Tuesday, 2 February 2016

Group therapy - the good, the bad and the potential triggers

Today's blog post has been inspired by a topic we discussed in this morning's group on the day program. The Tuesday morning group Body Image, where we were discussing how we feel in groups situations which was a continuation from last week's session.

The discussion lead to talking about group settings and how changes can really affect the dynamics. Changes within a group setting causes me a lot of anxiety whether this be in a work or treatment setting. We currently have two places available on the day program and someone is currently being assess - I am trying to not this get to me because I found this distracted me when I was an inpatient and I am trying really hard to focus on myself. While I am dealing with these feelings better this time; the group's anxiety about someone leaving last week and the possibility of someone new joining and how this may change the dynamics. As it is a small group (maximum of six at any one time), changes can really impact how everyone feels. Obviously, I am fairly new in the group but the other patients have been amazing at welcoming me and making me feel part of them.

Something which the other patients highlighted to me, is that the greater anxiety we have about the changes in the group are higher than say at work; this is because in treatment you are expected to make yourself vulnerable and this can be extremely difficult. Especially as you are challenging yourself on a daily basis on the day program - you are implementing new meal plans and are expected to put on weight.

Group therapy plays a major role in eating disorder recovery, whether this be in as an inpatient, day patient or finding groups to attend as an outpatient (which I have done before). I wanted to discuss the pros and cons of group therapy and some of the approaches to take when attending therapy.



Pros of attending group therapy

  • Finding people you can relate to and understand what you are going through
Eating disorders (and mental health problems) can be isolating and lonely. As well as part of the eating disorder is isolating yourself from people round you, it can also often feel that no one really understands how you are feeling and what you are going through. While doctors and therapist can speak to you about how you are feeling - sometimes you just need an honest, down to earth conversation which makes you feel less alone and realise your behaviour is not only just you! When I was first admitted as an inpatient I remember a huge sense of relief when talking to other patients - I wasn't alone! Groups can give you the opportunity to meet people who you can relate too, while you may not be from the same background or be suffering from the same problem, there is a sense of unity in understanding amongst the group. When you start thinking "omg me too, I do that too!" it can feel like a weight has lifted off your shoulders. I met one of my closest friends in an inpatient setting and I quite honestly do not know what I would do without her support, I joke that she is like my AA buddy.

  • It provides a place for you to vent your feelings and difficulties
  • It can help with building a support network
  • It is a place to learn new coping mechanisms and learn from others' experiences
Now this last one is particularly important - people at the group might be able to give you insight into some of your feelings and behaviours. They even might be able to suggest different coping mechanisms and what may or may not have worked from them. Having professionals in your life is great, however, sometimes the best advice can come from someone who has been through it themselves. It can also be more reassuring, when a professional says to me "it gets easier" - I think hmm course it will, when a patient says that to me, it fills me with hope as they have directly experienced it.



Cons of group therapy
  • It can be triggering...enough said really!
  • Unfortunately not everyone will consider your feelings when talking about their issues.
  • Conflict - I think their is always the potential of conflict when you put a group of individual together where they are discussing quite sensitive topics and making themselves vulnerable.
  • Picking up unhelpful behaviours
This one can be particularly harmful - this is something I struggled with as an inpatient and found really hard to separate myself from.
  • Feeling judged by other patients
This can be difficult - the other day someone commented on us both eating a cheese sandwich and the extremely high fat content in it. Comments like this can be quite upsetting - so be prepared to have to rationalise the thoughts this may bring up. Plus cheese sandwiches rock :)
  • Comparisons - speaks for itself really.
  • Picking up negative feelings
When I was discharged from inpatient treatment my therapist recommended seeking out further support before my sessions ended. So I started attending an eating disorders group which I found online. I found the group impacted my mood - my sister even said she had noticed that when she picked me up from the group I was consistently in quite a low mood. I did not find it helpful or productive, while I do not think this was a reflection on the group, but more so the impact it was having on me. So this is one to watch out for! Not all groups will be for you!


So now we have discussed the good and bad - I wanted to highlight things to consider when joining in group therapy!

  • If this is a group you are choosing to attend i.e. it isn't forced as part of an inpatient treatment, then always attend more than once. One sessions is not enough to decide whether it is for you or not. Small changes in the people who are attending the group that day can have a huge impact on the dynamics - remember some individuals may not attend every session. Remember to give it a try!
  • Be open to trying new things even if you don't think they will work - as part of the day program I attended dramatherapy - now I was sceptical and not really looking forward to it, but do you know what I actually enjoyed it. It made me feel more connected to the other two individuals on the program and I felt like it was really helpful. You never know what is going to work but be willing to try everything at least once, it can't hurt right?
  • Be honest! It can be so hard to be vulnerable but if you are not honest people can't help you. I always find I would rather say "I don't feel comfortable discussing this" rather than making stuff up.
  • Stay away from numbers - I think this one is pretty self-explanatory.
  • Be considerate of other people's feelings.
  • Be willing to be challenged on your views and fears - remember recovery is not meant to be easy and will not always feel comfortable!
  • Last but most certainly not least, always consider how this is impacting your recovery! If it is an unhelpful environment leave it, if you are finding it is negatively impacting your recovery then remove yourself from the situation. You and your recovery is the most important thing and these situations sometimes you need to be selfish!


Sometimes it is important to attend treatment with blinkers on. Remember you need to focus on yourself and not to pay attention to unhelpful behaviour. Your recovery is about you and how you want to change. This time I have enterered treatment I have had a very different mentality, if someone makes a comment about cheese, that is their eating disorder impacting them, but I want to fight through this and not let their eating disorder thoughts become mine. It isn't an easy task, but it is important to enter these situations with an awareness and understanding that this will be a potentially triggering environment, look after yourself, self-care is important and hey it isn't for everyone. So what may work for one person, may not work for you, that isn't a reflection on you as a person, everyone responds to treatment different. Be kind to yourself :)



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