Factors influencing the outcome of group psychotherapy for bulimia nervosa

Objective: Group psychotherapy is a widely used form of treatment for bulimia nervosa, and many open and controlled studies have demonstrated that it is relatively effective. However, it is not clear what factors enhance or reduce that effectiveness. This review considers the potential role of a number of such factors. Method: The literature on the effectiveness of group psychotherapy was selected on the basis of its publication inclusion in peer-reviewed journals. Unpublished material was not included. Factors considered included theoretical orientation, therapy dose, concurrent treatment, client characteristics, and service characteristics. Results: The research to date shows no obvious advantage attached to any single therapeutic orientation or to the gender of therapists. However, other aspects of group psychotherapy do seem to influence outcome. Better outcomes are associated with longer, more intensively scheduled groups and with the addition of other treatment components (e.g., individual work). There is also evidence that relatively large groups are a viable option. These conclusions are reasonably congruent with clients' own expressed preferences regarding therapy. Discussion: It is suggested that future research should focus on matching the characteristics of individual bulimics to the nature of the group psychotherapy, in order to increase engagement and effectiveness while reducing drop-out rates. (C) 1997 John Wiley & Sons, Inc.