Life change: adjusting to continuous ambulatory peritoneal dialysis

A period of psychological adjustment occurs when a patient switches from hemodialysis to CAPD. The authors have identified four major categories of obstacles that patients must overcome in adjusting to CAPD and its self-care techniques. Ongoing group treatment is a valuable tool for patients in learning coping skills and alternative behaviors during this adjustment period. Members move through stages in the group, from dependence and a feeling of isolation to a stage of struggle for individuation and a work phase. It is in this work phase that group members show increased mutual concern and understanding, personal responsibility, honesty, individuation, a willingness to share and to be open, and coping skills. The value of this progression within the group is that what members learn there can be carried over to patients' lives outside the group. Group therapy can assist CAPD patients in coping with isolation, perceived abandonment by the medical environment, the resurgence of predialysis conflicts, a possible increase in libido, and new areas of family functioning. The process of individuation that occurs in the group has set patients on a course toward increased independent living, closer self-scrutiny, mutual education, vocational and recreational productivity, and an improved ability to deal with the stresses of end-stage renal disease.