A Letter of Intent for Self Reflection on Co-Facilitation. Of A Relational Cultural Based Group for Women Struggling with Eating Disorders

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1 Self Reflection Proposal 1 Running Head: SELF REFLECTION PROPOSAL A Letter of Intent for Self Reflection on Co-Facilitation Of A Relational Cultural Based Group for Women Struggling with Eating Disorders Kerri Johnston Final Project Campus Alberta

2 Self Reflection Proposal 2 Introduction and Focus of the Project The origin of this self-reflective project arose from an intense desire to understand and explore the meaning of my participation as a student facilitator of a group for women struggling with eating disorders grounded in a Relational Cultural Model. This model is a feminist based model of human development based on the work of Jean Baker Miller from the Jean Baker Miller Training Institute and the Stone Center at Wellesley College (Jordan & Dooley, 2000). My hypothesis is that a focus on our common experiences as women and our need for relationship are key elements in supporting women who are dealing with anorexia and bulimia. The self-reflective journey that I intend to undertake with this project represents an attempt to intertwine theory, personal experience and practice into a unified written project. Specifically, it is my goal to examine how my experience in using Relational Cultural theory in co-facilitating a group for women with anorexia and/or bulimia demonstrates the efficacy of the relational cultural theory in explaining and treating the phenomena of eating disorders in general. The underpinning of this self-reflective project is my desire to explore cultural context and relationship in relation to women and eating disorders. The ideas of reflexivity and the value of questioning one s position, reactions and experience are fundamental aspects of this project. As well, Relational Cultural Theory (Jordan, 2001) provides a grounding of exploration in this self-reflection. I will be utilizing my own journal entries of personal reactions to the group, poetry written by myself, conversations with co-facilitators, relevant literature and my reflections on group themes as the foundational data to be collected and synthesized within this project. Please note that direct quotes will not be used at any time throughout the project.

3 Self Reflection Proposal 3 Situating Self Reflection as Critical Analysis Reflexivity Reflexivity and the practice of evaluating one s own experience, self and ways of being in relationship to clients are key areas that I would like to examine in this self reflective process (Smith, 2004). It is my intention to openly explore my personal challenges being a student facilitator in the group. I intend to examine my own reactions to this process in detail, including my personal reactions to themes emerging from the group and to tie them into relevant literature. Madigan and Goldner (1998) assert that when working with clients struggling with anorexia, the therapist must utilize the regular practice or reflexivity which is defined as the practice of asking ourselves our questions and therapeutic beliefs (p. 2). This enhances accountability to the client, according to Madigan & Goldner (1998). Pertinent reflexive questions I should be thinking and answering are: In what ways might I get trapped into reproducing the most common misconceptions about anorexia in session? How can I show a sincerity to help the clients without scaring them off? In what ways can I be aware of my professional position to acknowledge and not misuse my power as a therapist? (Madigan & Goldner, 1998, p. 3). In addition to enhancing therapist accountability, Lockyer, Gondoez, and Thivierge (2004) acknowledge reflection also transforms current ideas and experience into new knowledge and action. Eyler (2001) defines reflection as the process that helps students connect what they experience and observe in community with their academic

4 Self Reflection Proposal 4 study (p. 35). Following Eyler s (2001) reflection map, the reflection activities I chose to implement are: letter to self (completed before the group began and opened after it was complete), journal entries, and reflection essay writing. Eyler (2001) encourages students to discuss theory and draw upon experience to explain the power of that theory to explain social phenomena. Relational Theory Jordan (2001) describes Relational Cultural Theory as an alternative to traditional theories of psychological development (p. 92). She delineates this model is based on the concept that functioning is the ability to move towards relationship and connection versus the traditional focus on independence (Jordan, 2001). For instance, Jordan (2001) acknowledges the Eurocentric cultural bias of independence in the traditional theoretical focus on psychological development as movement towards autonomy, separation and self-sufficiency. Further, she cites mature functioning in traditional literature as the capacity for logical abstract thought, autonomous thinking, and separation of thought from emotion (Jordan, 2001, p. 92). Jordan (2001) explores the separate self model of human development and the work of Freud, where relationships are secondary to the satisfaction of primary drives. She surmises, In these models, connection, concern and love emanate from a reaction to the core primary aggressive drive (Jordan, 2001, p. 93). Although Jordan (2001) identifies that relationships have been acknowledged in almost all psychodynamic theories, they have been seen as secondary to separateness that has led to clinical focus on separate self, boundaries, autonomous functioning and the superiority of logic over emotion.

5 Self Reflection Proposal 5 Jordan (2001) states the impetus for the Stone Center relational-cultural model (Jordan, 1986, 1992, 1997; Miller, 1976; Miller & Stiver, 1997) came from evidence that women were being misunderstood and misrepresented by traditional psychodynamic models (e.g., classical analytical, object relations, Kohutian) (p. 94). The Stone Center relational cultural model places a greater emphasis on context and seeks a better understanding of both male and female development (Jordan, 2001). Finally, Jordan (2001) states, in listening to and learning from women, current feminist psychologists seek to correct these misunderstandings (p. 95). The relational model offers a way to examine the importance of relationships in women s lives. Relational theory posits that when relationship is in a process of connection we have emotional health while disconnection may lead to depression, low energy and poor emotional health (Tantillo, 2000). Relational theory was born from an exploration of how feminine psychological development converges with the forming of relationships. Tantillo (2000) asserts that a relational understanding of eating disorders focuses on disconnection in relationship as predisposing, precipitating and perpetual factors. Key relational theoretical constructs include: mutuality, relational images, relational paradox, connection, disconnection and strategies of disconnection (Tantillo, 2000). Each of these concepts would be further explored in the context of this proposed self-reflection project. Tantillo (2004) asserts there is a substantial amount of theoretical and clinical support for the relationship between mutuality or the perception thereof a supportive relationship that may influence the etiology of, as well as treatment, of

6 Self Reflection Proposal 6 psychiatric illnesses. Through my reflection of my experience of a group facilitator, I hope to examine how this connection might be apparent in the eating disorders group. Purpose The purpose of the proposed analysis is to create a written document that demonstrates unification of theory, self-exploration and practice. This process would involve the following steps. First, I intend to introduce and discuss the problem of eating disorders, specifically anorexia nervosa and bulimia nervosa. Second, it is my intention to review Relational Cultural Theory literature and how eating disorders may be understood from a Relational Cultural perspective. Third, I intend to review current, broader-based, literature that outlines the purpose of groups for women and eating disorders. Fourth, I will review the Relational Cultural group I participated in as a student facilitator and reflect upon this experience. This reflection includes reviewing group notes I wrote after each session pertaining to the group themes, personal journal entries and a reviewing a letter of expectation written to myself before I began the group. The group notes I intend to utilize for the proposed project are not notes that are from client charting or individual files, but my own personal notes that focused on general themes. Last, I intend to discuss the relevance of Relational Cultural Theory to support groups for women with eating disorders based on my self-reflection and examine future directions for research/reflection based projects. Structure of the Group The outline of this psychoeducational group, showing topics explored each week, is as follows: 1. Establishing a safe and nurturing place to share

7 Self Reflection Proposal 7 2. The influences of culture on the development of eating disorders 3. Connection and disconnection 4. Relational Images 5. Strategies of Disconnection 6. Stages of Change 7. Self Care The group was a psychoeducational format and was an introductory group designed to prepare participants for a second level process oriented group. The group was for women who are clients of an outpatient eating disorders clinic. The clinic is for persons over the age of eighteen who have an eating disorder of anorexia or bulimia. This does not include persons who struggle with compulsive eating or binge eating. As well, the group was a closed group to run for seven weeks for one and a half hours per week. The type of data collected were my own personal journal entries made after sessions, group notes on themes not entered into client files and personal journal entries based on consultation and debriefing sessions with co-facilitators. Throughout the final project individual quotes made by group members and/ or co-facilitators would be used in an indirect way to further explain and identify the themes that arise from my own writing about the group. Group members will not be named. All group notes are on a computer program that requires both a passname and pass word to access that only I can access. Further, any personal journal entries and co-facilitation correspondence does not include in it identifying pieces of information and are kept on my personal computer that is password protected. As a reflective paper, I understand the data I have collected is secondary data and I intend to seek ethics approval.

8 Self Reflection Proposal 8 The end result of this project is intended to answer the following questions: What theoretical themes were revealed in the experience of facilitating a group for women with eating disorders? Does my own experience of this process support the Relational theory it is grounded in? Does the theory support my own experience as a woman in Western culture? Discussion The Potential implications I believe honest description and examination of one s experience is an incredible learning experience for both the individual engaged in the process of self reflection and those reading it who are able to engage themselves in that experience and make meaning of it for themselves. Through personal reflection, summarizing the experience of others, and examining the literature, this project would represent an attempt to create a representation of reality integrating experience, reflection and theory. Moreover, my impetus for this project is to contribute to the field of eating disorders and feminist thought in some manner. It is my belief the Relational Cultural approach and how it intersects with literature on eating disorder groups has much to offer to clinicians and clients alike. Further, I believe this project has relevance to support other interns and clinicians in the area of eating disorders. Specifically, more discussion and research is necessary in the field of eating disorders in the area of group treatment. For instance, Tantillo (2000) states, at the present time, controlled studies are lacking on the relationship between mutuality and eating disorder symptoms and on the efficacy of an RT group approach (p. 19). Although this paper does not represent a controlled study, it

9 Self Reflection Proposal 9 does explore the efficacy of a Relational Therapy group approach. As well, it represents an attempt to evoke thought in the area of feminist thinking and eating disorders. I believe examining the problem of eating disorders from a feminist perspective may allow for greater understanding of the problems and in some way contribute to developing better solutions for the problem.

10 Self Reflection Proposal 10 References Eyler, J. (2001). Creating your reflection map. New directions for higher education, 114, Jordan, V. J. (2001). A relational cultural model: Healing through mutual empathy..bulletin of the Menninger Clinic, 65 (1), Jordan, J. & Dooley, C. (2000). Relational practice in action a group manual. Wellesley, MA: Stone Center. Lockyer, J., Gondoez, T., & Thivierge, R. (2004). Knowledge translation: The role and place of practice reflection. The Journal of Continuing Education in the Health Professions, 24, Madigan, S. & Goldner, E. (1998). A narrative approach to anorexia: Reflexivity, discourse and questions. In Hoyt, M. (Ed.), Constructive therapies, pp. 3-14, New York: Jossey Bass. Smith, J. (1994). Towards reflective practice: Engaging participants as co-researchers or co-analysts in psychological inquiry. Journal of Community and Applied Psychology, 4, Tantillo, M. (2000). Short-term relational group therapy for women with bulimia nervosa. Eating Disorders, 8, Tantillo, M. & Sanftner, J. (2003). The relationship between perceived mutuality and bulimic symptoms, depression, and therapeutic change in group. Eating Behaviors, 3,

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