Learning From Life: The Value of Peer-led Therapy for Eating Disorders

Australian Department of Foreign Affairs and Trade
Australian Department of Foreign Affairs and Trade

By Francesca Baker

At the recovery college where I have been volunteering, there’s a fantastically inspiring coach called Jeanette. She runs a group on assertiveness, the goal of which is to help individuals accessing secondary mental health services, like specialist mental health workers and support teams, to speak up and articulate their needs. She’s great, and numerous students have left her sessions feeling inspired and with far greater levels of self-efficacy than when they started.

It turns out that Jeanette herself has experience with accessing mental health services, and uses the very skills she teaches to help manage her bipolar disorder. She doesn’t hide this fact. Her history is an asset.

In groups like the one Jeanette runs, everyone’s history is an asset. The process of recovery draws on history, life events, and personal stories to support oneself and others. Expertise gives way to experience, discussion is more of a route to development than dictating, and the courses take a more collaborative bent. Students become empowered and enabled to recover, rather than a participant in a treatment dictated to them by experts.

This applies to the field of eating disorders as well. Because recovery is difficult, and in times of need, we depend on one another. Hearing others’ experiences can provide a sense of mutual solidarity and support.

This is a central tenet to the philosophy of the recovery college. These are facilities set up by Britain’s National Health Service and local authorities, and they run exactly like normal colleges, except they cater to students with difficulties with mental health or addictions. Students come here to learn skills and develop their knowledge in general educational areas as well as health and life skills.

As well as shifting terminology — participants are called “students,” not “service users” or “patients,” and staff are “teachers,” not “therapists” — recovery colleges’ unique strength comes from their focus on peer-led activities. All courses are co-produced, meaning that someone who has lived experience with a mental health difficulty — like Jeanette — has input on the course content and helps to deliver it.

The idea that someone with experience might have valuable advice, knowledge, or ideas to offer is not new. The peer-led movement has been used as a recovery model for alcohol addiction, drug abuse, support for schizophrenia, and other mental health conditions for a long time. From self-help groups in local church halls and courses in media literacy to support forums online, there is an increasing recognition of the value of peer support.

Through peer-led groups, the treatment experience becomes, if not a good thing, something that can be accepted as part of an individual’s journey and a way of helping them in the future. The shame of seeking help is less pronounced for participants in peer-led groups than in traditional treatment settings. Addiction, disorders, issues are all just part of life’s path, and are nothing to be ashamed of. By losing some of the formalities and bureaucracy of medical and therapy systems, peer groups may seem less daunting for people already intimidated by or reluctant to commit to the idea of recovery.

The experience of an eating disorder can be a very lonely one. Engaging in discussions with others in a similar situation is a reminder that no one has to go through it alone, and that others can and have reached recovery. More accessible than a formal tract of medical and psychological therapy, these groups can provide an entry point to support, or a step down from intense psychological settings. Furthermore, they are often much less expensive than formal treatment programs, allowing access to many who would find treatment costs prohibitive.

Most current examples of peer-led groups for eating disorder recovery focus more on body image than recovery, are largely online, and target younger people. Despite this narrowed focus, research suggests that they really are working. In 2005, Gail McVey and her colleagues studied the effect of peer-based support on preventing eating disorders among teenagers. They found the discussions and insight happening in these groups to be valuable.

Following a study in 2006 where peer-led groups were found to help recovery, Carolyn Black Becker set up the Body Project Collaborative, a program and set of resources for peer-led support within colleges.

MENTORConnect is another peer support program where volunteer mentors are matched up with mentees. The founders recognize the value of social support and “emotional support, information, and feedback,” and agree that mentees’ motivation, energy, and quality of life improve with participation in the program. However, they also raise concerns at the risk of entanglement in emotional issues and relapse.

There is a danger, particularly within eating disorder support groups, that harmful aspects of the illness thrive off one another. The competitive and manipulative nature of eating disorders can lead to tip-swapping and undermining of recovery goals. This is particularly the case for web-based support groups, where the line between pro-recovery and pro-ana / pro-mia communities is often blurry. Equally detrimental is when the urge to encourage others to recover can act as a distraction from focusing on one’s own recovery.

But this is not to undermine the compassion, care, and reassurance that comes from being among people who understand something of you and your situation.

By taking the initiative to seek out and join a group, individuals are asserting accountability and an acknowledgement that they alone can enable their recovery. The environment can also increase this sense of responsibility. The traditional therapist-patient relationship can be patronizing and dehumanizing for some people. But when the path to recovery is placed within your hands, there is a shift, and progress becomes easier.

Becoming a participant in recovery is crucial. Relying on other people for recovery, be they peers or therapists , can mean that the individual does not “own” their recovery. Self-efficacy and self-determination are crucial for healthy psychological and physical change, and studies show that patients exhibiting a higher degree of determination and responsibility exhibit more successfully the signs of recovery.

Peer groups work well when there is an urge from recovery, or a sense that change is possible. There’s value in listening to others with shared experiences, and it can be motivating to see stories of recovery.

These groups are not perfect, but neither is recovery. There will be highs, lows, muddles, and changing of minds. But taken with the right approach, they can be a helpful step on the road to life beyond the disorder.

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