statushature of the current relationship
you have with Ed? What are the positive aspects (if any) of the current
relationship? What are the negative aspects of the current relationship?
What do you want to do with the relationship at this time? What do you
need from Ed to change the current relationship? As students process
their letters, their interests in maintaining or changing their relation-
ships with Ed become public.
Visualization. Another technique that can be used t o help in decon-

structing the problem story is visualization. Mental images help people
to visualize the future; to consider possible outcomes and possibilities;
and t o imagine particular incidents, issues, or situations (Myrick &
Myrick, 1993; Oaklander, 1988; O’Connor, 1997). Imagery can be used
during Body Talk to increase students’ awareness of their attitudes and
feelings toward eating. For example, the counselor could guide students
through a possible meal at home. Students close their eyes as the follow-
ing is read to them:
Think about mealtime a t your home. Visualize where you will be eating,
who will be there, what the food smells like and looks like. What feelings
are you having as you look a t and smell the food? Are there other people
around during your meal? If so, who is there and what do people talk
about? Who is talking to whom? Next, imagine taking some food and put-
ting it in your mouth. Notice the texture and taste. How are you feeling
right now? Imagine yourself finishing your meal and getting up from the
table. Where are you going next? What are you going to do now?
Once the visualization was finished, processing involved going over the
various aspects of the experience and focusing particularly on the feel-
ings that came up for students. They were also asked to talk about Ed’s
presence, participation, and influence and how they felt about Ed‘s
involvement in the eating ritual. The following questions are used to
process the activity:
Tell us about Ed’s presence at your house. What influence does Ed have in
your life? How do you feel about Ed’s involvement in your mealtimes? Are
there any changes you would like to see in Ed‘sinvolvementin your life?
This technique helps students to feel more comfortable expressing their

feelings and provides an avenue t o look at making changes and being
more assertive.
Videotapes. Film is a powerful tool for helping young women see the
impact that media and the culture have on forming our images of our-
selves as women. Two videos that could be used during the group 88s-
sions were Slim Hopes (Kilbourne, 1995) and Teen Body Talk (Connolly,
1997a).Slim Hopes is an expos6 about the media’s portrayal of women.
The video provides facts about the burgeoning diet industry, about ad-
vertising’s messages to women, and about the fashion industry‘s por-
trayal of women’s bodies. Teen Body Talk features girls and boys of vari-
ous ages talking about and challenging the pressures of media messages
and their feelings about body image and self-esteem. The video also fea-
tures three young women who tell their stories of their own struggles
with anorexia, bulimia, and compulsive overeating. Some questions
that prompt discussion after the videos are (a)What thoughts and feel-
ings came up for you in watching this video? (b) How did you identify
with any of the individuals in the video? (c) What new information did
you learn from watching the video? (d)What can we do to address the is-
sues that the video introduced? To further focus group members’ atten-
tion on the issues of gender, perfectionism, power, the media’s portrayal
of women, and the culture’s press for thinness, the following questions
also can be used: (a) How does Ed use the media to gain power in
women’s lives? (b) Why is it that Ed tends t o affect primarily women of
Western culture? (c) If women wanted to protest the power of Ed in their
lives, what would you suggest that they do? (d) What messages do Ed
and the media send to women about how they should look?
Food diaries. Another way that eating disturbances affect women’s

lives is that they frequently lose their ability to accurately assess hun-
ger and to recognize fullness. To regain this power, students might ex-
periment with keeping a food journal (Kratina, 1996)that incorporated
charting hungerhatiety levels in addition t o tracking types and
amounts of food eaten. In using a hungerhatiety scale, students rate
their hunger level before they eat and again when they are finished with
eating. Doing this helps students become more aware of their eating
patterns and be able to recognize not only the feeling of hunger but also
the intensity. These activities also generate discussion about what “nor-
mal’’ eating looks like as opposed to disordered eating.
CONCLUSIONS
Disordered eating behaviors have been increasing among the adoles-

cent population and also have been occurring among increasingly
younger students. Recent studies point t o the myriad factors that con-
tribute to the disturbing increase in these behaviors. Research has
found that sociological and familial factors, along with individual fac-
tors such as depression, self-esteem, and preoccupation with body
image, contribute to the development of disordered eating behaviors
(Emmons, 1994; Fabin & Thompson, 1989). The prevalence of such
behaviors among the female adolescent population supports the need
for educational programs in the schools.
Among the types of interventions that can be used to treat disordered
eating behaviors, research indicates that group modalities are effective
in helping adolescent girls feel less isolated and more supported (Laube,
1990;Riess & Rutan, 1992).The model presented in this article is based
on the research indicating that group interventions with eating distur-
bances are effective (Laube & Trefz, 1994;Weiss & Orysh, 1994).
Evidence of the success of Body Talk can be seen in the group mem-
bers’ initiative in recruiting new members and actively taking a role in
keeping the group alive for the next school year. Group members were
also consistently present and actively involved in discussions, addi-
tional evidence of their interest in the group and of their valuing of the
experience.
Body Talk is based on a narrative-feminist theoretical perspective.
Although this approach has been used successfully in individual ther-
apy for the treatment of eating disorders (Zimmerman & Dickerson,
1994)and has been used in a group setting for the treatment of depres-
sion (Laube & Trefz, 1994),the use of this theoretical approach in treat-
ing eating disturbances within the adolescent population has not been
described previously. The experience reported by the students who
210 JOURNAL FOR SPECIALISTS IN GROUP WORK/June 2000
participated in Body Talk indicate that this approach provided them

with a venue for discussing the issues of gender, power, perfectionism,
and the media’s portrayal of women. The narrative perspective that we
create our own realities led students to understand that they also have
the power to recreate reality for themselves. Having an opportunity to
experience a caring, concerned community of other female students also
encouraged the students to express their voices and to experience con-
nection rather than isolation. This trusting, caring community allowed
students to give and receive feedback. Group members also learned that
the issues surrounding body image, self-esteem, and eating distur-
bances have societal foundations and that societies can be changed
through advocacy and awareness. Although the purpose of the group
was not to “cure” group members of all of their problematic behaviors,
the weekly sessions did provide a valuable forum for the students t o
bring issues out into the open and to experience support and caring from
the other group members.
Despite the anecdotal evidence of the group’s success, the model pre-
sented in this article has not been empirically tested. Future research
on this approach t o working with eating disturbances in a school setting
is needed to substantiate the efficacy of using this approach.
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The Journal for Specialists in Group Work

ISSN: 0193-3922 (Print) 1549-6295 (Online) Journal homepage: http://www.tandfonline.com/loi/usgw20

Body talk: A school-based group intervention for

Susan Dahlgren Daigneault

To link to this article: http://dx.doi.org/10.1080/01933920008411461

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Among the female adolescent population, the prevalence of eating

Susan Dahlgren Daigneault, a former assistant professor o f counselor education at Appa-

JOURNAL FOR SPECIALISTS IN GROUP WORK,Val. 25 No.2,June 2000,191-213

son (1989) found significant correlations between eating disturbance,

Other studies have demonstrated that sociological factors, such as

experience. In their meta-analysis of 40 studies on group treatment

dating the client’s reality‘and encouraging a sense of personal agency

DESIGNING A SCHOOL-BASED GROUP INTERVENTION

In developing a school-based group intervention, there are several

Purpose and Goals of the Group

are showing some indication of problems around healthy eating, body

Theoretical Foundations for the Group

1. “Knowledge is socially constructed (Smith, 1997, p. 3).

identity through relationships of intimacy and care” (Gilligan, 1982, p.

Recruiting Group Participants:

Emily also produced a flier and posted it on mirrors in the girls’

Organizational Aspects of Group Meetings

Naming. Naming the group is an important initial decision,Students

Scheduling. Group facilitators who work within a school setting must

the counselor informed teachers of the group’s purpose and meeting

Group guidelines. For trust to develop, all groups need t o establish

Confidentiality. During the development of ground rules, issues of

counselor called the parent and strongly suggested that an assessment

Stucturing meetings. The students in Body Talk wanted group meet-

relationship with body image issues, t o request additional time during

TECHNIQUES AND ACTMTIES

(Smith & Nylund, 1997).To establish such an environment, it is impor-

By participating in this activity, the girls increased their insight about

Deconstructing the Problem Story and

troubled by the problem. Other narrative techniques used during this

The miracle question. The technique of asking a miracle question en-

courages clients to look at possibilities and helps t o build a rationale for

Suppose a miracle happened and Ed was not affecting your life as he is

As they contemplated these possibilities, the students talked about how

Unique outcomes. Miracle questions also help clients look at times

In response to these questions, Emily said,

Therapeutic metaphors. Metaphor is another powerful tool for gain-

Developing a Sense of Personal Agency

agency is used in narrative therapy to refer to clients’ strengths and

Recruiting a Wider Audience

Recruiting a wider audience also has aspects of advocacy attached t o

Processing of the group drawing occurred spontaneously as students

Assessment. Group facilitators might consider using a structured as-

as concrete as they wanted to be in constructing their pictures. In proc-

Visualization. Another technique that can be used t o help in decon-

This technique helps students to feel more comfortable expressing their

Food diaries. Another way that eating disturbances affect women’s

mal’’ eating looks like as opposed to disordered eating.

Disordered eating behaviors have been increasing among the adoles-

participated in Body Talk indicate that this approach provided them

Freeman, J. H., Epston, D., & Lobovits, D. (1997).Playful approaches to seriouspmblems.

chology and psychotherapy. American Psychologist, 46,187-197.