You will have been asked by someone with bulimia nervosa or a related problem to help them use the self-help manual in this book to overcome their problems with eating. This appendix sketches out some general principles about how you might best be able to fulfil this function.
At the outset it is worth saying that this self-help manual is evidence-based and has been used to considerable benefit by a great many people with bulimia nervosa. It is therefore a perfectly reasonable expectation that using this manual will be beneficial. However, the self-help program contained in this manual is obviously not the right way to proceed for everyone. In the introduction to the manual a list is provided of people for whom the manual is not appropriate. Before proceeding to help someone work through the manual you should consult this list and consider whether self-help is indeed the appropriate course of action. If you feel that it is not, clearly you must discuss this with the person you are trying to help and together you must come to a decision about the most appropriate way to proceed.
In order to help someone use this manual you should obviously be familiar with its contents. This does not mean that you must be an expert in the treatment of eating disorders. However, the self-help program follows certain definite principles in a highly structured fashion and a basic familiarity with these principles is necessary. In fact, the manual is divided into relatively small sections and it would be possible, when meeting someone you are helping, to skim through reasonably quickly the section with which they are currently concerned.
The most useful function that you can perform is to provide basic support and encouragement. There are bound to be times when someone trying to deal with her eating problems feels discouraged and even hopeless about ever effecting a significant change. It is at these times that the balanced perspective of an outsider can be most useful. When all one can see is one’s failures, it can be immensely reassuring and helpful to be reminded of the successes one has had and the progress one has made.
It is important to emphasize that the manual is a guide to self-help; and if you are assisting someone in their use of this manual then you are helping her to help herself. So it is not your role to devise plans and strategies for her, but rather to encourage her to develop her own techniques for overcoming her difficulties. This does not mean, of course, that you should refuse to make any suggestions at all. There are times when, by looking through someone’s monitoring sheets, certain patterns she has missed are obvious to an outsider. If you spot anything you feel might be important then obviously you should raise it. Similarly, certain points of detail, concerning, for example, the sort of food eaten or the timing of meals, may well seem to you worth mentioning and it is perfectly reasonable to do so. However, while you should feel free to make suggestions about prudent courses of action, in the end it is those strategies which the person generates for herself which she is most likely to follow and which are therefore likely to be of most benefit to her. And, of course, in the end the responsibility to use whatever points you make is hers and not yours.
Overcoming bulimia nervosa is a struggle which will take many months. In the early stages of this self-help program it would be useful for the person using the manual to be able to see her helper often. Weekly sessions are usually advisable at this stage. Once some control over eating has been achieved, such frequent sessions may not be needed. Sessions every two weeks are then sufficient for a few months, after which meetings can become less and less frequent. However, it is important that the door is left open for help. This is especially important at times when someone who has been doing well experiences a lapse. If left entirely on her own she can become so disheartened that she gives up altogether, and what was really a minor lapse becomes a relapse. This is unnecessary; a couple of booster sessions with a helper is usually sufficient to get the person back on the course to recovery.
Deciding to recruit such a helper and make a genuine effort to use this manual to overcome eating problems is a brave decision. Anyone making that decision deserves a great deal of respect, support and encouragement. And with such help, she stands a good chance of making substantial improvement.