Dialectical Behavior Therapy for Binge Eating and Bulimia by Debra L. Safer, Christy F. Telch, Eunice Y. Chen Page B

members, while the other writes these on a white board or large piece of paper. (Note: If conducting treatment within an individual format, the therapist may list the pros on a piece of paper.) After eliciting the pros of binge eating (and purging), therapists inquire about the cons: “What are the serious disadvantages to remaining a binge eater [and purger]? What types of things brought you into treatment?” Again, one therapist elicits these and the other writes them down. Once the lists are created, therapists should use the strategy Playing the Devil’s Advocate to help solidify the motivation:
    “Those pros look pretty darn compelling! We’re not sure we’d be able to fnd a way to say to ourselves that we would work like heck to give up bingeing [and purging]. Convince us—why can’t you continue to binge eat [and purge] and still lead a highly satisfying life? Now, when we refer to this quality of life, we’re not talking about a life in which you’re simply existing or ‘getting through’ and trying to minimize pain. We’re talking about feeling fully alive, living up to your potential, having the best life that you’re capable of.”
    When Playing Devil’s Advocate, therapists draw group members into arguing the position that it is imperative for them to stop binge eating (and purging) in order to live the quality of life clients most desire. The therapists remain skeptical, continuing to wonder aloud whether clients might indeed be able to continue binge eating (and purging) while simultaneously living a fully satisfying life. The key to this strategy’s success is polarizing the argument by describing clearly and reiter— ating as needed what is meant by a high quality of life. If this is done, most clients readily argue that their binge eating (and purging) is destroying any possibility of their having a high quality of life.
    When the therapists are convinced that the group is strongly in agreement, they might summarize:
    “Based on what we have heard from you, we’re convinced that there is abso— lutely no other choice than to stop binge eating [and purging] and to get control over any other problem eating behaviors. So, let’s face that reality and put it on the table before we move ahead. Binge eating [and purging] is over. Whenever you had your last binge [and/or purge], that was it—the last one. You simply can’t have the life you want and continue this kind of eating. If you stop all these problem eating behaviors, you have a shot at the life you want to lead. But if you continue, you simply don’t have a chance. So the only choice you’ve got is to stop binge eating [and purging]. Are we truly agreed?”

The Pretreatment Stage
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    Getting Verbal Commitment to Abstinence from Binge Eating and/or Purging The next step is obtaining each client’s verbal commitment to abstinence. The therapists explain this request as follows: “One thing we believe would be helpful, according to our model, is for you to make a commitment to stop binge eating [and purging]. The reason we say this is that we know from the research that there is a power to making a commitment that isn’t there when you simply say: ‘I’ll try.’ People who make a commitment to do something are more likely to follow through. So we’re asking you to make a verbal commitment, to look deeply within yourselves and make a decision to give up binge eating [and purging] as an ineffective way of coping with emotional distress.”
    Therapists then ask clients to take a moment to think over the discussion that just took place, reminding them that it was they who convinced the therapists about the incompatibility of binge eating (and purging) and living a high-quality life: “This is not something we are telling you, this is something you know in a deep way, based on your own experiences. Stay in touch with the high cost of binge eating [and purging] and fnd a way to make a deep commitment to yourself and to the treatment