Clinical psychologist Beth McGilley, PhD, remembers when anorexia nervosa began its descent on her life. At age 17, she was driving from Kansas City to San Diego to start her freshman year at the University of San Diego. Her mother had committed suicide 10 months earlier, and she was leaving the comfort and loving support of the all-girls Catholic school she’d attended for 12 years.
“Both of my umbilical cords had been severed and I was floundering in the universe,” McGilley recalls. “Not eating was a way to hold time still and ‘starve off ’ the pain.”
She found herself hopping on the scale several times a day, getting lost in food rituals and going for long runs in the middle of the night. Unaware of exactly how bad things were, she didn’t seek professional help until graduate school, where she quit running, began seeing a therapist and “peanut-butter sandwiched her way up” to a healthy weight, she says.
Twenty-five years later, McGilley no longer suffers from anorexia, but she continues to work to manage the underlying issues that triggered the disorder — namely, grief and loss, perfectionism, fear avoidance and a genetic predisposition toward depression. It’s a battle that, since 1986, she has helped hundreds of other women fight first as the director of the University of Kansas School of Medicine–Wichita inpatient eating disorder unit, and later as a private practitioner. She’s also co-founder of the Healing Path Foundation, a nonprofit dedicated to the prevention and treatment of eating disorders in Wichita and throughout Kansas.
To help her clients, McGilley works with them to build healthier views of themselves. “If you’re alive and female in America, there’s no way you have a perfect body image,” says McGilley, co-editor with Margo Maine, PhD, and Doug Bunnell, PhD, of “The Treatment of Eating Disorders: Bridging the Gap Between Research and Practice,” due out from Elsevier in the fall. Her work helps transform these patients’ tendencies toward silence, starvation and solitude into a reliance on supportive relationships and an appreciation of individual differences and strengths, says longtime colleague and fellow Wichita psychologist Maureen Morrison, PsyD.
“She’s doing the deep work of examining how it all got started [for these women] and [helping them] make systemic, structural changes in each person’s life so they don’t stay symptomatic,” Morrison says.
Perhaps as a result of the adolescent onset of her own anorexia, McGilley most enjoys providing group therapy to high-school and collegeaged women. She started her feminist-oriented group as a psychology intern at the University of Kansas. Now, 25 years later, she still spends one night a week leading two-hour group therapy sessions with four to eight adolescents.
The group is open-ended and process-oriented, meaning once a member is accepted, she is part of the group until she “graduates,” a milestone that varies from months to years. (Three years is the typical length.) Unlike some groups that focus exclusively on one eating disorder, McGilley’s group has clients representing each of the three diagnostic eating disorder categories listed in the Diagnostic and Statistical Manual of Mental Disorders — anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified, which can include binge eating.
To participate in the group, patients must be willing to talk about their eating disorders, view them as a problem and demonstrate a commitment to recovery. McGilley also requires participants to see a therapist for individual work and additional support. Competition to gain a seat in the group can be tight: At times, the waiting list has been nearly 18 months, McGilley says.
Each group session begins with a “go around” in which members update the group on the status of their eating disorder symptoms, as well as other relevant dimensions of recovery. For example, a member might report whether she purged or restricted food over the last week and how she managed family, school and relational demands. Participants are discouraged from discussing weight or specific maladaptive eating/purging behaviors, which may be addressed in individual psychotherapy, to keep them from feeling competitive with each other. Group members do, however, discuss the underlying issues they may need help with — perhaps, a member may have starved herself over the weekend as a result of a friend who hurt her feelings and needs help confronting that person.
Lessons in empowerment
McGilley serves mainly as a facilitator of therapeutic processing and healing, not as a therapeutic authority. Her role is to empower her clients to find their own voice, and since they can’t live without food, to “learn to have a healthier relationship with the substance they act out around,” she says. The group’s membership of newcomers and veterans allows older members to assume leadership positions and model what they’ve learned, asking thoughtprovoking questions about the issues that may have driven a fellow member to a bulimic episode, for example. “That whole aspect of empowerment and voice is essential to recovery,” she says.
Although therapists very considerably in their use of or comfort with self-disclosure, McGilley discloses that she is recovered from anorexia when it becomes pertinent with her clients. Many patients even begin treatment knowing McGilley is recovered because she has written and spoken on the topic professionally. Otherwise, she uses self-disclosure when it is in the service of the client’s recovery — as a means to demonstrate her openness and authenticity, instilling hope for recovery and serving as a positive role model for change. However, because many patients with eating disorders struggle with boundary issues, often as a result of abuse or other boundary violations during childhood, she remains vigilant about the possible negative impact of self-disclosure on patients, and assists patients in identifying and processing issues related to interpersonal boundaries when they arise inside and outside of sessions.
In addition, unlike some psychologists who forbid outside contact among group members, McGilley embraces it. “This generation has a very different way of relating to one another,” she explains. “These girls are Facebooking each other within 24 hours of meeting, so I try to help stoke these connections in therapeutic ways.”
Using the group e-mail list, the girls send each other recovery-oriented links, and many have told McGilley how helpful it is to communicate with the other girls as a way to stay grounded and recovery-focused between group sessions. She does, however, set some rules for outside contact. “The one thing I ask them is that they don’t try to resolve group issues or do group therapy outside the group,” McGilley says.
She also hosts group outings — to museum exhibits or arcades to play laser tag, for example — and uses group food challenges to help participants reincorporate problematic foods back into their repertoire. She holds the girls to three rules for group meals: no diet foods, no salads without protein and no solo trips to the bathroom, where the girls may be inclined to purge. In her latest challenge, the girls tackled hamburgers and fries together. “I teach them that they don’t have to be alone for those ‘second first times’ when they’re braving eating foods they’ve been symptomatic around,” she says. To increase their comfort and success, she encourages them to eat with someone who understands their dread and dilemma.
When McGilley and the group determine that someone is ready to graduate from the group, they provide her with feedback about her progress and what she still needs to work on. McGilley estimates that she has graduated nearly 500 girls from group. “Some of these girls have come in with such serious symptoms that a lot of clinicians would run the other way,” Morrison says. “But Beth takes them on and [when they graduate], they’re healthy physically, they’re going on to college, and they’ve navigated issues in their families. She has literally saved their lives.”
Expanding her reach
In addition to saving the lives of her clients, McGilley is also working to increase eating disorder awareness in other ways. In 2006, for example, after several of her patients began abusing ipecac syrup to induce vomiting, she successfully advocated for all local pharmacies to put the syrup behind the pharmacy counter.
On a broader scale, she has been heading up an international Academy of Eating Disorders health club task force to create a toolkit that helps health and fitness club employees identify members who may be excessively exercising or displaying other symptoms of having an eating disorder. Using guidelines originally developed in Australia, the toolkit provides tips on how to intervene once a member has been identified and recommends that an employee try to intervene by setting up a private meeting to discuss concerns about a member’s exercise habits. If the member continues to work out compulsively at the facility, the task force recommends putting the client’s membership on hold and requiring them to see a qualified health-care provider to evaluate for an eating disorder before her or she is allowed to return to the fitness club. The task force hopes to partner with international health clubs and fitnessoriented associations to distribute the toolkit, and it’s also recommending that collegiate fitness centers implement the program.
Such efforts, says Morrison, will increase awareness of eating disorders among the public and may lead to earlier diagnoses of the diseases — one of the most positive prognosticators of recovery.
“Eating disorders can be a complicated issue for everyone, and it’s always hard to know how and when to do an intervention with someone you suspect has an eating disorder,” Morrison says. “Many people might think it’s not their business if someone is eating or not, and Beth takes it upon herself to help people figure out what to do, and her efforts have really made a difference.”
Amy Novotney is a writer in Chicago.