Art Therapy for Clients with Bulimia Nervosa
Malinda Ann Hill

The complex interaction of emotional and physiological problems in bulimia nervosa calls for a comprehensive treatment plan, involving a variety of approaches. Bulimia nervosa is a challenging disorder to treat and is most successfully treated when diagnosed early. The longer abnormal eating behaviors persist, the more difficult it is to overcome the disorder and its effects on the body.

I would arrange to have an out-patient group art therapy program for college women, ages 18-22. In an on-campus program, because of the semester schedule, clients would have the opportunity to meet weekly, for 2 hours, for approximately twelve weeks. This would allow for enough time to build group cohesion, in order to deal with the presenting issues.

Treatment goals should focus on correcting the patient's distorted body image, improving self-confidence and self-esteem, treating underlying depression, establishing normal eating habits and preventing relapse. The ultimate goal should be for the client to accept herself and lead a physically and emotionally healthy life. Success depends on tailoring each directive to the individual's needs.

Group therapy, in which people share their experiences with others who have similar problems, is especially effective for individuals with bulimia. Group therapy can supplement other individual interventions by letting clients with bulimia help one another and themselves. Through group interactions, clients realize they are not alone as they express their feelings in a situation that is accepting, understanding and supportive.

For many women suffering from bulimia it seems that words are inadequate or useless. Many clients are verbally articulate and can talk about their problems superficially, hiding their true feelings and fears. They often arrive in therapy with a theory surrounding their problems and can even explain to some extent why they binge and purge, however, they seems to lack a connection with their feelings.

The creation of artwork gives them a renewed potential for self expression. Art therapy provides a means of self-discovery, an opportunity to explore the self through the image. Art therapy helps move the client away her feelings form being locked up in the body to a place where they can be expressed.

Art therapy offers many advantages as a treatment modality; it strengths include helping the client to break patterns of denial, to examine thoughts and feelings, and to form a strong therapeutic alliance. It is also instrumental in aiding clients in establishing a sense of trust in their own feelings and abilities. Many clients have found that they were able to more effectively resolve issues of self, body image and personal effectiveness through art therapy.

Art therapy must assist the client in becoming aware of herself as a participant in her own recovery. She must confront her illness and give it up in exchange for more adaptive and healthy coping mechanisms. Art therapy can help clients confront their maladaptive responses and visualize new goals.

In group art therapy work, the major goal is to involve each individual in group participation. Art therapy in groups can be a important way for members to share their thoughts and feelings. Social bonding skills are promoted as group members experience working on jointly created tasks, sharing space, making group decisions, exchanging feedback with other members, and having a positive social experience. Commitment to the therapy process is promoted, particularly for new patients, who are typically resistant. When new members interact with participants who have progressed, they can then forsee the possibility of their own gains. Group treatment allows members to learn from one another at different stages of recovery and to model healthier skills. Because of mutual support and understanding, individual members are able to break through their patterns of isolation and loneliness.

Group art therapy tasks should be designed to enhance social bonding, sharing, expressing emotions, problem solving, confrontation of body image and mastery of media. Art therapy directives can be adapted to work in outpatient or inpatient settings, for groups of four to eight clients.

For example, in the beginning sessions of a group art therapy, group members may be asked to create a mural together, working together silently, without the use of words. A variety of media should be available for the members to choose from. This allows them to practice their non-verbal communication skills and to break through barriers of distrust and isolation. After the art project is completed, they are given the opportunity to express in words what they experienced during this process.

In another art therapy technique, the client's body is traced and then the client fills in the space with collage, drawings and words. For the eating disorder client there is a great need for master and control of her body and its needs. She is generally a woman who is disconnected from her body self. Body tracing is an exercise which is intended to break through the maladaptive coping mechanisms of the woman with bulimia. Two to three sessions are needed in order to complete this directive. In the first session, the group is divided into pairs and partners take turns tracing around each others' bodies. After the tracings are completed, the outlines must be filled in. The clients are directed to portray their feelings symbolically within the frame of their body tracing. This technique gives the participants a means to gain awareness of the hidden emotions that reside within their bodies. All types of media should be made available to the clients and several sessions may be required to complete this project. The body-tracing exercise is especially valuable when done in the group context, since resistance is usually overcome with group support. Social interaction and bonding are encouraged as clients work with partners during the tracing phase.

When the artwork is finished, it is then displayed on the wall. In the sharing phase, the multiple drawings provide a dramatic visual impact, and reality testing is promoted as the drawings are discussed and feedback is given. All members are encouraged to share their self-portraits along with the feeling that may have arose when they began this task. This allows each individual to gain new insights and greater acceptance of her own body image. Each client is able to view her body objectively, alongside all other group members. Feedback from the other group members helps to reinforce the individuals' insights.

Art therapy treatment plans must be modified to meet the client's individual needs. Emphasis should be place on the client's ability to recognize her own needs and make decisions regarding them. The goal of therapy is for the client to become aware of her ability to understand her feelings and communicate with others.

Relaxation training at the beginning of art therapy sessions is very useful in facilitating expression. It helps individuals develop coping skills for tension release and stress reduction. It allows them to increase awareness and have a positive body experience. Physical tension occurs when an individual is anxious. Through imagery and muscle relaxation, anxiety can be decreased and the individual is more prepared for open self-expression. Therefore, allowing the individual to be more receptive to exploring the art therapy techniques.

Art therapy offers many advantages as treatment option for clients with bulimia. It can be instrumental in aiding clients to establish a sense of trust in their own feelings and abilities. And, it helps clients develop skills so that they can communicate more effectively with others. The creation of artwork gives them renewed energy and potentials for insight and expression.