Eating Disorders, 23:89–97, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1064-0266 print/1532-530X online DOI: 10.1080/10640266.2014.940789
HOW I PRACTICE
Using Experiential Group Therapy in the Treatment of Eating Disorders RANDY K. HARDMAN, MICHAEL E. BERRETT, P. SCOTT RICHARDS, and SHARON BLACK Center for Change, Orem, Utah, USA
During the past 18 years as we have worked with women in a residential eating disorder treatment center, we have developed and used a wide variety of experiential interventions and activities in group and family therapy, such as family sculpture, psychodrama, life experience reenactments, and structured role plays. These activities make the implicit more explicit so that each patient has opportunities to increase awareness of her power to choose to change. Patients become more honest as they make real connections to themselves and with the other women in the group. Another benefit of experiential group activities is that patients can experience and share emotions that have been previously repressed. They can have new, corrective emotional experiences. Experiential activities can also help women understand more about the nature of their eating disorder and the impact it is having on them. They can make connections and revisit relationships they have avoided. Experiential activities can help them recognize that they are worthy of love and can accept love that is offered to them. When handled appropriately, experiential activities can provide powerful healing opportunities for patients.
GENERAL PROCESS GUIDELINES FOR EXPERIENTIAL GROUP ACTIVITIES In experiential activities, a group therapist needs to be specific in setting up and processing the activities of the group. He or she will need to take a Randy K. Hardman is now affiliated with the Counseling Center, Brigham Young University-Idaho. Sharon Black is now affiliated with the McKay School of Education, Brigham Young University. Address correspondence to Michael E. Berrett, Center for Change, 1790 North State Street, Orem, UT 84057, USA. E-mail: [email protected] 89
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leadership role; direct the processes; explain the experiential interventions; and fully engage patients in honest and emotional ways that can be lost in talk therapy alone. Because patients most often tend to hide from the real issues and conflicts in their lives, the therapist must take responsibility for creating and supporting the energy in these experiential group sessions and for directing the process in ways that help patients develop self-awareness, emotional connections, and relationship experience. It is also the therapist’s role to provide empathy, encouragement, and validation, and to nurture hope in the group processes. The therapist provides the necessary direction in the structured events and guides the exploration and interventions that grow out of each event. The therapist can help patients see what they cannot see themselves. In many ways, recovery is a process of self-discovery and renewal, a process of change from the inside out. Such a change in awareness sometimes begins with patients taking risks during experiential interventions. Therapists can use whatever level or degree of emotional intensity that occurs within the structured experiential group activity. There are no hidden agendas or expectations about what should happen in any activity or group process. No outcome is predetermined. Experience has taught us over the years that totally dissimilar group outcomes can result from the same activity. Emotional intensity is based on honest expressions of the patients who are involved in any activity in the moment. The therapist accepts what happens and attempts to work with whatever level of emotional intensity occurs. The therapist is ethical and direct and approaches each group member with sensitivity to her readiness for change. Many patients are not ready to take full advantage of all they experience in every activity. Since members in the group are at different levels of recovery, therapists must take care to avoid asking individuals to go further at any point than they are ready to go. Group members will learn from other patients who are ahead of them in the recovery process. It is important for therapists to make sure that group activities are varied over time so that activities that generate painful awareness such as sadness or anxiety are counterbalanced with experiential experiences that generate positive awareness such as hope and love. Achieving this balance is important because most patients have lived with one-sided negativity for a long time.
EXPLORING THE PATIENT’S EATING DISORDER WORLD Exploring the patient’s eating disorder world—a world in which she denigrates and hides from herself—is the first step in treatment and recovery. Experiential activities can help patients acquire more realistic understandings of the eating disorder and more healthy views of themselves.
How I Practice
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Activity: Enacting the Negative Mind This activity awakens self-awareness by vividly portraying the negative mind and eating disorder messages of the individual with the disorder, including all inner self-criticisms and negative self-judgments. Participants are asked to get into groups of three, designating one to stand between the other two as the first focus person for the activity. One group member’s role is to whisper the messages of the negative mind into the focus person’s ear; the other group member simultaneously whispers messages from the positive mind and heart. The person speaking for the negative mind whispers thoughts she hears inside her own mind, anything she knows about the focus person’s negative thoughts, or the general negative messages of an eating disorder. We encourage the person representing the positive voice to express affirmations of support, hope, and love. We encourage both voices to struggle for the heart and soul of the focus person. As patients participate in this activity, the room becomes full of voices, messages, energy, and commotion. The group members in each triad take turns participating in each role and have opportunities to share and process their experiences from each perspective. We then ask the same triads to go through the activity again, but this time, we ask the focus person to make a genuine effort to listen and tune into the positive voice and messages. We do not instruct them to ignore the negative mind. We simply ask them to choose to listen to the positive messages and to see if they can hold onto that voice. We help them see that the messages they choose to listen to impact their beliefs and their mood. We emphasize that although negative eating disorder messages will come to their minds, these messages do not have to be believed or obeyed.
BEING HONEST ABOUT LIFE EXPERIENCES Therapists can help stretch their patients’ emotional comfort zones as they strengthen the expectations of honesty during group work. If patients know that vulnerability, genuineness, and honesty are expected in each group session, most of them will plan for it and many of them will actually look forward to the opportunity.
Activity: Reenacting Life’s Experiences Avoidance and denial are much more difficult to maintain and openness becomes more natural in a group activity in which the patients’ lives are shown or played out in front of each other. Individuals cannot as readily defend or protect against their own experiences and emotions when these experiences are apparent in the group activity. The experiential activities
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invite group members to let down their defenses to become more honest and real because other patients are doing the same. In providing these opportunities, we sometimes use family sculpture and structured role plays to re-enact aspects of family life, such as traumatic experiences, relationship conflicts, and communication patterns. In small subgroups, patients might role play a family heartache or triumph—something real—and play it out, with everyone in the small group participating. Many patients are excited to actively create these scenes from their lives, and the other group members enjoy participating in the activity. All group members can find something of themselves in the reenactments. With honesty and openness they explore aspects of the event and see possibilities or choices that could have been different. With anticipated events they can rehearse difficult or threatening encounters. During these enactments, patients can safely notice things about themselves or others that they have never before allowed themselves to see or feel. Group members offer support by observing and sharing their insights and feedback. No one is allowed to hide or avoid, but everyone is engaged in the therapeutic work and recovery process.
Four Levels of Honesty Complete honesty met with acceptance from group or family members can help patients experience vulnerability as empowering and opens their hearts and minds to the possibility of change. Most patients are self-critical while they are learning to express themselves more honestly. They feel a sense of vulnerability, and the therapist needs to provide encouragement and support for their risks and honesty. We encourage four levels of honesty (see Table 1) when working with patients in experiential activities. The first level of honesty is to simply tell the truth—to “say it without hiding anything.” To be honest in this way, the patient needs to put what is going on inside her out in the open. Patients are often initially uncomfortable revealing themselves truthfully, although doing so is crucial for them to begin the change process. The second level of honesty is to tell the truth without self-judgment and self-contempt. Patients can learn to be honest without unrelenting selfcriticism. At the point in recovery when they regain the ability to experience and honestly share their emotions, it is important for them to do so without beating themselves up with shame and self-judgment. Experiential activities can help patients learn to do this. A third level of honesty is to engage in honest self-correction with self-kindness. Honest self-correction with self-kindness makes possible new choices and self-improvements over time as patients gain more awareness about what they need to change in order to recover. Patients experience a
93
How I Practice TABLE 1 Four Levels of Honesty in Experiential Treatment of Eating Disorders Level Level 1: Tell the truth
Patient Holds nothing back Stops denying, pretending, hiding Reveals lies, secrets, deceptions Talks honestly about pain, fears, conflicts, choices, beliefs, behaviors Becomes willing to be vulnerable
Level 2: Be honest without self-judgment or self-contempt
Learns to be “neutral” and non-judgmental Allows self to experience emotions and feeling again
Experiences a personal and positive level of genuineness and vulnerability Separates addiction and problems from sense of identity Decreases avoidance, increases self-congruent expressions Level 3: Be honest with ongoing self-correction and self-kindness
Level 4: Accept and benefit from truths offered about self from others
Therapist Invite and encourage honesty Recognize that shame, self-contempt may still be present, despite relief Anticipate that pain will accompany relief Support with kindness, empathy, reassurance Recognize the pain and risk of vulnerability Be receptive, encouraging, and affirming Encourage patient to be more present and connected to her feelings, conflicts, and pain while expressing them honestly. Help patient expand, clarify, and explore the honesty Guide patient in seeing herself honestly and accurately Keep her from “beating herself up” over what she reveals
Shifts to new perspectives, strategies, and corrections in recovery within the framework of self-kindness Focuses on changes in the present time, and becomes more positive and hopeful about personal responsibility and choice Becomes more open and flexible—learns more quickly from life’s experiences Senses belonging and inclusion—feels connected with herself, with other people, and with higher power Learns to trust herself, feels self-empowerment
Teach, validate, and support self-kindness in honest self-expression
Increases in ability to “hear,” “see,” and “feel” positive messages, personal truths, and expressions of love
Support the patient in sensitivity to the quiet messages of the heart
Clarify and assist in self-corrections, positive choices and changes Help her see that what needs correction is not about her personal identity. Support context of self-kindness and compassion that encourages these connections Encourage self-trust, willingness to take risks, and ability to follow through
(Continued)
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TABLE 1 (Continued) Level
Patient
Therapist
Becomes more sensitive to emotional and spiritual impressions Develops capacity for self-validation and positive sense of self Increases emotional connection to family, friends, and others Becomes more reciprocal in relationships: empathy, kindness, love and service to others
Recognize and support intuition and spiritual growth Support patient’s recognition of personal strengths and abilities Recognize and encourage relationship connections Point out and encourage aspects of giving and receiving love in relationships with others
sense of empowerment when they realize they can correct mistake and have choices over the eating disorder. This helps them recognize that the eating disorder is the problem, not who they are. Experiential group activities can facilitate honest self-correction with self-kindness by encouraging honesty in a context of loving acceptance. The fourth level of honesty is to choose to accept and benefit from the feedback and love offered by others, and for spiritually minded patients, from God or their Higher Power. As patients learn to accept feedback and love, their capacity for self-validation grows. Their emotional connection to family and friends increases. They become more reciprocal in their relationships, showing forth more kindness and empathy to others. They become more sensitive to the spiritual and emotional impressions of their heart. Experiential group activities give patients opportunities for receiving and accepting feedback and love from others.
RECEIVING LOVE It is love that speaks to the hearts of those who suffer from eating disorders and creates a positive context for change. Love creates a powerful and safe atmosphere in group experiential activities. It becomes, over time, a very important part of the group experience for the patients to mutually give and receive love. Patients begin to openly express their tender feelings of love and genuineness honestly to one another, and to receive expressions of love from others. These loving connections can be free of judgment or conditions. Over time individuals struggling with an eating disorder tend to lose the positive connection to their heart and to love. It feels good to them to experience love again. One of the powerful ways to evoke change is through the experience of love that is shown and felt by group
How I Practice
95
members during experiential activities. When a patient has an experience of love in an experiential group activity she begins to see that she is not alone and that she can replace her eating disorder with real purpose and loving connections.
Activity: Receiving Love With Tissues One young woman’s experience with love and tissues is given as an example of a love-based activity. A college-aged patient believed with all her mind that she was the exception to love: She was too broken, too undeserving, and too unacceptable. Because she felt she had not merited love, she refused love, even though there were many people in her life, including many women in the group as well as staff members, who loved and cared for her. For this experience we had her sit on a chair in the front of the group and had other participants in the group come to her one at a time with white tissues in their hands. One by one they knelt before her and handed her a white tissue as they expressed each statement of their loving appreciation and affirmation of her, each describing a specific perception, experience, or remembrance of her or a particular gratitude they felt towards her. When the activity was nearly over, the patient sat with her arms full of white tissues and many tears were running down her face. She said, “I can see the love.” She could not deny it; it was tangible and real. She talked with the group about her desire to let their love in, to feel it, and to let it help her. She expressed her desire to stop running away from love. She knew that to recover from the eating disorder, she would need to let love in wherever it was available. It was a turning point in her recovery and a powerful message for all the women in the group. Everyone in the group can participate in this activity as both givers and receivers of love. For many patients it is an opportunity to receive love in ways that were lost to them during the development of the eating disorder. The therapist should attend to the reactions of all group members, not just the patient in the chair. Sometimes exploring the emotional responses of the non-focus group members can provide powerful healing opportunities.
Making Connections Recovery is often about relationship connections. As patients disconnect from the illness of their eating disorder it becomes paramount that they have something to reconnect to in order to replace it. These new connections can be to their own heart, to their families, to God or a Higher Power, or to a new purpose for their lives.
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Activity: Connecting in Family Circles When providing family therapy, structured activities can be created which invite all family members to be involved. During extended family weeks, we bring together multiple families and have them sit together as family groups within a large circle. Each patient sits on a chair facing her family, with the patient chairs forming an inner circle. We ask all the patients to stand up and move to the chair to the right of them, facing a family they do not know, which becomes their “new family” for a short time. Patients and their new family members are given questions about the impact and consequences of the disorder as well as needs for recovery. Patients and family members answer and discuss the questions with each other, while honestly sharing their thoughts and feelings. At a signal, the patients again move to the right to sit in front of a new family. As they move around the circle to different families and answer specific questions honestly, they find themselves sharing the same feelings, concerns, pain, love, and truths they are all experiencing due to the eating disorder. By the time that the patients get back to their own families after answering eight or nine questions during the rotation, both patients’ and family members’ hearts often seem much softer, and they tend to be much more open with each other and more receptive of each other’s ideas and feelings. The following are examples of questions that may be discussed during these family rotations: 1. What is it really like having an eating disorder? 2. What is it really like being a family member or a loved one of someone suffering from an eating disorder? 3. As one suffering from this illness, what do you really want to be forgiven of in your relationship with your family? 4. As a family member, what would you seek forgiveness of from your loved one who has been suffering in an eating disorder? 5. What do you really want the most from your family as you walk the path of recovery? 6. What do you really want the most from you daughter, spouse, sibling, or other loved one suffering in an eating disorder?
CONCLUSION Experiential activities provide opportunities for patients to be actively involved—with their own feelings, ideas, and impressions—and with other group members. Every aspect of an eating disorder can be played out in a visual, expressive, emotional, and experiential way. Every aspect of recovery can be played out in experiential and expressive ways. This ongoing
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engagement and activity prevents patients from getting stuck in mental overanalysis. Honest self-reflection can occur after the group activities, at which time it is often helpful to ask patients to process out loud what they felt and learned. We have found that the most important thing about these activities is that patients begin to see themselves more honestly and accurately and to separate themselves from the eating disorder. They learn the power of connections, love, honesty, and vulnerability in ways that have not been a part of their life during the course of their illness. They have these experiences in the context of belonging, acceptance, compassion, and love.
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HOW I PRACTICE
Using Experiential Group Therapy in the Treatment of Eating Disorders RANDY K. HARDMAN, MICHAEL E. BERRETT, P. SCOTT RICHARDS, and SHARON BLACK Center for Change, Orem, Utah, USA
During the past 18 years as we have worked with women in a residential eating disorder treatment center, we have developed and used a wide variety of experiential interventions and activities in group and family therapy, such as family sculpture, psychodrama, life experience reenactments, and structured role plays. These activities make the implicit more explicit so that each patient has opportunities to increase awareness of her power to choose to change. Patients become more honest as they make real connections to themselves and with the other women in the group. Another benefit of experiential group activities is that patients can experience and share emotions that have been previously repressed. They can have new, corrective emotional experiences. Experiential activities can also help women understand more about the nature of their eating disorder and the impact it is having on them. They can make connections and revisit relationships they have avoided. Experiential activities can help them recognize that they are worthy of love and can accept love that is offered to them. When handled appropriately, experiential activities can provide powerful healing opportunities for patients.
GENERAL PROCESS GUIDELINES FOR EXPERIENTIAL GROUP ACTIVITIES In experiential activities, a group therapist needs to be specific in setting up and processing the activities of the group. He or she will need to take a Randy K. Hardman is now affiliated with the Counseling Center, Brigham Young University-Idaho. Sharon Black is now affiliated with the McKay School of Education, Brigham Young University. Address correspondence to Michael E. Berrett, Center for Change, 1790 North State Street, Orem, UT 84057, USA. E-mail: [email protected] 89
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leadership role; direct the processes; explain the experiential interventions; and fully engage patients in honest and emotional ways that can be lost in talk therapy alone. Because patients most often tend to hide from the real issues and conflicts in their lives, the therapist must take responsibility for creating and supporting the energy in these experiential group sessions and for directing the process in ways that help patients develop self-awareness, emotional connections, and relationship experience. It is also the therapist’s role to provide empathy, encouragement, and validation, and to nurture hope in the group processes. The therapist provides the necessary direction in the structured events and guides the exploration and interventions that grow out of each event. The therapist can help patients see what they cannot see themselves. In many ways, recovery is a process of self-discovery and renewal, a process of change from the inside out. Such a change in awareness sometimes begins with patients taking risks during experiential interventions. Therapists can use whatever level or degree of emotional intensity that occurs within the structured experiential group activity. There are no hidden agendas or expectations about what should happen in any activity or group process. No outcome is predetermined. Experience has taught us over the years that totally dissimilar group outcomes can result from the same activity. Emotional intensity is based on honest expressions of the patients who are involved in any activity in the moment. The therapist accepts what happens and attempts to work with whatever level of emotional intensity occurs. The therapist is ethical and direct and approaches each group member with sensitivity to her readiness for change. Many patients are not ready to take full advantage of all they experience in every activity. Since members in the group are at different levels of recovery, therapists must take care to avoid asking individuals to go further at any point than they are ready to go. Group members will learn from other patients who are ahead of them in the recovery process. It is important for therapists to make sure that group activities are varied over time so that activities that generate painful awareness such as sadness or anxiety are counterbalanced with experiential experiences that generate positive awareness such as hope and love. Achieving this balance is important because most patients have lived with one-sided negativity for a long time.
EXPLORING THE PATIENT’S EATING DISORDER WORLD Exploring the patient’s eating disorder world—a world in which she denigrates and hides from herself—is the first step in treatment and recovery. Experiential activities can help patients acquire more realistic understandings of the eating disorder and more healthy views of themselves.
How I Practice
91
Activity: Enacting the Negative Mind This activity awakens self-awareness by vividly portraying the negative mind and eating disorder messages of the individual with the disorder, including all inner self-criticisms and negative self-judgments. Participants are asked to get into groups of three, designating one to stand between the other two as the first focus person for the activity. One group member’s role is to whisper the messages of the negative mind into the focus person’s ear; the other group member simultaneously whispers messages from the positive mind and heart. The person speaking for the negative mind whispers thoughts she hears inside her own mind, anything she knows about the focus person’s negative thoughts, or the general negative messages of an eating disorder. We encourage the person representing the positive voice to express affirmations of support, hope, and love. We encourage both voices to struggle for the heart and soul of the focus person. As patients participate in this activity, the room becomes full of voices, messages, energy, and commotion. The group members in each triad take turns participating in each role and have opportunities to share and process their experiences from each perspective. We then ask the same triads to go through the activity again, but this time, we ask the focus person to make a genuine effort to listen and tune into the positive voice and messages. We do not instruct them to ignore the negative mind. We simply ask them to choose to listen to the positive messages and to see if they can hold onto that voice. We help them see that the messages they choose to listen to impact their beliefs and their mood. We emphasize that although negative eating disorder messages will come to their minds, these messages do not have to be believed or obeyed.
BEING HONEST ABOUT LIFE EXPERIENCES Therapists can help stretch their patients’ emotional comfort zones as they strengthen the expectations of honesty during group work. If patients know that vulnerability, genuineness, and honesty are expected in each group session, most of them will plan for it and many of them will actually look forward to the opportunity.
Activity: Reenacting Life’s Experiences Avoidance and denial are much more difficult to maintain and openness becomes more natural in a group activity in which the patients’ lives are shown or played out in front of each other. Individuals cannot as readily defend or protect against their own experiences and emotions when these experiences are apparent in the group activity. The experiential activities
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invite group members to let down their defenses to become more honest and real because other patients are doing the same. In providing these opportunities, we sometimes use family sculpture and structured role plays to re-enact aspects of family life, such as traumatic experiences, relationship conflicts, and communication patterns. In small subgroups, patients might role play a family heartache or triumph—something real—and play it out, with everyone in the small group participating. Many patients are excited to actively create these scenes from their lives, and the other group members enjoy participating in the activity. All group members can find something of themselves in the reenactments. With honesty and openness they explore aspects of the event and see possibilities or choices that could have been different. With anticipated events they can rehearse difficult or threatening encounters. During these enactments, patients can safely notice things about themselves or others that they have never before allowed themselves to see or feel. Group members offer support by observing and sharing their insights and feedback. No one is allowed to hide or avoid, but everyone is engaged in the therapeutic work and recovery process.
Four Levels of Honesty Complete honesty met with acceptance from group or family members can help patients experience vulnerability as empowering and opens their hearts and minds to the possibility of change. Most patients are self-critical while they are learning to express themselves more honestly. They feel a sense of vulnerability, and the therapist needs to provide encouragement and support for their risks and honesty. We encourage four levels of honesty (see Table 1) when working with patients in experiential activities. The first level of honesty is to simply tell the truth—to “say it without hiding anything.” To be honest in this way, the patient needs to put what is going on inside her out in the open. Patients are often initially uncomfortable revealing themselves truthfully, although doing so is crucial for them to begin the change process. The second level of honesty is to tell the truth without self-judgment and self-contempt. Patients can learn to be honest without unrelenting selfcriticism. At the point in recovery when they regain the ability to experience and honestly share their emotions, it is important for them to do so without beating themselves up with shame and self-judgment. Experiential activities can help patients learn to do this. A third level of honesty is to engage in honest self-correction with self-kindness. Honest self-correction with self-kindness makes possible new choices and self-improvements over time as patients gain more awareness about what they need to change in order to recover. Patients experience a
93
How I Practice TABLE 1 Four Levels of Honesty in Experiential Treatment of Eating Disorders Level Level 1: Tell the truth
Patient Holds nothing back Stops denying, pretending, hiding Reveals lies, secrets, deceptions Talks honestly about pain, fears, conflicts, choices, beliefs, behaviors Becomes willing to be vulnerable
Level 2: Be honest without self-judgment or self-contempt
Learns to be “neutral” and non-judgmental Allows self to experience emotions and feeling again
Experiences a personal and positive level of genuineness and vulnerability Separates addiction and problems from sense of identity Decreases avoidance, increases self-congruent expressions Level 3: Be honest with ongoing self-correction and self-kindness
Level 4: Accept and benefit from truths offered about self from others
Therapist Invite and encourage honesty Recognize that shame, self-contempt may still be present, despite relief Anticipate that pain will accompany relief Support with kindness, empathy, reassurance Recognize the pain and risk of vulnerability Be receptive, encouraging, and affirming Encourage patient to be more present and connected to her feelings, conflicts, and pain while expressing them honestly. Help patient expand, clarify, and explore the honesty Guide patient in seeing herself honestly and accurately Keep her from “beating herself up” over what she reveals
Shifts to new perspectives, strategies, and corrections in recovery within the framework of self-kindness Focuses on changes in the present time, and becomes more positive and hopeful about personal responsibility and choice Becomes more open and flexible—learns more quickly from life’s experiences Senses belonging and inclusion—feels connected with herself, with other people, and with higher power Learns to trust herself, feels self-empowerment
Teach, validate, and support self-kindness in honest self-expression
Increases in ability to “hear,” “see,” and “feel” positive messages, personal truths, and expressions of love
Support the patient in sensitivity to the quiet messages of the heart
Clarify and assist in self-corrections, positive choices and changes Help her see that what needs correction is not about her personal identity. Support context of self-kindness and compassion that encourages these connections Encourage self-trust, willingness to take risks, and ability to follow through
(Continued)
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TABLE 1 (Continued) Level
Patient
Therapist
Becomes more sensitive to emotional and spiritual impressions Develops capacity for self-validation and positive sense of self Increases emotional connection to family, friends, and others Becomes more reciprocal in relationships: empathy, kindness, love and service to others
Recognize and support intuition and spiritual growth Support patient’s recognition of personal strengths and abilities Recognize and encourage relationship connections Point out and encourage aspects of giving and receiving love in relationships with others
sense of empowerment when they realize they can correct mistake and have choices over the eating disorder. This helps them recognize that the eating disorder is the problem, not who they are. Experiential group activities can facilitate honest self-correction with self-kindness by encouraging honesty in a context of loving acceptance. The fourth level of honesty is to choose to accept and benefit from the feedback and love offered by others, and for spiritually minded patients, from God or their Higher Power. As patients learn to accept feedback and love, their capacity for self-validation grows. Their emotional connection to family and friends increases. They become more reciprocal in their relationships, showing forth more kindness and empathy to others. They become more sensitive to the spiritual and emotional impressions of their heart. Experiential group activities give patients opportunities for receiving and accepting feedback and love from others.
RECEIVING LOVE It is love that speaks to the hearts of those who suffer from eating disorders and creates a positive context for change. Love creates a powerful and safe atmosphere in group experiential activities. It becomes, over time, a very important part of the group experience for the patients to mutually give and receive love. Patients begin to openly express their tender feelings of love and genuineness honestly to one another, and to receive expressions of love from others. These loving connections can be free of judgment or conditions. Over time individuals struggling with an eating disorder tend to lose the positive connection to their heart and to love. It feels good to them to experience love again. One of the powerful ways to evoke change is through the experience of love that is shown and felt by group
How I Practice
95
members during experiential activities. When a patient has an experience of love in an experiential group activity she begins to see that she is not alone and that she can replace her eating disorder with real purpose and loving connections.
Activity: Receiving Love With Tissues One young woman’s experience with love and tissues is given as an example of a love-based activity. A college-aged patient believed with all her mind that she was the exception to love: She was too broken, too undeserving, and too unacceptable. Because she felt she had not merited love, she refused love, even though there were many people in her life, including many women in the group as well as staff members, who loved and cared for her. For this experience we had her sit on a chair in the front of the group and had other participants in the group come to her one at a time with white tissues in their hands. One by one they knelt before her and handed her a white tissue as they expressed each statement of their loving appreciation and affirmation of her, each describing a specific perception, experience, or remembrance of her or a particular gratitude they felt towards her. When the activity was nearly over, the patient sat with her arms full of white tissues and many tears were running down her face. She said, “I can see the love.” She could not deny it; it was tangible and real. She talked with the group about her desire to let their love in, to feel it, and to let it help her. She expressed her desire to stop running away from love. She knew that to recover from the eating disorder, she would need to let love in wherever it was available. It was a turning point in her recovery and a powerful message for all the women in the group. Everyone in the group can participate in this activity as both givers and receivers of love. For many patients it is an opportunity to receive love in ways that were lost to them during the development of the eating disorder. The therapist should attend to the reactions of all group members, not just the patient in the chair. Sometimes exploring the emotional responses of the non-focus group members can provide powerful healing opportunities.
Making Connections Recovery is often about relationship connections. As patients disconnect from the illness of their eating disorder it becomes paramount that they have something to reconnect to in order to replace it. These new connections can be to their own heart, to their families, to God or a Higher Power, or to a new purpose for their lives.
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Activity: Connecting in Family Circles When providing family therapy, structured activities can be created which invite all family members to be involved. During extended family weeks, we bring together multiple families and have them sit together as family groups within a large circle. Each patient sits on a chair facing her family, with the patient chairs forming an inner circle. We ask all the patients to stand up and move to the chair to the right of them, facing a family they do not know, which becomes their “new family” for a short time. Patients and their new family members are given questions about the impact and consequences of the disorder as well as needs for recovery. Patients and family members answer and discuss the questions with each other, while honestly sharing their thoughts and feelings. At a signal, the patients again move to the right to sit in front of a new family. As they move around the circle to different families and answer specific questions honestly, they find themselves sharing the same feelings, concerns, pain, love, and truths they are all experiencing due to the eating disorder. By the time that the patients get back to their own families after answering eight or nine questions during the rotation, both patients’ and family members’ hearts often seem much softer, and they tend to be much more open with each other and more receptive of each other’s ideas and feelings. The following are examples of questions that may be discussed during these family rotations: 1. What is it really like having an eating disorder? 2. What is it really like being a family member or a loved one of someone suffering from an eating disorder? 3. As one suffering from this illness, what do you really want to be forgiven of in your relationship with your family? 4. As a family member, what would you seek forgiveness of from your loved one who has been suffering in an eating disorder? 5. What do you really want the most from your family as you walk the path of recovery? 6. What do you really want the most from you daughter, spouse, sibling, or other loved one suffering in an eating disorder?
CONCLUSION Experiential activities provide opportunities for patients to be actively involved—with their own feelings, ideas, and impressions—and with other group members. Every aspect of an eating disorder can be played out in a visual, expressive, emotional, and experiential way. Every aspect of recovery can be played out in experiential and expressive ways. This ongoing
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engagement and activity prevents patients from getting stuck in mental overanalysis. Honest self-reflection can occur after the group activities, at which time it is often helpful to ask patients to process out loud what they felt and learned. We have found that the most important thing about these activities is that patients begin to see themselves more honestly and accurately and to separate themselves from the eating disorder. They learn the power of connections, love, honesty, and vulnerability in ways that have not been a part of their life during the course of their illness. They have these experiences in the context of belonging, acceptance, compassion, and love.
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