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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Leadership styles and Deming's behavior factors

Although total quality management scholars, including W. Edwards Deming, consider leadership to be important, there has been little work which considers linkages between specific leadership styles and TQM behaviors/policies. This paper examines the relationship between a full range of leadership styles (Bass & Avolio, 1994) including laissez-faire, management-by-exceptionpassive, management-by-exception-active, transactional and transformational leadership, and five specific TQM behavior factors derived from Deming's (1986) Fourteen Points, i.e., change agency, teamwork, trust-building, short-term goal eradication and continuous improvement.The authors gratefully acknowledge the helpful suggestions of Boas Shamir, Don Spangler, Bruce Avolio, Francis Yammarino, and Susan Kang to earlier versions of this paper.     

Leadership emergence in task groups with egalitarian gender-role expectations

Although they differ in their explanations of the antecedents of gender-role expectations, gender role and expectation states theories agree that mixed-sex and initially leaderless task groups will confirm these expectations by selectively reinforcing male task participation and leadership emergence. Based upon this assumption held in common by the two theories, we hypothesized that groups whose members expressed significantly egalitarian gender-role expectations would reinforce male and female task participation and leadership emergence impartially. Analysis of data from 31 mixed-sex groups whose members expressed significantly egalitarian gender-role expectations, and who were racially and ethnically homogeneous, found that males participated more in group discussions and were more likely to be selected as task leaders. Male advantages were explained only partly by token effects and their advantages in task resources. Implications are suggested for theories of male and female role performance in initially leaderless groups.     

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.