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Why intensive and why group therapy?

P
eople with eating disorders are experts at rationalizing or shutting down completely in sessions that last one hour, or even in two-hour-long group sessions. These sessions must be long enough for patients to let go of their obsessions. Learning more about their past or behavior, doesn’t really help everyone move forward. Some stay trapped like prisoners, unable to find an escape, feeling an emptiness that only food can assuage. Intensive sessions that focus on the present and on interpersonal relationships (which last at least a few days per month, or even every three months) are more effective for observing dysfunctional thoughts and behaviors. They also provide enough time for people to learn how to be themselves and, at the same time, how to be with others.

In intensive therapy, because of the “mirror effect”, people may be surprised to feel things that run contrary to what they always thought. The interactions incite them to take a step back from their feelings and thoughts, even when the exercise is about someone else

My thirty years of experience now more than ever support a different approach. Today, psychiatrists recognize that the origin of the problem is a vulnerability that stems from early childhood (even though the problem does not generally appear until adolescence). Actually, most of the time, all over the world, the traditional therapeutic approach to eating disorders is still oriented toward nutrition, body (relaxation, personal styling…) enriched by art-therapy or verbal-expression workshops.

My experience as a psychologist with thirty years of experience and also an ex-bulimic leads me to propose a different therapeutic process. Of course, I agree that people with addictions (no matter the addiction) have an enormous need to relax, to express themselves, to reconnect with their body. But according to my experience, they are unable to properly do so. They need first get rid of the “broken record” of their unresolved identity and relational problems. They need to discover who they are and what they need in relationships with people other than a therapist (whose position must be neutral). They need to discover what their true values are (and not those they have adopted as a reaction to/against their environment) and how to live with others according to those values.

One of the greatest advantages of group therapy based on the present is that it requires authenticity. The interactions between people, and the role-playing games, allow people to drop their masks, focus on themselves (without excluding others), and getting rid of their shame by taking responsibility for one’s feelings, which leads to higher self-esteem..

T
hanks to the interactions, role-playing games, and the authenticity of the group, they learn to re-examine, to stand back, to talk more about how they feel in the moment of the group. The focus isn’t on what they think about their lives, their pasts, their parents, or their bodies (which would only lead to intellectualization or rumination), but on discovering through their reactions, in the present of the group, who they are and how they can successfully exist among others without sacrificing themselves or abusing others.

This kind of psychotherapeutic work must be the first priority to gain self-esteem. Entering into real relationships with others and with oneself is the only way to be free from obsessions about food and even other symptoms. Some in the group speak liberally, others are reserved, but all are affected by this work, which is based on a deep investigation of emotions and values.