Meal support group

STEP 1: Rationale, Website Info, & Facilitator Coordination

RATIONALE

At Nourishment Works, we are committed to supporting individuals on their journey to eating disorder recovery. Our drop-in meal support group was created to offer a flexible, accessible, and supportive community for individuals working to overcome disordered eating and improve their relationship with food and eating challenges. This group is designed to provide a safe, non-judgmental space where members can share a meal of their choice, offer and receive mutual support, and connect with others who are navigating similar challenges.

Eating disorders are complex and can be particularly difficult to manage during meals, as these are often moments of heightened anxiety and discomfort. Group support during meal times can provide a sense of accountability, reduce isolation, and offer reassurance, which can help mitigate the intense emotional and psychological stress that many individuals face. By offering a flexible, drop-in format, we create a space that meets people where they are, allowing them to engage in recovery at their own pace and according to their current needs.

The Importance of Community and Support

Research highlights the importance of community support in eating disorder recovery. This group provides a unique opportunity for individuals to practice eating in a supportive environment, offering a more flexible and relaxed setting compared to structured treatment programs. By gathering in this virtual space, group members can build connections, offer mutual encouragement, and share coping strategies in real time, creating a sense of belonging and understanding that can be transformative in their recovery journey.

Balancing Flexibility and Structure

Unlike structured meal support programs in residential or intensive outpatient settings, our drop-in group allows for greater flexibility while still offering essential support. Group members have the freedom to attend when they feel they need additional guidance or companionship during meals, helping them to stay engaged in recovery without the pressure of a more formal commitment. This balance of structure and flexibility makes the group an accessible resource for individuals in various stages of recovery, whether they are in the early stages of change or maintaining long-term progress.

Our goal is to offer a compassionate, non-judgmental space where individuals can share meals, connect with others, and continue to grow in their recovery journey.

Reach out to kate@nourishmentworks.com with any questions, comments, concerns related to the rationale of this group.

WEBSITE INFO

1. Familiarize yourself with our GROUPS PAGE to review all the information needed for this group.
2. Completely read the MORE INFO to further prepare for this group.

Facilitator Coordination

Email kate@nourishmentworks.com to connect with any other interns or staff members who may be facilitating this group. If more than one intern is assigned to the group, it's essential to communicate and coordinate roles in advance. Decide together who will take the lead as facilitator and who will co-facilitate, and determine the specific dates each person will be responsible for. Clear communication will ensure a smooth group experience and to avoid any confusion on the day of the session.

STEP 2: Guidelines and Sticky Situations

Familiarize yourself thoroughly with the Group Guidelines. They are provided in text form below. This doc is also available in Google Drive of the intern email account.

Group Guidelines

• Please have a pen and paper during group meetings.

• We will begin and end group on time and ask you to do the same.

• For both in person and virtual groups, please turn off and put away cell phones and other devices.

  • During virtual groups, to help us be fully present, we highly recommend that each particpant hide your self view. You can simply put a sticky note over your image, or you can implement this in your Zoom settings.
  • To do this, select the three dots in the top right corner of the rectangle with your image, and select “Hide Self View.” Note that we will still be able to see you.
  • If you want to bring your "self view" back later, you can click on the three dots at the top right of anyone else's image, and a drop down menu will appear. Choose "Show Self View" to see yourself again.

• Confidentiality: What’s said in group, stays in group. Confidentiality and safety are priorities of each group. In joining, you agree not to use other group members’ names or disclose any information that could be used to identify them.

  • For Zoom sessions, please find a private quiet space where you are alone and others cannot overhear the group discussions or see your screen. Please wear headphones with a mic as you are able, and if you need to step away for a moment, mute and hide yourself on the virtual platform.

• Please remember to share from your own experience by using “I” statements or “From my experience…”

  • Share from the “I” and add “because...”

• As a group we commit to the practice of expressing when we are activated. Our goal is to practice communicating when we are activated in the moment. However, should in the moment processing not occur, it is encouraged that the individual circle back around when ready to bring this to group.

  • When on Zoom, please use the chat feature should you need to connect with the facilitator at any point during the group.
  • You have permission to email the group facilitator(s) at any time, including between group meetings.

• During your share, please refrain from mentioning numbers of any kind (especially related to food, weight, body, etc) unless the group has established different expectations.

• Please refrain from talking about or describing specific behaviors unless the group has established different expectations.

• Please be respectful of yourself and others in your language, attire, and behavior. Groups are a time to focus on ways we can connect with ourselves and each other. This includes refraining from self-deprecating talk.

• As a group, we are committed to practicing a non-judgmental stance. Please refrain from labeling foods or behaviors as “good” or “bad” “healthy” or “unhealthy.” This helps us continue to practice non-judgment.

• If a group involves an eating component, please be mindful to not comment or ask about another group member's food/meal to ensure a comfortable judgment free zone.

  • During virtual sessions that involve eating, we will not show each other our plates or food.

• Each group member is encouraged to talk openly and honestly about any concerns. It is the responsibility of the group member to let others know how they are feeling.

• Accommodations: As always please take care of yourself. We all come with needs. When you're comfortable sharing, please inform us of your needs.

• Given that this is a therapeutic setting, the consumption of alcohol or drugs is not permitted during group sessions, whether they are occurring in-person or virtually.

Thank you for your attention to these guidelines to help keep our group a safe space. If you have any questions about any of these guidelines please feel free to reach out to the facilitators.

As our group grows and changes, we are reminded that we are all in beta.* This list of guidelines is too and will grow and change with us. We encourage you to notify the group of any changes you would like to see in these guidelines.

*Beta is a term often used in computer software programs that means a version of a product that is in progress. It will undergo changes, get polished, and debugged.

Handling sticky situations

Facilitating this group almost always goes as planned and generally works well when you follow the script and prepare ahead of time (by choosing a specific check-in, a few conversation starters, and checking out how to start/document sessions in Healthie). Through the intake process for this group, we do our best to screen participants who are at a place in their recovery process in which they can attend and benefit from group without being disruptive or activating. However, on the occasion that something happens during a group meeting, you will want to know what to do ahead of time.

Some sticky situations may come up in the Meal Support Group sessions. Here is a list of some potential issues that may arise, why they are a problem, and some ways to address each of them. Most responses include: 1) interrupting or addressing something as soon as possible after it is said, 2) kindly reminding folks of the group guidelines, and 3) redirecting the conversation to a different topic. Other helpful responses may include: taking a collective pause to re-regulate through deep breathing, reminding the group that they can step away and take care of themselves in the moment, and offering direct support/follow-up from a staff member.

If someone seems particularly activated during the group, you can message them privately using the chat feature in Zoom and/or you can lead the group through a couple of deep breaths to stimulate emotional regulation. If a client is experiencing severe distress or issues persist, consult with the staff after to discuss what steps need to be taken.

While addressing things, remember that the way you convey things is important. People in groups may find receiving feedback extremely difficult, potentially perceiving feedback of any kind as an attack or criticism or feeling extreme shame for having made a mistake or potentially causing harm. While word choice (“calling in” the group vs. “calling out” an individual) matters, using a gentle, calm, and compassionate tone is just as or even more important.

Another addition to using a loving tone, is to simply use the language "I'm noticing..." Here's an example: "Hey everyone, I'm noticing the topic has shifted to food/exercise/weight. It's not uncommon for this to happen! And it's my role to notice, name it, and shift us in a different direction when these things come up. So let's pause this discussion and I'm going to shift our conversation to the baby raccoon videos out there, who has seen any baby animal videos? Please tell us about them!"

Remember, when you have used the host link for a virtual meeting, you should have the ability to turn someone’s camera off, mute them, or remove them from the group as needed.

Situation 1: Food talk or showing plates

• What it is: someone is talking about food, describing what or how they are eating, commenting on portion sizes or utensils, showing their food to the group, etc.
• Why this matters: Every client’s struggle with eating is different. What may seem like harmless descriptors to one client may be triggering to another client, and this group does not have a “process” component to work through how clients feel. Also, it's clearly stated in the Group Guidelines and facilitators must adhere.
• Things to do: Gently interrupt a client when they start to discuss food or show their plate, and remind attendees that the guidelines ask everyone not to engage in food talk. If a comment is made, address it as soon as possible, in the moment.
• What this might look like: If you catch a comment before it is completed, you might say, “Excuse me for interrupting, but I just want to remind everyone that we don’t engage in food talk or show each other our plates. We want this space to be safe for people at different points in their recovery, and what might seem like no big deal to someone could be very activating to others. Let’s talk about something else.” If a comment has already been made, you might say, “I notice we just heard some food talk. I just want to take a moment to call everyone in and remind us all that this group is a place to focus on our own recovery process and that any food talk might be activating to others. Let’s change topics.”

Situation 2: Comparing meals

• What it is: Commenting on someone else’s portions or food choices, saying things like, “I could never eat that!” “You’re so good to eat that!” or “That’s so much food!” etc.
• Why this matters: Eating disorders often have an element of competition, and each client’s recovery will follow an individual path. What might be intended as or sound like a compliment may actually make someone question a recovery decision or make them feel that they are “failing” at their eating disorder (or at recovery) if they hear it.
• Things to do: Interrupt a comment if you can, or jump in after a comment to remind attendees that comparison is not appropriate for this setting.
• What this might look like: “Let’s remember that we don’t comment on each other’s meals, please! Recovery looks different for everyone, and I want to make sure that everyone is able to make choices that support their individual recovery without comparing them to anyone else’s.”

Situation 3: Sharing inappropriate numbers

• What it is: Someone mentions weight, BMI, calories, food or body measurements, clothing sizes, etc. Note that dates, times, and ages are usually appropriate to share, but use your judgment and be prepared to address anything that makes people uncomfortable.
• Why this matters: Eating disorders show up in many different ways. Some people may have little distress about numbers relating to body size (like clothing sizes, weight, or BMI) but may be very activated by numbers related to food (like calories or measurements of foods). The reverse may be true for another client, and others may find all of these triggering.
• Things to do: Interrupt a comment about any of these numbers as soon as you hear it, especially if you can do so before they mention any thoughts about the numbers. If something slips by you, address it as soon as possible, offer a check-in to help people re-regulate, and remind folks they can use the chat to message you directly.
• What this might look like: If you catch a comment before it is completed, you might say: “Excuse the interruption, but I just want to remind everyone that we ask people to refrain from mentioning numbers. We want to make sure the conversation stays appropriate to meal times for everyone no matter where they are in recovery. Let’s talk about something else.” If a comment has already been made, you might say: “I notice we just heard some numbers. I know that may be very activating for people, so I’d like us to pause for a moment, take a deep breath or two, and check in with what we need right now.” (Model this by taking a visibly deep breath or two with your hand over your heart. Keep your eyes on the group members, and see if you notice anyone having a strong reaction.) “Let’s get back to the meal, and if anyone needs to message me directly please feel free to use the chat function.”

Situation 4: Someone sharing inappropriate information or TMI for this setting

• What it is: Talking about bodily functions, describing very distressing events or relationships:
• Why this matters: This is a support group to eat a meal in a supportive social setting. We want the conversation to be lighthearted and engaging to help balance distraction/distress tolerance during the meal.
• Things to do: Redirect during or after the comment.
• What this might look like: “Let’s get onto a different topic; I want to make sure we keep this conversation light and appropriate for a meal group.”

Situation 5: Asking too many questions or for too much personal information from others

• What it is: Asking clients or facilitators about romantic relationships, for details about a client’s job, about where someone lives, etc. This may extend to anything that appears to make the person being asked uncomfortable.
• Why this matters: Clients have agreed to respect each other’s privacy and the confidentiality of attending group sessions. People may not want to share personal information about their lives for various reasons, including not being “out” in their sexual orientation or having a sensitive job. Regardless of the reason, clients should not feel pressure to share anything they don’t want to in this setting.
• Things to do: Remind folks that this is a meal support group and that people may have different comfort levels about sharing personal information. Redirect if necessary.
• What this might look like: “Let’s remember to respect each other’s privacy please. We want everyone to share at their own comfort level without any pressure. What do you all think about {different topic}?"

Situation 6: Someone takes up too much airtime/impedes others’ ability to participate

• What it is: Sharing much more than was asked, speaking for a long time without stopping, responding first to every discussion prompt, etc.
• Why this matters: In groups, it’s important to create a space in which everyone has the opportunity to share, speak, or be quietly present as they choose. When someone speaks a lot during a group, it may discourage others from engaging, especially if someone does not pause or leave space for others to chime in. As a facilitator, you set the expectations for group dynamics and can shift the communication patterns if they are not conducive to everyone participating.
• Things to do: Invite other group members/everyone to respond to a new prompt or ask "who have we not heard from?" If after this general redirection, someone continues to take up a lot of verbal space and it seems disruptive to the group, you can be more direct in inviting others to speak. If someone still seems completely unaware that they are being disruptive, you can follow their contribution with a comment about leaving space for everyone. Generally, this is not something to directly confront a client about during group unless it seems to be malicious/purposefully disruptive.
• What this might look like: “Let’s hear from everyone; what do people think about {topic}?" or “I notice some folks have not chimed in; from those who have not shared, what thoughts do you have about {the current topic}?” or simply, “What do others think?” If gentle redirections have not helped, something like, “Let’s be mindful of our airtime and make sure we give everyone a chance to participate” may help. If a client does not catch onto any of the redirections, you can follow up with the staff (Kate) after the group to discuss alternatives to address the issue.

Situation 7: Abusive, disrespectful, or malicious/disruptive language, behavior, or attire

• What it is: This includes the use of offensive or hurtful language, disregarding group boundaries, engaging in disruptive behavior, or wearing attire with offensive or harmful messages (including clothing that promotes dieting or weight loss). Examples may include escalating disagreements, refusing redirection, or inappropriate displays of the body.
• Why this matters: Our primary goal is to maintain a safe, welcoming space for everyone. Every member deserves to feel respected and valued. While we honor individual expression, it's equally important to ensure that all attendees feel safe and supported during the group. Addressing harmful or inappropriate language, behavior, or attire is necessary to protect the integrity of the group environment.
• How to respond: If a group member engages in disrespectful or harmful behavior, respond with compassion but firmly address the situation. You can turn off the person’s camera and privately message them to ask them to pause or adjust their behavior. If the behavior continues or they do not respond to your request, calmly explain that for the safety of the group, you will need to remove them, and then do so. Afterward, reassure the rest of the group that the situation is being addressed. You may find it helpful to lead the group in a grounding or breathing exercise to restore a sense of safety. Encourage group members to check in with themselves, and let them know that you or another staff member are available to follow up if needed.
• How this might sound: When addressing the member, you could say, “We need to keep this space safer for everyone. The language/behavior you’re using isn’t okay for this group. I’m asking you to stop so we can continue supporting each other.” If the person apologizes or adjusts their behavior, acknowledge their response with appreciation and continue with the group as normal. If they don’t respond or the behavior persists, calmly state, “Excuse me, but for the safety of the group, I’m going to have to remove you.” After the person is removed, gently reassure the group by saying, “What just happened was not okay. I will be following up with Kate and our team to make sure this is fully addressed. Let’s take a moment to breathe together and reset.” Lead the group in a brief breathing or grounding exercise, and offer them the option to reach out for individual support if needed. You might say, “If anyone feels like they’d like to talk more about this, let me know, and we’ll make sure someone follows up with you.” Write down any names of those who request follow-up and notify Kate after the group.

STEP 3: Facilitator Instructions and Script

As the facilitator of this group, you are expected to follow the script and be mindful of the timing as you lead the group session. If you are co-facilitating, please familiarize yourself with the group format and expectations so you can support the facilitator and model present and supportive behavior for the clients.

Before Group

1. Have the food/beverage you plan to consume during group ready.
2. If you are facilitating, start the Zoom meeting in advance (at least 5-10 minutes early). To do so, sign into Healthie, and open the calendar in the "Organization" tab. Locate the scheduled event on today's date in the calendar, which will have the title "Mindful Eating Support Group." Click on the event, then on the pop-up sidebar, use the blue "Click to Join Zoom Meeting" link to launch the group. When facilitating, make sure you do not use the client link to make sure you have full access to the host controls of the Zoom Meeting. If you are not facilitating, you will want to use the host link and update your name (see below #5) in case the facilitator is disconnected, so clients are not assigned to be a host.
3. Once you as the facilitator have started the meeting, make sure that all clients who join prior to the official start time remain in the waiting room until then.
4. Make sure to allow any other interns and staff who are attending to enter group as they arrive.
5. Update your Zoom name according to the group format: (Name, pronouns, title). For example: "Kate she/her staff" or "Sam they/them intern"
6. Make sure that if you're facilitating, you have a timer (typically easiest to use one on your phone) set up for the group's check-in interval and that the volume is set to be loud. Choose a pleasant chime to play when time is up (we often choose "Crickets" or "Timba" when using the iPhone timer).
7. Choose a few conversation starters from Step 7 (or appropriate ones for an eating disorder group from elsewhere) to have ready during the group. Topics that have sparked more discussion successfully have included TV shows and movie recommendations, tik-toks, animals/pets, and "would you rather" questions. Make sure to have some questions that everyone can speak to so no one feels left out.
8. At the actual start time of group, as the facilitator, you will click to “admit all” clients into the Zoom meeting from the waiting room.

FACILITATING GROUP

Please use the following rough timeline and script. You will read the italicized print out loud to the group attendees.

Welcome (Time: 6:00-6:02pm CST) (allow 1-2 minutes for everyone to arrive) Hello! Welcome to our Meal Support Group. We're glad you are here. I’m {{state your name & pronouns}}, and I will be facilitating tonight’s group. Let's start with a brief tech check in. Give a thumbs up if you can hear me? Thumbs up if you can see me? In order to see everyone else, you can select gallery view at the top right of your Zoom window. We recommend that to get more of an in-person feel during this group, you hide your self-view. To do this, select the three dots in the top right corner of the rectangle with your image, and select ‘Hide Self View’. We will still be able to see you.

If you want to bring your "self view" back later, you can click on the three dots at the top right of anyone else's image, and a drop down menu will appear. Choose "show self view" to see yourself again.

As a reminder, group will end around 6:50 central time. There is no official bathroom break during this group, so please do what you need to do to take care of yourself. If you step out or pause your video, please feel free to send us a "BRB" in the chat. Please also note that we might be in different time zones, or joining group for different reasons. Some people may be joining for accountability and community before or after they eat a meal rather than during it. We encourage everyone to do what best serves their recovery.

In case anyone is joining for the first time, I'll just give a quick overview of what to expect. To start, we'll do introductions and a quick check-in. I'll lead us through a mindful moment together, and then we will each set and share individual intentions for tonight since we might be working on different goals for our recovery. After that, I'll share the prompts, and we'll start our meal and conversation. Every few minutes, we'll take some individual time to answer the prompts. After the last check-in with the prompts, we'll do a check out and share reflections if there is time. Sound good?

Introductions & Intentions (Time: 6:03-6:06pm CST) Let's go around and share three things:

1. Your name and pronouns
2. A statement on how you're doing as you join group
3. Set an intention for tonight’s group

Who would like to start?

• Jot down each client's answer to include in the Healthie note later.
• Always make sure everyone has introduced themselves by saying... Is that everyone? before moving on.

Intention examples if someone needs guidance: Staying engaged and connected, completing your meal or leaving some behind, attention to meal pacing, tuning into the hunger/fullness scale, to be present, to connect with others during this group, etc...

Mindful Moment (Time: 6:05-6:06pm CST): Read this section slowly and calmly. The mindful moment should only last one minute!

• Let's shift to sharing a mindful moment together. Begin by slowing down. Get comfortable in your seat, take a deep breath, and settle in. {Pause at least 5-10 seconds}.
• As you take another breath I invite you to soften or close your eyes. {Pause at least 5-10 seconds}.
• There is no right or wrong way to do this practice. As you take another breath, notice your chest rise and fall. As you notice, allow your awareness to drop down into your heart and get connected. {Pause at least 5-10 seconds}
• Take another breath. If you'd like, place your hand on your heart to deepen your connection. {Pause at least 5-10 seconds}.
• At this time I invite you to do a hunger/fullness check-in. You may drop this practice or participate. You decide what's most helpful for you in this moment. Shift your awareness to your belly and take another breath. {Pause at least 5-10 seconds}.
• Simply notice where you are regarding hunger/fullness. {Pause at least 5 seconds}
• Take another breath and begin bringing your awareness up to your head and back towards your eyes. {Pause at least 5 seconds}.
• When you're ready, gently open your eyes and jot down where you are regarding hunger/fullness if you did this practice. We will have a chance to check in with hunger/fullness again at the end of group.

As a facilitator, you don't need to call on people, but make sure everyone gets an opportunity to share. When the group members seem to be done sharing, you can ask, Did everyone who wants to share get a chance to do so?

Take note of the time that the meal starts and begin the conversation and begin eating. Use the "Conversation Starters" you planned or choose a few from Step (further down on this page) to start a discussion.

Halfway Announcement (Timing is based on when you started and when group ends; usually the halfway point is between 6:20 and 6:25pm CST) For anyone that is working on pacing, we are halfway through the group.

Closing Group/Reflections (Time: 6:45-6:50pm CST)As we conclude the group session, take a moment to reflect on what you have learned or experienced during tonight's group. I invite you to share one thing that stood out to you tonight, whether it relates to your intention, is an insight about your experience, a change in perspective, or how your feelings shifted/stayed the same throughout the meal. {Pause to allow reflection.} Who would like to share?

Please note, sharing is not a requirement but an invitation. Make sure everyone who wants to share a statement can and for those who did not want to share, simply move on.

Thank you all for being here tonight, have an enjoyable evening and we look forward to having you all with us again next week, same time/same place!

As the facilitator, always be the last one to log off. Should a group member want to check in with you about something, they can do it at this time. Once everyone has logged off, end the meeting in Zoom.

STEP 4: Admin/Post-Group Tasks

Track Attendance and Write the Note in Healthie

If there is any other status option that needs to be selected, such as no one shows up to group, mark cancelled then notify kate@nourishmentworks.com and billing@nourishmentworks.com that no one attended group.

Add attendees to next week's group meeting

Open next week's group in the Healthie Calendar, and add any clients that attended tonight and need to be added to next week's group. Clients receive a notification when they are added to the group in Healthie.

Assign Follow-up Task to Kate

After finishing the note and adding attendees to next week's meeting, you will assign a Healthie task to Kate letting her know that the group note is completed and ready to be reviewed and signed by a licensed clinician.

To do this, click the button in the top bar of Healthie that has a box with a checkmark in it. Click into the text book that says "Write New Task Here." Write "Meal Support Group Note for (Date) is complete" and click the plus sign to Assign Provider/Tag Client. A pop up will appear. You can either scroll down in the top part of the list or start typing Kate Merkle into the search bar. Select the listing that has Kate's picture and the title of provider, then click "Add." Once that popup closes, click the blue bar that says "Add task" to send the task to Kate.

This concludes our Meal Support Facilitation Training!

Thank you for all your help and support! Our clients value the opportunity!