A group therapist perspective on self-help groups

The author provides an overview of self-help groups in terms of their origins, growth, scope, and effectiveness, and then compares these groups with professionally conducted psychotherapy groups. A framework for evaluating group helping systems is proposed which includes five principal dimensions: the helping group as a social microcosm; technological complexity/simplicity; psychological distance/closeness between helper and helpee; specificity/generality of help methods; and differentiation versus nondifferentiation among participants. The author concludes his article by recommending four strategies for how group therapists can contribute to self-help groups.     

Meta-analysis of medical self-help groups

Self-help groups (SHGs) may rival all other forms of treatment sometime within the next century (see Goodman & Jacobs article in "The Handbook of Group Psychotherapy," Wiley, 1994), though the "purist" model of SHGs seems inaccurate because many professionals are actually involved. Although traditional forms of group treatment have kept pace with empirical research (Fuhriman & Burlingame, "The Handbook of Group Psychotherapy," 1994), SHGs have not. In particular, medical SHGs, often promoted by hospitals as viable treatment alternatives, have no systemized database from which to draw conclusions about overall effectiveness compared to traditional group therapies. A preliminary assessment of this area is presented using a meta-analysis of articles culled from a comprehensive review of the literature from 1970 to 1997. Results indicate that although the posttreatment analysis produced no significant differences between active and control conditions, pre to posttreatment scores indicated that SHGs produced higher patient improvement when compared to the control condition. Future implications for research and use of medical SHGs are explored.     

An organizational typology for self-help groups

Conclusion Several continuing obstacles have hindered the compilation of a research-based body of literature on self-help groups. Among them are the diversity of the groups and the need for appropriate research methodology. The validated typology described above was designed to address some of these problems. It provides a means of recognizing the diversity of the groups and sorting them into broad types without stating that one is better or more productive than another. It supplies a framework for examining the organizational features of a group in order to facilitate comparison with other groups. It recognizes the potential effects of time, change, and leadership on the small local units of self-help organizations. It has implications for making research more compatible with self-help groups. The use of this typology might eliminate some of the ambiguity and conflicts currently found in the literature and thereby help people — professionals and self-helpers — to more clearly understand the nature and functioning of self-help groups.     

Factors contributing to the survival of self-help groups

Despite the growing utilization of self-help groups, there have been only a handful of studies that have examined the factors that contribute to their survival. The purpose of this study was to explore the factors that contribute to self-help group survival by examining their relationship with external sources (i.e., national and local self-help organizations, professionals) and group organizational characteristics (i.e., leadership diversification, recruitment, attendance at group meetings). Representatives from 245 active and 94 recently disbanded self-help groups were included in the analysis. Results indicated that the primary factors that discriminated between active and disbanded groups were the number of new people to attend a meeting, average group meeting attendance, length of existence, leadership diversification, outreach to potential group members, and support from national and local organizations. Results are discussed in terms of what national self-help organizations, self-help clearinghouses, and others who interact with self-help groups can do to empower and support them.     

Leadership skills and helpful factors in self-help groups

The effects of training on leadership skills and group processes in cancer and anorexic self-help groups are investigated. Three components of the study are reported. Firstly, an observational case-study of each type, of group was conducted to investigate the nature of the leadership input. Secondly, a Self-Help Questionnaire based on Lieberman's classification of leadership skills was administered to members of eight self-help groups to compare the experiences of groups with trained and untrained leaders. Thirdly, group members completed a Helpful Factors Questionnaire based on Yalom's analysis of group processes. The observational case-study revealed significant differences between the trained and untrained leaders in that, unlike the trained leader, the untrained leader clearly dominated the group. Results from the Self-Help Questionnaire showed that trained leaders scored higher on Caring and Emotional Stimulation but lower on Attribution of Meaning. Member satisfaction, however, was similar in the two types of group. Results from the Helpful Factors Questionnaire showed that most of the helpful factors were seen similarly by the two types of group, though differences were found concerning the relative rankings of both Guidance and Altruism. It is concluded that some degree of training of group leaders could be usefully incorporated into the self-help movement.     

The impact of trauma on drug users' identities

This article addresses drug users' identity construction, and invites counsellors, psychotherapists, researchers and others who work with drug misusers to notice how cultural and societal discourses can shape drug misusers' stories, and the positions from which helpers listen and respond to them. By representing and analysing parts of two life stories, gathered as part of a wider narrative inquiry, this article draws attention to the learning embedded in a person's story about how traumatic life experiences shaped their drug misuser identity during adolescence and young adulthood. It suggests that by focusing on identity construction and reconstruction we can enable drug users to identify the discourses that have shaped their identities and thereby open up spaces for new and more hopeful stories of identity to emerge.     

Group psychotherapy with alcoholics: Interface with self-help groups

This paper addresses recovering alcoholics' concurrent involvement in psychotherapy groups and self-help groups. A developmental model of alcoholism group psychotherapy is presented, differentiating between early and advanced sobriety. Psychotherapy and self-help groups are compared and contrasted. Multiple group membership entails various areas of compatibility. Divergence and conflict result from differences in underlying conceptual framework and approach. Clinical implications of members' involvement in partially discrepant group settings are explored with an emphasis on transference and countertransference reactions. Multiple group membership is identified as a salient factor in alcoholism group psychotherapy at all levels of recovery.She is also in private practice.This paper was presented at the American Group Psychotherapy Association Annual Conference, Boston, February 1990.     

Alcohol recovery in self-help groups: Surrender and narcissism

This study was designed to determine if subjects participating more actively in Alcoholics Anonymous (AA) were higher on surrender and lower on pathological narcissism than those less involved in AA or participating in Rational Recovery. Male subject groups scored as predicted on surrender. As hypothesized, surrender also correlated negatively with pathological narcissism and was not associated with nonpathological narcissism. Results failed to support the predicted relationship between levels of participation in AA and pathological narcissism. A sex difference was found both on pathological narcissism and on surrender. Females scored lower on narcissism and higher on surrender than males.     

Psychology and self-help groups. Predictions on a partnership

Continued growth and increased legitimacy are anticipated for the American self-help group (SHG) phenomenon. Currently estimated at six and a quarter million participants annually, self-help groups will assume a central role in the nation's mental health delivery system over the next two decades. The first part of this article illuminates the self-help group phenomenon itself. Its scope, characteristics, supporting social climate, and associated research issues are reviewed. The second part is a futuristic examination of its interface with the newly industrializing world of health care. Massive increases in mental health services are predicted, especially via the SHG format. Theory development, research sophistication, changing SHG formats, a place in public policy, and acceptance into graduate curricula are also expected, as are collaborative relationships with a variety of professional disciplines. Psychologists are urged to enhance the relevance of the profession by taking an early leadership role in these developments.     

Professional involvement in self-help groups for parents of high-risk newborns

Patterns of professional involvement and control in self-help groups were studied through a questionnaire completed by representatives of 63 self-help groups for parents of high-risk newborns located throughout the United States. Results indicated that when professionals began a group, they were likely to continue to maintain control over it. Groups controlled by professionals were more likely to utilize professional counseling as a form of support and less likely to provide outreach services to parents following hospital discharge of their infants. Group stability, growth, and innovation were associated with more consultation between parents and professionals in the planning process.     

Effectiveness of self-help and support groups for cancer patients: A Review

Abstract

Following the recognition of the psychological difficulties faced by cancer sufferers, there has been a rapid growth in forms of group help. There is a wide variety of types, and nomenclature is far from consistent. Evaluation studies are reviewed, and issues of potential harmfulness are considered.     

Augmentation of in vivo exposure treatment for agoraphobia by the formation of neighbourhood self-help groups

The advantages of selecting agoraphobic patients for treatment by group exposure according to their residential geographic neighbourhood were evaluated in terms of facilitation of ‘homework’ practice and increased social contact. Both ‘zoned’ and ‘unzoned’ groups showed gains in ability to perform hierarchy items after 11 sessions of exposure, relative to a no-treatment control group. However only zoned subjects showed significant reductions in experienced anxiety when executing such items. Self-ratings of overall phobic severity also suggested a zoned group was superior to unzoned while assessors' ratings indicated both groups as equally improved. Only zoned subjects showed a significant increase in social range. Improvements were maintained at 3-months follow-up. No effect of treatment was found on either the Zung measure of anxious mood or on social integration.These results suggest that, where practical, zoning might offer the means for desirable continuation of intensive clinic-based group treatment as well as the benefit of extending treatment into the patients' environment as in home-based treatments. Crucial levels of group cohesion might also be increased although therapists should be prepared to negotiate resistance to a socially demanding programme from patients with significant additional social phobias.     

Researching self-help/mutual aid groups and organizations: Many roads, one journey

Self-help and mutual help groups are defined and the status of the literature described and reviewed. Self-help groups are different from peer and nonprofessional services under the supervision of professionals. Controlled studies of mutual help groups may be neither possible nor desirable as the method of choice by which to understand the phenomena of interest. Other approaches to research, including worldly evaluations, and ways of construing self-help organizations, that is, as normative communities and political action organizations rather than as psychological treatments, are discussed, and suggestions for future research are presented.     

Participatory action research with self-help groups: An alternative paradigm for inquiry and action

Conclusion I have not sought here to make a case for participatory action research as theonly mode for inquiry and action with self-help groups, but to raise issues that may help counter the dominance of the conventional model and encourage a more pluralistic scientific enterprise. Researchers must be competent in and free to use (or try to use) whatever paradigms and techniques best fit their own epistemological preferences, the phenomena they wish to understand, and the goals and resources they and their coparticipants have. In particular, the assumptions and operating styles associated with PAR seem especially relevant and useful for inquiry and action that can advance knowledge about, and contribute to the effectiveness of, self-help groups. Dogma about the proper scientific method may suit the current scientific establishment and governmental funding agencies, but it does not necessarily lead to good research, research that is valid and useful to the scholarly community and to the self-help movement.In preparing this paper I benefited enormously from the suggestions of David Bargal, Thomasina Borkman, Barry Checkoway, Thomas Powell, and Margaret Weigers. An informal version of this paper was presented at the Planning Session on Collaboration with Parent Groups, sponsored by the National Project on Self-Help Groups, funded by a grant from Maternal and Child Health (MCJ-009127).     

Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment

Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.     

Alternative professional roles in health care delivery: leadership patterns in self-help groups.

The increasing professionalization of health care delivery systems, improved client awareness, funding cutbacks, and an emphasis on voluntarism have led recipients of health services to turn increasingly to self-help groups. This article examines the leadership and organizational pattern of such groups, using a study of 43 self-help groups from around the U.S. whose members are parents of children with cancer. Three leadership patterns emerged: groups were independent and parent-led, were led by professionals, or had a shared leadership of parents and professionals. Data indicate that the professionally led groups were the smallest, least formal, and had the narrowest range of activities. The groups with shared leadership had the greatest longevity, tended most often to retain as members parents of deceased children. The authors conclude that such coalitions of clients and professionals are vital for ensuring proper service delivery at a time when health care systems will likely remain bureaucratic and public resources for professional care are being reduced.