Body Esteem Program - Australian Women's Health Conference ...

Body Esteem Program – Healing through Sharing Stories.
A community based peer facilitated self help program for women with eating disorders.
Introduction – Mandy Stringer
My name is Mandy Stringer – I am the Executive Director of WOMEN’s Healthworks (WHW).
WHW is one of 12 independent women’s health centres in WA and is located approximately
26 kilometres north of Perth – as some of you would know – we are located in the middle of
the ever increasing urban expansion of the ‘Northern Corridor’ suburbs of the city.
WHW has been offering health, education and resource services to the women of Perth for
over twenty years. About seven years ago now, WHW noticed an increasing demand for
support services for women who were suffering from eating disorders and from families
wanting to support their daughters/sisters. A long, turbulent, frustrating and yet incredibly
rewarding journey ensued. A result of that journey is that we are now in a position today to
talk with you about our experiences, and hopefully share with you the lessons we have
learned and where possibilities and opportunities lie in the future.
Introduction – Tracey Hennessey
My name is Tracey Hennessy; I am the Program Manager at WHW. My role since being
with WHW is to manage a suite of social services, one of which is the unique and aptly
named Body Esteem. We will now take you on a small journey of the BE, it’s history and
some of the lessons which have been learned in delivering a consumer driven service:
Body Esteem Program History
In 2003 WHW became aware of an increase in the number of enquiries from women
experiencing the anguish of an eating disorder and who were seeking support to assist them
in their recovery. WHW was only able to refer to extremely limited services within Perth.
Extensive community consultation followed, via public forums which targeted those families
with a lived experience and subsequently led to the development of a peer supported self
help group which was adapted from an evidence based program originating from the
Netherlands.
Initially the program was delivered over a consecutive 35 week period, and through
evaluation and further analysis, a revised version of the program was piloted in 2005/06.
Further delivery and evaluation led to redevelopment of the program to better suit the
Australian context and was subsequently reduced to a twenty week program (consisting of
two ten-week blocks).
The Body Esteem Program
The Body Esteem Program is an umbrella term which incorporates three programs which
are offered at regular intervals throughout the calendar year. The Body Esteem Program
provides:
1. A self-help peer facilitated 20 week program for women experiencing and wanting to
recover from an eating disorder (this includes specific groups for Anorexia/Bulimia
sufferers as well as those experiencing Binge/Overeating symptomology).
This program provides education around eating disorders and health consequences,
identification and understanding of what constitutes ‘normal’ and healthy eating, it
provides strategies for making positive changes around eating behaviour and
provides participants with opportunities to explore and address issues through

Body Esteem Program – Healing through Sharing Stories.
A community based peer facilitated self help program for women with eating disorders.
discussion and activities (issues such as self image, body image, loneliness,
perfectionism, relationships, relapse, sexuality and decision making). Each group is
facilitated by two women who have experienced and recovered from an eating
disorder. The facilitators provide support and guidance based upon their own
experiences.
2. A support and information program for parents/partners and family members who
have loved ones suffering from an eating disorder. This program provides education
and insight into the experiences and difficulties experienced by sufferers, and are
delivered over eight weekly sessions (of 90 minute duration). Key stakeholders and
service providers across public and private mental health services in WA, who
specialise in eating disorders provide presentations and allow opportunities for
participants to ask questions and interact with each other in a supportive and
developmental environment.
3. A ‘Step-Down’ program for participants who have completed the peer facilitated self
help program and are needing additional support to assist in the maintenance of
recovery. This program is only available to those who have completed the initial
program and are wanting/needing further support to assist them in refraining from
returning to destructive and harmful thinking patterns and behaviours.
The Body Esteem Program – A snapshot of the 20 week program
• The emphasis of the BEP is upon women accepting responsibility (and credit!) for
effecting positive change in their own lives. It is also about the sharing of support
and guidance between women who are, and who have experienced similar
difficulties.
• Facilitators guide their groups through a series of themes, group activities and
homework tasks.
• Each group session runs for 2 and a half hours and has a regular structure: opening
circle, theme discussion/evaluation of homework task; work time; closing circle.
• Each group has a cut off of 15 participants. Experience has shown us that optimum
numbers for group dynamics and retention sits at approximately 8 – 10 participants.
• The group celebrates the end of the program by sharing a meal together at a local
restaurant. This is a significant achievement for all members of the group and this
event enables the participants to gain practical experience of engaging in an event
which has previously been far too terrifying to contemplate.
BEP – an integrated approach to best practice
• The BEP promotes an environment of safety, respect and one that is free from any
judgement. It provides an opportunity for role modeling and the visualisation that
recovery can be achieved. Choices can be made that can lead to the retention of positive
emotional health and wellbeing for the women it serves.
• Results of the continual improvement processes gained from consumers, presenters,
facilitators, key stakeholder agencies as well as administrative staff has ensured ongoing
content review, policy development and program accessibility. Referral pathways are
continually updated.
• Continual liaison and negotiation with key stakeholders has meant that WOMEN’S
Healthworks has established a fundamental place within eating disorder services in
Western Australia, as well as at a national level.

Body Esteem Program – Healing through Sharing Stories.
A community based peer facilitated self help program for women with eating disorders.
• Early affiliations were initiated with (the now defunct) EDAWA (Eating Disorders WA)
Since this time (2003) The BEP and WHW has developed key stakeholder relationships
with:
- Bridges Assoc Referencing Group and Bridges Management Committee,
- The Butterfly Foundation
- The Eating Disorders Australian National Network and the National Eating Disorders
Collaboration Project
- Eating Disorders Foundation Victoria Inc,
- Princess Margaret Hospital Eating Disorders Clinic (WA),
- The Centre for Clinical Interventions (Perth WA) and
- Hollywood Clinic – a private hospital providing treatment services for eating disorder
sufferers in Perth.
- As well as a number of private GP’s and psychologists providing services to eating
disorder sufferers and their families.
Affiliations with current research initiatives ensures that all staff connected to the Body
Esteem Program are informed and kept abreast of contemporary trends and research.
• Whilst the current strategic direction for mental health services in WA embraces
consumer driven services and supports the involvement of consumers in determining
their own recovery journey, WOMEN’S Healthworks has been at the forefront of putting
this discourse into practice – the BEP can lay due claim to delivering services which are
innovative and which embrace best practice of including consumers and responding to
their needs, at every possible level of service delivery.
• WOMEN’S Healthworks has responded to a need that has been identified in delivering
the education and support group and has negotiated with Carers WA to work together to
provide support for this client group within an environment that is conducive and
supportive to the participants’ unique needs. This client group do not typically see
themselves - or avail themselves of the services available for carers however, by
establishing an MOU with Carers WA and by delivering the programs from the premises
of this organisation, the participants are enabled to access services and resources which
can greatly contribute to their own health and wellbeing.
• Clinical supervision arrangements are provided through a MOU overseen by the
Principle Clinical Psychologist at Princess Margret Hospital. This arrangement ensures
that staff of the Body Esteem Program gains the direction and guidance needed to assist
them in their roles and ensures that inter-service collaboration remains active, and that
support for the facilitators is provided at a multi-agency level.
• It has been imperative that the organisation implement strong facilitator and program
guidelines, rigorous staff management strategies, contingency planning and the
assurance of flexible supervision and de-briefing opportunities (for all staff involved in
service delivery). The content of the program combined with the personal revelations of
the participants, staff are continually exposed to ongoing threats to their own wellbeing
which can lead to the possible ignition of triggers that can then incite relapse. WOMEN’S
Healthworks has responded to these additional staff needs by putting intensive human
resource management strategies into place and has actively embraced the development
of policies and procedures which protects consumers, staff as well as the integrity of the
organisation.

Body Esteem Program – Healing through Sharing Stories.
A community based peer facilitated self help program for women with eating disorders.
The unique attributes of our BEP Facilitators
A unique attribute of the Body Esteem Program is the dual expertise that the facilitators of
the program hold. Different to that of a peer led unstructured program, the Body Esteem
Program has evolved so that the facilitators hold professional qualifications (or work and
facilitation experience) as well share the experience of having an eating disorder. This
distinguished difference that sets this program apart is that it bridges the gap between
professional pedagogical styled treatment programs and peer led groups which are formed
through promoting mutual assistance whereby the participants have come together to satisfy
a common need.
The adaptations and continual review processes have established a West Australian
evidence base which is unique to mental health service provision and supports a model of
facilitation that embraces both the lived experience and professional expertise. This model
has not come about by chance. The implementation of the Netherlands program leaned
towards the engagement of women who had the lived experience who could be then trained
in the art of facilitation – the focus was not on professional skills and experience as being an
equal and balanced factor in the recruitment and selection process. The impact therefore
which was felt early on in the BEP journey was that a majority of the women who were
accessing the service, were still vulnerable and not ready to take on a facilitator role,
following the initial 20 week program.
The Western Australian experience soon informed us that to ensure program guidelines
were adhered to and that participants’ additional mental health needs could be supported
and responded to in an appropriate manner, suitable staff who had a level of professional
and or relevant work experience, be employed to meet this need. As a result it is now a
requirement of the recruitment process to ensure that all facilitators working for the Body
Esteem Program bring with them a diverse range of experience, skills and knowledge
around the specific mental health issue of eating disorders which is personal and
professional, subjective yet balanced with objectivity.
As alerted to earlier, the challenge here is that it is essential for the organisation to
implement and activate strong policies for the training, guidance, supervision and support of
staff. Every situation whereby the facilitator engages with a participant - holds within it, a
possible trigger which could initiate relapse for the staff member. A strong duty of care and
flexibility to meet individual needs is a quintessential requirement when supervising staff who
each day, are exposing themselves to potentially very threatening situations.
A five minute film clip of an interview we held with some of our facilitators about
their own experiences of how they manage this issue themselves will be shown.
Interview Questions:
• Can you please describe why you were drawn to the role of facilitator with the BEP?
• In facilitating a 20 week BEP program, how do you protect yourself from potential
triggers?
• How does the organisation support you in protecting yourself?
• What is the best thing about facilitating for the BEP?
• Why do you thing the lived experience is so powerful when working with women,
wishing to overcome their eating disorders?
Finally,

Body Esteem Program – Healing through Sharing Stories.
A community based peer facilitated self help program for women with eating disorders.
Let us now conclude by looking at the profiles and experiences of the participants
themselves.
With over eight 20 week programs now having been delivered, we can develop a profile of
common characteristics and behaviours for those women entering the program.
Participants come from across the Perth metropolitan area to attend the weekly program.
The majority of participants tend to be employed, approximately half are studying and only a
small minority is unemployed. All participants report that only the occasional family member
is aware of the severity of their eating disorder and despite many hospitalisations – prior to
attending the program - there are frequent reports by the participants about the isolating
nature of eating disorders and how sufferers quickly develop the ability to hide and mask the
intensity and malignity of the ailment. The average age of participants entering the
Anorexia/Bulimia program is 28.7 years.
Differing from the Anorexia group, the average age of participants in the Binge/overeating
program is 37.8 years. Pre-selection interviews note that where participants have accessed
professional services previously, the majority found that little help was forthcoming and that
overwhelmingly, psychologists and counsellors did not take their condition seriously. Many
participants entering this program take prescription medications for depression and/or
anxiety related problems.
Rather than give you dry data, let us now finish with a testimonial from a participant of the
BEP who has gone on to be a facilitator with the program: let us hear Jemma’s story:
A testimonial:
My name is Jemma and I have now been a faciliator with the BEP for two years.
I still don't really understand why - but 10 years ago when I was 15 - I developed an
eating disorder.
I wasn't unhappy at school, I wasn't unhappy at home, I didn't want to be like the
women in fashion magazines, it was more that I was unhappy with myself, I thought this
unhappiness would go away if I lost weight.
For two years no one knew. I had a routine. I'd eat breakfast (I believed that I'd burn
off these calories during the day so I was OK about eating breakfast). Besides a frozen
fruit box, I wouldn't eat then until dinner - which I'd later vomit up, or "purge".
I'd set myself weight loss targets but then when I'd achieved them, I'd decide it
wasn't good enough and I'd set another target, and on it went until it was out of
control.
In Year 12, I told a friend and then a teacher about my eating disorder. I'm not sure
why, I guess I felt very alone. On the other hand, I really didn't want anyone to know
(although in retrospect maybe I did on some very subconscious level).
Some time later after I began suffering dizzy spells at school and, as a result, my
teacher told the school counsellor about the eating disorder, who in turn informed my
parents.
It was then that my life began to fall apart. I felt so ashamed and embarrassed, yet
couldn't stop my behaviour. My mother was devastated and was always monitoring what
I ate. We fought constantly and as a result I ended up moving out of home to live with
my nanna. The fact that the eating disorder was out in the open only motivated me to

Body Esteem Program – Healing through Sharing Stories.
A community based peer facilitated self help program for women with eating disorders.
lose more weight and towards the end of Year 12 I had my first period of
hospitalisation.
Whilst I gained some weight in hospital, the program really didn't work for me. When I
was discharged, I went well for a while but soon after fell back into old habits, as
these were comfortable and familiar to me.
I was very underweight when I was first hospitalised. When I returned to hospital for
a second time about six months later I weighed 3 kilograms less than I did the first
time I was admitted. After I was discharged from my second admission, instead of
eating and purging after some meals I became anorexic; and avoided eating almost
completely.
Over subsequent years I was hospitalised a further three times and my weight went
down as low as 10 kilograms below my first admission weight - however the target in my
head had gone down another kilo.
During my last two admissions I wasn't allowed to participate in group therapy sessions
as they told me I had done them all before and had gained no benefit. Each stay was
more and more boring and more demoralising. Due to my frustration, I continuously
pushed the boundaries of the program.
However in hospital I met a nurse. We spent a lot of time talking and she told me that
she too had had an eating disorder. After I was discharged, she told me about the Body
Esteem pilot program which she was coordinating and asked if I'd like to join.
I felt comfortable with her and decided I would give it a go, because I really had
nothing to lose.
The Body Esteem Project offered me a completely different perspective than hospital
and the other efforts that I had either tried or that had been forced on me.
My eating disorder had always been focused around weight and calorie counting.
With Body Esteem for the first time I was genuinely able to take the focus away from
‘weight" and consider a range of other issues surrounding body image, self esteem
issues, insecurities, emotional problems and other things which were possibly linked
with our eating disorders.
In the Body Esteem Project, we looked at our broader life goals and how we would
achieve these goals. I felt that it was possible to work towards these goals to regain
some hope and happiness.
The level of support from the facilitators - whom I found to be inspirational - and
other participants also worked for me. With previous treatment methods, I found that
once I was discharged from hospital, there was no support, thus increasing the chances
of relapse.
While participating in Body Esteem I was also supported by a friend who I'd met in
hospital. She also wanted to overcome her eating disorder - in fact, she was the one
who first suggested to me that we combine our efforts to overcome our eating
disorders. Together we set short and long-term goals, we started to eat more
appropriate amounts supported each other. I tried to stay away from the scales so I
wouldn't know how much I weighed.
Today thanks to my participation in the Body Esteem Program and the pact I made with
my friend I have a lot of positives in my life:
• I have a partner. We had our first child - a son in December 2007.

Body Esteem Program – Healing through Sharing Stories.
A community based peer facilitated self help program for women with eating disorders.
• My mum is really excited about being a grandmother and we have rebuilt the good
relationship we once had.
• I am now in my last year of a university course, majoring in Youth Work –
There's still something there in the back of my head and I know I could become
anorexic again BUT I also have many positive things in my life and would never want to
do anything to risk my baby's happiness and so I'm confident I won't regress.
What were the costs of those years?
• Although I had many health problems along the way, some of them very serious, I
don't think I have any permanent health problems.
• My mother suffered a lot - she had a lot of health problems arising out of stress and
for my first two hospitalisations we had no private insurance and so mum paid out
around $350 a day for a period of around 6-8 weeks in total, so the financial cost was
also very high.
I know that there are those who think that people with an eating disorder are selfish
and self-absorbed and should just get over it. It's not like that - it's completely the
opposite, there is such a self loathing that sufferers want to fade away. Somewhere
along the downhill spiral, they also lose touch with emotional reality.
I found it soul destroying. At one stage everyone had given up on me. My psychiatrist
told me she wouldn't see me anymore because I hadn't made any progress over a three
year period. My mum was worn out. I had lost some very good friends and never went
out - the only interests I had were for counting calories and exercising. I'd given up on
myself. I'd lost everything.
I didn't mean to reach this state, I wasn't happy about being there. But the support I
had simply did not seem to work for me. I felt trapped and couldn't break free.
It is terrific that the BEP exists, It's helped a lot of people, including giving me back
hope and offering support that helped me move past the stage, most dangerous for
regression, after being discharged from hospital for the fifth, and I'm pleased to say,
final time.