I applaud David J. Hellerstein for the bravery he shows in his article, “The Dowdy Patient” (NY Times Sunday Review, June 14th). Dr. Hellerstein honestly laments that he couldn’t help a woman patient that wanted to have a romantic relationship; but who refused to alter her appearance to make herself more appealing to men. I wondered if he had considered referring her to group psychotherapy? Group might have been able to help her. While I don’t have a crystal ball, I know from my own experience as a group leader that members can say things to each other that a therapist could never say without causing narcissistic injury to the patient. This may have been particularly true in this case, even if the individual therapist were gay or female. The frightened woman might have felt intimidated by, and suspicious of any individual therapist’s interest in her appearance. It’s not so much the therapist’s gender or sexual orientation that can be intimidating, but the role relationship itself. Hellerstein seems to confirm this hypothesis when he notes that his patient found him ‘creepy’ when he tried to engage her in a conversation about her ‘dowdy’ appearance. In a well mixed group of men and women of various personalities types and different levels of healthy narcissism, she might have felt less offended hearing how she comes across from her group peers. It could have been especially therapeutic for her to receive non-threatening support for enhancing her look from the women in the group. This might then have allowed the group leader to play the devil’s advocate by supporting her resistance to looking ‘too good’ by saying:” Why does she need to change at all?” One maxim that I learned in group training was: “Never be an aggressive force in a frightened woman’s life”.
Group Might Have Helped
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About the Author: Robert S. Pepper, Phd.
Dr. Pepper has been running groups for over twenty-five years and specializes in group therapy. He has a special gift in helping member's resolve conflicts with.
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This sounds like excellent advice. I wonder if dr. Hellerstein actually used the word “dowdy” when speaking to the patient. That would have been hurtful and insulting, I believe. There must be a better way of approaching the problem. Oh yes, there is. Group!
Hi Elane: Thanks for your insightful comment. It’s a very good question. Referring to the patient as dowdy is derogatory. Even if he didn’t say it, he thought it. Sadly, the patient would get the unspoken message.