Providing Individual Counseling
The first major hurdle to offering individual counseling to boys with body image disorders is the societal stigma for males seeking psychological assistance. Moreover, among males there is a greater taboo against revealing a body image problem because these problems largely have been associated with gifts and women. Also, a boy might be feeling a sense of isolation, believing that he is "the only one" who feels this way about his body. Becoming an approachable, trustworthy adult in a male adolescent world is the first step toward providing individual counseling for boys with body image disorders.
Despite the limited opportunities some school counselors have for providing individual counseling, those who are able to utilize this option may find a cognitive behavioral approach useful (Pope et al., 2000). Rational emotive behavior therapy (Ellis, 1994, 1998, 1999) consists of confronting a client's faulty belief through a disputing intervention, replacing the faulty belief with a new belief, and creating a new feeling in the client. Corey (2001) offered the following diagram to show how this form of cognitive behavioral therapy (CBT) works for the client:
A (activating event) ←B (belief) → C (emotional and behavioral consequence) ↑ D (disputing intervention) - → E (effect) → F (new feeling)
Let's return to the case of Brian. Imagine that Brian were to be caught for skipping class (A--activating event), and his response would be to "come unglued' and yell at the principal who asked him why he skipped class (C--emotional and behavioral response). The principal might then refer Brian to the school counselor. The counselor, through his or her listening skills and ability to draw Brian out, might discover Brian's negative feelings about his body. The counselor's realization that Brian's outburst had little to do with the principal's questions and more to do with Brian's unwillingness to admit his own insecurities about his body (B--belief) would be a significant aspect of applying CBT to this case. The counselor would then challenge Brian's beliefs about himself(D--disputing intervention) by asking Brian what proof he had that his body was terribly inadequate or by showing Brian images of the various body shapes that real men truly have. If the counselor can begin to change Brian's thinking about the way he looks, Brian might experience a new effect (E) and then a new feeling (F) about himself.
Of course, this example is a simplified version of what might happen, as it is very likely that a counselor would have to work with Brian for some time to get him to change his ideas about himself. However, such an approach would help Brian begin to get past the filtering (ignoring all the positive aspects about himself while choosing to focus on the negative) and polarized thinking he is doing, making it possible to create a change (Pope et al., 2000).
Providing Group Counseling
Group counseling in the schools also can be an effective way to change adolescent boys' opinions about their own bodies. Akos and Levitt (2002) suggest that the peer groups of middle- and highschool students can have strong positive effects on adolescents' self-concepts, including body image. Because many boys with body image disorders suffer in silence, learning that other boys in their peer group suffer from the same insecurities and receiving support from those peers can be quite beneficial to adolescent boys working within a single-gender support group.
An effective counselor facilitator is key to the efficacy of these groups. Rhyne-Winkler and Hubbard (1994) give several recommendations for counselors to make these groups a success, such as using materials that build self-esteem and maintaining current information on eating and body image disorders. For many adolescent boys, however, just knowing that an adult is aware of and cares about what they are going through can be the beginning of rebuilding a positive self-image.
Working with Parents
Arguably the most influential adults in a boy's life are his parents, who are likely to be the most accessible instruments for change in a boy's ideas about himself. School counselors can be important bridges between parents and their adolescents. Counselors can offer informational groups and support groups for the purpose of raising awareness among parents of the seriousness of body image problems for adolescent males. Pope et al. (2000) outlined the following simple interventions that parents can do when they suspect that their son might be suffering from a body image disorder. Counselors can assist parents with these interventions individually or in support groups.
First, counselors can alert parents to the value of listening to their sons. Many times personal insecurities emerge when least expected, such as when a parent and a son are doing an activity together. It is when the boy is active that he might feel most comfortable about opening up. Second, parents can be intentional about talking to their sons about the prevailing and unrealistic male body ideals in society. They can let their sons know that having muscles is not the only way to be a real man. Third, counselors can caution parents to express their concerns to their sons without blaming. It is important for parents to let boys know that they care about their well-being but are not judging them from their mistakes. Fourth, counselors can remind parents to refrain from criticizing their sons' appearance. Counselors can help parents to see that although they want their sons to be healthy, putting undue pressure on them to conform to a certain body type can cause more harm than good. Fifth, although most parents want to offer their sons reassurance, it must be done wisely. Counselors can help parents remember not to dismiss their sons' concern about their bodies by saying, "Oh, I think you look great!" Such a response might keep the boy from opening up again, thinking that his parents just do not understand what he is experiencing. Finally, counselors can assist parents in helping their sons look for other sources of self-esteem. If a boy's only source of self-esteem is his body, parents need to point out other strengths that he has and encourage him to use those strengths in positive ways.
Overall, parental support and encouragement not to conform to societal images of the perfect man can do a lot to help a boy who might have a mild body image disorder. Having parents acting as the role models also speaks volumes to adolescent boys.
Consulting with Teachers and Coaches
Next to parents, teachers and coaches exert significant influence on adolescents. Often, however, they themselves may ascribe to some of the media-driven notions of what constitutes the "ideal" male physique. These adults have the potential to reinforce the cultural norm or to become open opponents of it. School counselors, by virtue of their role as both staff members and student advocates, have a special opportunity to influence the thinking and behavior of their colleagues. By conducting in-service and even pre-service training for teachers and coaches, school counselors can increase awareness of the growing body image disorders among adolescent males. Such training requires helping colleagues confront and address the ways in which they have accepted the prevailing views of masculinity as muscularity. Exposing the tactics of the media through a review of television commercials and magazine advertisements will help teachers and other school personnel understand the unrealistic goals they may set for themselves and, concomitantly, the adolescent boys they mentor. Engaging the support of school administrators and other officials will lend credibility to such training programs.
Organizing Consciousness-Raising Campaigns
Once there is grassroots acknowledgment of the body image disorder problem among adolescent males, and when teachers, coaches, and other school personnel commit themselves to providing alternative, healthy perspectives on body image, school counselors can spearhead a consciousness-raising campaign in the entire school. Such a program would involve seeking volunteers from the community as well as colleagues to hold forums, to host informal focus groups, and potentially to infuse alternative ideas into the curriculum in health and physical education classes. Inviting local celebrities, athletes, and medical personnel to speak in schoolwide assemblies to counter the existing cultural messages about the ideal body could be effective. Such a program could be the vehicle to break the silence about adolescent boys' body image problems. It could be a turning point for changing young people's unrealistic goals and attitudes about attaining the "ideal" in physical appearance.
Making Outside Referrals
Sometimes a boy's body image disorder can be severe enough that he needs to seek more intensive professional help. Family therapy is an important treatment option, given the known reciprocal impact of a family on disease and recovery (Anderson et al., 2000).
In addition, antidepressants prescribed by psychiatrists have been shown to be an effective treatment for bulimia nervosa. They can treat the symptoms of bulimia even if the patient is not depressed (Pope et al., 2000). Especially in the more extreme cases of body image disorders, a medical evaluation by a physician would be essential in the boy's healing process.
Boys in America are in a crisis over their bodies. Although it might be firmly entrenched in many minds that masculinity and muscularity go hand in hand, much can be done to put an end to that perspective. School counselors can be important catalysts for parents, educators, coaches, and other adults to become aware of the damaging effects that society's conception of the ideal male body image are having on adolescent boys. School counselors can provide work with individual boys on body image issues when time and circumstances permit this approach. They can provide information and support to parents as they work intentionally with their sons to combat the prevailing notions of masculinity in the culture. School counselors can function as consultants to teachers and coaches who may unwittingly participate in perpetuating the harmful and skewed beliefs about what it means to be "perfect man." School counselors can organize consciousness-raising campaigns in their schools to increase awareness of the problem and to minimize the stigma of boys seeking help. In cases of severe body image disorders, school counselors can make outside referrals to appropriate mental health providers. Moreover, school counselors can work to educate boys on what it truly means to be a man. Counselors can assist other adults in an adolescent boy's world to model the notion that being a man is about love, responsibility, tenderness, work, dependability, kindness, and respect, all of which can be attained regardless of one's body shape. The sooner we can emphasize those important inner qualities over the outer appearance, the sooner we will see adolescent boys become happy, healthy, real men!
- Stout, Eric, & Marsh Wiggins Frame; Body image disorder in adolescent males; strategies for school counselors; Professional School Counseling; Dec 2004; Vol. 8; Issue 2.
Reflection Exercise #12
The preceding section contained information
about strategies for counselors related to body image disorder in adolescent males. Write
three case study examples regarding how you might use the content of this section
in your practice.
Online Continuing Education QUESTION
Why has group counseling with adolescent boys suffering from body image disorders proved to be so effective? Record the letter of the correct answer