Client Pretreatment Characteristics as Predictors of Outcome in Brief Therapy for Bulimia
Guiffrida, Douglas A., Barnes, Kristin L., Hoskins, Christine M., Roman, Lisa L., Journal of College Counseling
An overview for college counselors of the literature on bulimia treatment outcomes is presented for purposes of screening, treatment, and referral. Pretreatment characteristics that seem amenable to success in brief therapy are outlined, as are those that do not lead to a positive outcome.
The prevalence of bulimia nervosa, often referred to simply as bulimia, has received a vast amount of attention on college campuses during the past decade. A study of 643 college women found that as many as 3% of college students meet the diagnostic criteria for bulimia, 33% reported inappropriate and unhealthy forms of weight control (i.e., vomiting, commonly called purging, and use of laxatives), and 38% had problems with bingeing or consuming large amounts of food in a short amount of time (Mintz & Betz, 1988). The traditional approach to treatment of bulimia has been long-term psychotherapy that incorporates many hours of in-depth individual, group, and family counseling in both inpatient and outpatient treatment settings. These models of treatment pose a serious challenge to college counselors who are increasingly mandated to meet with students briefly (Gyorky, Royalty, & Johnson, 1994; Quintana, Kilmartin, Yesenosky, & Macias, 1991). These counselors must make the best use of limited time with clients w ho have bulimia. One manner in which this may be accomplished is through brief therapy.
Brief therapy, the current treatment of choice in many college counseling centers (Gyorky et al., 1994) is defined as "counseling in which time is an intentional aspect of treatment planning" (Steenbarger, 1993, p. 8). Brief therapy models offer an alternative to more traditionally accepted methods of counseling. Instead of seeking to uncover and deal with deep-seated issues thought to be at the root of bulimic symptoms, brief therapy for bulimia often focuses on understanding the primary function that the symptoms fulfill in the client's life. Through active involvement with the therapist, clients learn to reframe their disorder, engage in behavioral and cognitive therapeutic interventions, and seek to focus on other areas of their lives outside of their eating disorder (Moley, 1987).
In examining the effectiveness of brief therapy for bulimia, Johnson, Tobin, and Dennis (1990) concluded that it might be beneficial to identify sub-groups of clients who may require differing levels of intervention. This type of systematic method of client referral and treatment matching has also been recommended by Quintana et al. (1991).
Although dozens of studies have begun to identify client characteristics that may lend themselves to successful treatment (with both brief and nonbrief approaches), there has yet to be a synthesis of the information available for practitioners. This article reviews the outcome literature on bulimia treatment and cites those pretreatment client characteristics that seem amenable to brief therapy and those characteristics that do not. It is hoped that addressing the promises and limitations of brief therapy for bulimia will better equip college counselors to meet the challenges of appropriate triage and referral.
Overall Effectiveness of Brief Therapy for Bulimia
Research on treatment and outcomes of bulimia has suggested that brief therapy may be appropriate for some clients suffering from bulimia nervosa Bologna, Barlow, Hollon, Mitchell, & Huppert, 1998; Bulik, Sullivan, Joyce, Carter, & McIntosh, 1998, 1999; Fahy, Eisler, & Russell, 1993; Fahy & Russell, 1993; Johnson et al., 1990; Walsh et al., 1997). For example, after 8 weeks of brief cognitive-behavioral treatment, 42% of clients exhibited significant reductions in abnormal eating behaviors and psychopathology, and these reductions were maintained at 16 weeks and after 1 year (Fahy & Russell, 1993). Bulik, Sullivan, Joyce, et al. (1998) found that brief cognitive-behavioral therapy (CBT) produced broad improvement in several outcome areas: 53. …