Sociocultural Model Applied to Client
Several examples of sociocultural influences are seen in Sarah's case. First, Sarah's interest in reading fashion magazines at the gym and watching reality shows about modeling may make her vulnerable to thin-ideal messages. In counseling, she reports that she has always enjoyed reading fashion magazines and that she often compares her body with those of the models and believes she comes up short. Second, Sarah's relationships with her siblings are characterized by criticism and competitiveness. Sarah describes her older sisters as successful, and she has always tried to prove herself to be as smart, athletic, and attractive as them. Sarah believes that her siblings have always been supportive of her, but she notes that when they teased her about being chubby she felt very hurt, lonely, and rejected. Third, Sarah's relationship with her mother is complicated because they were involved in dieting and weight loss efforts together. Although Sarah believes this brought her closer to her mother, it may also have contributed to her eating concerns by modeling unhealthy dieting behavior. Thus, Sarah has felt pressure from both the media and her family. Her tendency to be a perfectionist has likely contributed to her sensitivity to these pressures and to her desire to attain the ideal body.
Recommendations for Treatment
Sarah may benefit from a cognitive-behavioral approach that examines her distorted thinking related to body image. This approach is currently the most popular one used to treat EDs (Fairburn, 2008; Jarry & Cash, 2011) and is also part of a very effective approach to prevention (e.g., C. B. Becker et al., 2008). Sarah appears to have developed some unhealthy ways of thinking about her body, she engages in frequent comparisons, and she has low self-esteem. A cognitive-behavioral approach can, for example, encourage Sarah to challenge and replace her negative beliefs about herself as the overweight runner or the chubby little sister. This approach can also help Sarah to critically examine the media sources she consumes and how these sociocultural influences affect her beliefs about her body and appearance.
Sarah may benefit from an interpersonal approach that examines her relationships with significant others and the counselor. Sarahs relationship with her boyfriend may have been characterized by anxiety about emotional closeness, and this pattern may also emerge in her relationship with her counselor. For example, an interpersonal approach could encourage Sarah to practice in counseling how to talk about her difficult emotions without fear of being rejected or dismissed, as she felt she was growing up in her family of origin.
Sarah may benefit from a family systems approach that addresses the family dynamics that have contributed to her eating concerns. A timeline approach might be helpful in determining how specific events and relationships may have made her more vulnerable to developing eating and body image concerns. For example, a family systems approach can encourage Sarah to examine how receiving negative messages about her body from her mother and sisters may have contributed to her body image disturbance.
