| Summary: | Currently, there is a limited understanding of change mechanisms across all treatment approaches for eating disorders (ED), particularly with regard to group psychotherapy. This presents one of the major obstacles in the development of more effective treatments. The purpose of this study was to extend current understanding of therapeutic processes in group psychotherapy for bulimic disorders. Thirty-one women were randomly assigned to either 16-weeks of Emotion-Focused Therapy (EFT) or Motivation/Education and Skill Building (M/ESB) as part another study at a participating outpatient ED program. The goals of this study were to: (1) evaluate the relationship between in-session processes; (2) compare these processes between two group treatments; (3) examine in-session differences as a function of client activity in group EFT; (4) and identify a pathway to change. As expected, the findings demonstrated that mid therapy emotional arousal was associated with higher levels of insight, and an increase in insight overtime was associated with an increase in therapeutic alliance. Arousal was not positively correlated with alliance. There was a significant interaction between group treatment x time: clients in EFT reported gains in insight overtime, as measured by post-session change measure, whereas clients’ scores in M/ESB did not change over the course of psychotherapy. Alliance increased significantly over the course of therapy in both groups. Contrary to expectations, clients in the EFT group did not report higher levels of arousal compared to the M/ESB group. The limited sample size in the control group precludes firm conclusions about group comparisons. When examining client activity within EFT, the results demonstrated that clients that were actively engaged in the chair-tasks reported higher post-session change scores, arousal, and alliance compared to when they were in the observing role; however, there was a significant upward trend on post-session change scores regardless of the client role. The pathway to change was partially supported: the observer-rated degree of resolution scores predicted a third of variance in post-session change scores; controlling for pre-treatment outcome scores, post-session change scores predicted variance at the outcome on several EDI-3 subscales. These preliminary findings are discussed in the context of psychotherapy process literature, highlighting limitations and future directions.
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