Many young children and teenagers find individual therapy so daunting that they just clam up. They see the therapist as yet another adult who doesn't understand them and who is trying to make them do something they do not want to do. Certainly Joe fitted into this group. He couldn't really communicate with his keyworker (psychotherapist) on a one-to-one basis. He liked her, but he felt he was well on the way to getting better simply by being at the in-
patient unit and he didn't feel comfortable discussing personal issues with her. Instead he would pour out all his troubles to me and then I would try to relay them back to his keyworker.
In contrast he found the group therapy sessions at the unit much easier to deal with. Some of the sessions encouraged the patients to speak about their difficulties. Even when Joe didn't join in he derived some benefit from hearing about how the other patients were feeling. Other sessions were more structured with role-plays and problem-solving tasks. Joe found these sessions useful, easy to participate in and he even enjoyed some of them.
Many patients feel safe in group therapy sessions. They are with people experiencing similar problems and feelings. They can join in if they feel like it or be passive observers if they don't. Many patients have been suffering from feelings of isolation and low self-esteem for some time. They soon realise that other patients in the group feel the same way. In a successful group the patients will stop looking just to the therapist for support and they will start to give each other support.
To participate in a group session the patient needs to be able to overcome any fear he may have of interacting socially. This is important as many anorexics lack assertiveness. Group discussions enable the patients to re-evaluate their attitudes to shape and body weight through other people's eyes. This can help them to realise how illogical and irrational their thought processes have become. As a patient becomes bolder and more confident he can make a positive contribution to group discussions and start to question his fear of food and becoming fat.
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