Psychodrama and the treatment of bulimia

By Monica Leonie Callahan

Since 1981, I have been exploring ways of using psychodrama as part of individual and group psychotherapy with bulimics in an outpatient setting. Almost all of my clients are women; their ages range from the late teens to the early 50s. Psychotherapy is only one part of the treatment.

I encourage clients, as needed, to consult with a physician, meet with a nutritionist and attend meetings of support groups such as Overeaters Anonymous (OA). I do not require a commitment to specific changes in eating behavior in order to begin treatment; indeed, the ambivalence about such a commitment is often the issue that must be dealt with first.

This chapter introduces the reader to psychodrama in the treatment of bulimics. “Bulimia” here refers to the DSM-3 (American Psychiatric Association, 1980) definition of the disorder, which is less restrictive than the definition of bulimia nervosa in the DSM-3R, (American Psychiatric Association, 1987). In particular, the women I describe may or may not meet the DSM-III-R criterion of, regularly engaging “in either self-induced vomiting, use of laxatives or diuretics,  strict dieting or fasting, or  vigorous exercise in order-to prevent weight gain.”

 Others have written extensive reviews of the literature focusing on: psychodrama (Bischof, 1970; Buchanan, 1984; Haskell, 1975; Kipper, 1986; Z. T. Moreno, 1959; Starr, 1977; Yablonsky, 1976) and on the treatment of bulimia (Emmett, 1985; Garner & Garfinkel, 1985; Neuman & Halvorson, 1983). A number of authors (Boskind-White & White, 1983; Browning, 1985; Neuman & Halvorson, 1983; Roy-Bryne, Lee-Renner, & Yager, 1984; Shisslak, Schnaps, & Swain, 1986; White & Boskind-White, 1984) refer to action methods, such as role playing; gestalt techniques, and assertiveness training used to treat eating disorder, but none of these applications utilize psychodrama: as a primary methodology.

The chapter begins with an overview of the basic principles, objectives, and techniques of therapeutic psychodrama. I discuss how psychodrama is best applied to the treatment of people with bulimia and then demonstrate the use of these techniques to address four central clinical issues. For each issue, I present a psychodramatic group exercise and a reconstruction of a full-blown psychodrama pertaining to that theme. A general discussion follows…..

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Original publication: Chapter 6, pp 101 – 120, in L. M. Hornyak & E. K. Baker (Eds.), Experiential Therapies for Eating Disorders. (New York: Guilford, 1989.)