Surveying the drug service users' perspective through self-help groups

Survey data is presented from a questionnaire designed and distributed through Victorian drug self-help groups. This survey yielded 203 returns representative of Melbourne metropolitan admissions to drug treatment services on the variables of sex and region. The survey is examined both from the perspective of its methodological potential for providing entry to this hard-to-access population and also on the basis of its findings. Questioning of this sample concerning the difficulties they had encountered when seeking help revealed that the most frequently listed difficulties were waiting periods for access to services. Respondents that had previously used particular services were asked how beneficial they had found these services: Respondents most frequently listed self-help groups, residential and methadone services as beneficial and least frequently listed medical (hospital casualty) and doctor services as beneficial. Stepwise logistical regression revealed six variables significantly predicting selfhelp treatment. Those reporting having sought self-help groups were predicted by more frequently listed problems with alcohol and ‘over the counter’ drugs, reports of having sought counselling services and more frequently reported difficulties due to a lack of information and admission restrictions when seeking services. Despite a number of methodological weaknesses identifiable in the survey, experience with this project suggested collaboration between researchers and those active in self-help networks as a useful model for future research into the drug service users perspective. Such collaboration should, however, begin at an earlier phase than occurred in the present study.     

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.     

Professional support of self-help groups: a support group project for Chronic Fatigue Syndrome patients

Professionals are involved in self-help groups in a variety of roles as advising experts, facilitators and even as group leaders. A few studies focus on attitudes toward professional involvement, but very little is known about the nature of this collaboration. The study follows a collaborative support group project between a team of health professionals at a regional hospital in Norway and a Chronic Fatigue Syndrome patients' group. It is arguably an advantage for professionals to decide upon the aim of a joint intervention in dialogue with the participants, but simply asking the participants what their aims are does not guarantee actual agreement. As this case study demonstrates, participants may have reason to conceal their objectives.     

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.     

Critical incident debriefing in groups: a group analytic perspective

This paper looks at providing critical incident debriefing in groups. It outlines key group analytic concepts that are relevant to debriefing, including mirroring, group dynamics and supervision. It details how these concepts, along with the facilitator's and supervisor's free-floating attention, can help in thinking about the group and the organizational impact on the individual and the group. Using examples of debriefing, suggestions are made about how to use these concepts within the debriefing session and the impact of the dynamics of the organization on the debriefing.

The paper emphasizes the importance of supervision for debriefers and how the dynamics of the debriefing and the organizational context can be mirrored in the supervision. It illustrates the interplay between the individual, the group and the organization through commentary on vignettes, which include a debriefing session and the subsequent supervision session for debriefers.     

The courage of the group therapist

This report strives to legitimize for the field of psychodynamic group therapy the reflection on and study of courage. The authors surveyed group therapy leaders, asking them to describe courageous moments in their own group practice, and then explored the common themes arising in these examples, including openly confronting their mistakes, facing their own and group members' anger, and dealing with unexpected moments in group sessions. Attending to courageous leader moments-and the feelings of hope and pride that they engender-help to neutralize the negative emotions that group leaders are constantly invited to contain. Paradoxically, accessing courageous moments can also evoke feelings of shame in the leader. If we are to require ourselves to embrace the sometimes terrifying challenge of journeying into the unknown with our patients, we must learn to be honest not just about our mistakes and our weaknesses, but also about our successes and our strengths.     

Reinforcing self-help group activities of welfare recipients

The attendance rates of welfare recipients at self-help group meetings was compared when supplementary reinforcement was given for attending and when it was not. Reinforcers included donated items, such as clothing and household goods, and information about welfare services. It was found that the attendance at meetings averaged three recipients per meeting without reinforcement and 15 recipients per meeting with reinforcement. There was evidence that attendance was associated with participation in other self-help activities. It was concluded that practical forms of reinforcement can be found to maintain the participation of severely disadvantaged populations in self-help groups.     

Group properties and outcomes: a study of group norms in self-help groups for widows and widowers

Despite the nearly universally shared agreement among group therapists about the importance of group norms, empirical studies have rarely demonstrated a positive relationship between specific norms in psychotherapy groups and patient benefit. The study explored this relationship by examining the linkages between norms, a specific therapeutic process, and patient outcome. Examined were seventy-two spousal bereavement groups. Subjects' responses to a thirty-one item behavioral inventory were used to define norms; outcomes were based upon Time 1/Time 2 differences on a series of eleven measures indexing depression, anxiety, somatic symptoms, abuse of psychotropic medication, coping mastery, well-being, self-esteem, target problem rating, several measures of role stress and strain, and stigma. The findings suggest that normative characteristics were linked to a process, reciprocal social exchange, that influences positive outcomes. The results are preliminary, since they only serve to demonstrate such a relationship can exist.     

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.     

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.     

Personal reflections on Hugh Mullan: existential group therapist

This article reviews the work of the psychiatrist Hugh Mullan, a pioneer of modern group therapy. Heavily influenced by existential philosophy, Hugh Mullan applied notions from that perspective to his innovative and unorthodox approach. Central to this was an early, indeed prescient, advocacy for the use of the therapist's personal subjectivity, striving for mutuality, and non-rational experience in the conduct of psychotherapy. This way of thinking was not in accord with prevailing theories throughout most of his life as a practitioner (1946-1986); Hugh Mullan was not considered a mainstream theorist in his time. However, contemporary relational theorists have begun to give these ideas a great deal of attention, offering validation and support for his original insights. This writer recalls, as well, his experience of Hugh Mullan as a therapist and mentor.     

Group member contacts without the group therapist

After presenting some of the arguments against patients having contact with one another outside the regularly scheduled group psychotherapy sessions with the therapist, we present our counterarguments. Rather than forbidding extragroup socializing, thereby assuming the role of moralistic, punitive parental authorities to be deceived or challenged, we accept that such socializing is likely to happen and then establish beforehand the rule that information about extragroup contacts is to be shared with the entire group during regular therapy sessions with the therapist. In this way, the extragroup behaviors are dealt with just as any other material in group, i.e., searching for the underlying dynamics. Some positive aspects of extragroup socializing, as well as some negative aspects, are discussed, with examples taken from clinic groups and private practice groups.     

The two faces of the group therapist

The group therapist wears two faces: spokesperson of the Establishment and spokesperson of significant truth. To run vital groups, these two roles of group leadership must stand in dialectic relationship to each other. The therapist introduces principles and practices that normalize group relations and provide a sense of cohesion, continuity, and regularity. However, to be constructive and promote significant truth, the group therapist must also be deconstructive, and encourage and support the group's questioning and challenging the very principles and practices that he or she asserts. A case example illustrates how the group leader is also two-faced in another sense of the term, since he or she may be false and insincere--or perceived as such--when being either the conservator or challenger of group process and culture.     

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.