Group Therapy Engagement

Groups gave people a reason to leave the house, which was valued by those kept isolated by physical conditions; even arriving for a cancelled session felt worthwhile as an opportunity to go out. Having other group members with MLTCs was especially important for reducing self-consciousness and fear of judgment; when groups lacked others with physical conditions, participants could feel unable to relate or misunderstood. Physical and mental health challenges compound each other cyclically: stress can worsen bowel symptoms, pain can worsen anxiety, and fatigue or medication side effects can reduce concentration and engagement. Participants repeatedly described determination to attend despite pain, fatigue, and travel difficulty, and this effort strengthened their commitment to making use of therapy once present. Non-attendance created emotional strain, with participants often feeling guilty, disappointed, or ashamed when illness, increased pain, or other health appointments prevented them from attending. The pre-group one-to-one therapist meeting was essential for many participants, with some saying they would not have engaged without it, yet it was also a missed opportunity to direc…