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.     

Giving and Receiving Help: Interpersonal Transactions in Mutual-Help Meetings and Psychosocial Adjustment of Members

The helping transactions that occur in group meetings have been theorized to be important therapeutic mechanisms within mutual-help (or self-help) groups. Hypothesized links between giving and receiving help and psychosocial adjustment were examined in a mutual-help group for individuals with serious mental illness (GROW). Participants' adjustment was assessed at two time points and helping behaviors were measured with observational coding of weekly group interactions during the period between assessments. Frequencies of helping behaviors were used to predict Time 2 adjustment after controlling for initial adjustment. Consistent with the helper therapy principle, giving help to others predicted improvements in psychosocial adjustment; giving advice was a unique predictor. Total amount of help received was not associated with adjustment, but receiving help that provided cognitive reframing was associated with better social adjustment. A predicted interaction suggested that receiving help was related to better functioning when members experienced high levels of group integration.     

The self-help group: The mental health professional's role

The self-help group has become an increasingly important vehicle for providing mental health services for populations that have been otherwise therapeutically disenfranchised. The article discusses the role of the mental health professional in organizing self-help groups and in facilitating their fulfilling their goals. Transference, countertransference, and group dynamic issues are discussed in detail. These issues are illustrated with particular reference to a self-help group for the parents of cult members.The author would like to extend his appreciation and thanks to the Division of Group Psychotherapy of the Department of Psychiatry of the Mount Sinai Hospital, where this paper was first presented. He would also like to express his appreciation to Arnold Markowitz, A.C.S.W., of the Cult Hotline and Clinic of the Jewish Board of Family and Community Services for his help and to the staff of Westchester Jewish Community Services for their support.     

Self-help groups for the bereaved: Theory,theology, and practice

Self-help groups for the bereaved are a relatively unexplored area of wholistic ministry. The article grows out of the author's experience as an advisor to a local chapter of The Compassionate Friends, a group of parents whose children have died. The article explores the self-help concept, describes the experience of losing a child and the way the self-help process functions in that dynamic, and enumerates some roles the author has been able to fill as an aid to a local chapter. Within that framework, the article shows the affinities between self-help and ministry.Dennis Klass, Ph.D., is Chairman of the Department of Religion at Webster College in St. Louis. He is also co-author ofThey Need to Know: How to Teach Children about Death, published by Prentice-Hall in 1979.     

Helping and change without traditional therapy: Commonalities and opportunities

The therapeutic elements of four types of helping interactions (friends/family, religion, cinematherapy/bibliotherapy, and self-help groups), and their commonalities with traditional psychotherapy are explored. Empirical findings in these areas are discussed, along with suggestions for process and outcome research. Recommendations for the integration of self-help and paraprofessional counseling with professional therapy are presented.     

Communal Orientation and Burnout Among Self-Help Group Leaders

To assess the relationship between burnout, communal orientation, and leaders' perceptions of balance in their relationships with group members 102 self-help group leaders were interviewed. Leaders had low to moderate levels of burnout as measured by the Maslach Burnout Inventory subscales of emotional exhaustion, depersonalization, and personal accomplishment. As hypothesized, leaders' communal orientation was negatively related to the burnout subscales of depersonalization and personal accomplishment. Contrary to the study hypothesis, burnout was not related to balance. It was speculated that the salience of need-based norms in the group's helping relationships reduced expectations of reciprocity. The findings illustrate the usefulness of applying equity theory to studies of helping relationships within the setting of self-help groups.     

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.     

The Use of Groups in Religiously Based Helping Relationships

The author examines the use of the small group modality for providing helping services in religious settings and the use of religious-spiritual content in small helping groups. Included is a review and critique of various types of service, including group therapy, marital treatment, marriage enrichment, growth groups, and assertion training. Issues of philosophy and implementation are discussed; recommendations are made for the training and practice of persons who engage in religiously oriented helping relationships.     

Assertive community treatment: Correcting some misconceptions

Conclusions Except for Mowbray, the commentators approach the issue of mental health services quite differently than we do, a fact which may have contributed to some of their misconceptions. Although not stressed in our original report, our view of mental health services is eclectic and pragmatic, encompassing a wide range of psychosocial approaches. We agree with Salem that a range of options needs to be developed and maintained. The motivation for the development of both the ACT and DIC programs was to address the needs of a population neglected by existing mental health services. By contrast, the commentators' agendas converged on the promotion of nonprofessional forms of help-giving. Like the commentators, we have long advocated for consumer choice, self-help groups, and the use of natural supports. Where we part company with them is what we hypothesize would be a minimally sufficient response to over 2 million persons with SMI in the United States. For us, it is not enough to assert that self-help groups might be a partial answer. For us, the self-selection into self-help groups and drop-in centers (which all of the commentators readily acknowledge) leaves open some troubling questions from apolicy standpoint about what happens to those who do not self-select into such groups, especially because we believe that those who select themselves out are likely to include some of the most vulnerable segments of the SMI population. Editor's Note. This paper is an invited reply to several commentaries on an earlier paper by the authors.Preparation of this report was supported in part by Research Scientist Development Award MH 00842-01 from the National Institute of Mental Health to the first author. Our thanks to Debra Pavick for her help in preparing the drop-in center statistics cited in the report.     

Minority Group Membership and Perceptions of Self-help: Evidence from Israel

This study explores the meanings associated with the term ‘self-help’ in the general Arab population in Israel. It compares these associated meanings across various groups created by several demographic variables. The Arab population in Israel numbers nearly one million, comprising 18% of the total population of the state. The study used a random sample of 250 participants, representative of the general Arab population in Israel. Data was collected in a telephone survey which lasted 3–7 minutes. Three themes surfaced as the most prevalent meanings associated with the concept ‘self-help’: the individual meaning, which refers to one's ability to solve one's own problems and to rely on one's own strengths and resources; helping the ‘other’; and helping the needy. Significant differences in the associated meanings of the self-help concept related to level of education, marital status, and whether the respondent had heard of the self-help concept. The significance of the findings is discussed within several frames of reference. First, they are examined within the context of a particular minority culture which is constantly interacting with Israeli Jewish cultural values and is undergoing a change from traditional systems of values to modern Western ones. Second, the universal and particular attributes of the self-help phenomenon are outlined. Third, the initial developmental stages of self-help organizations within the Arab population living in Israel are discussed.     

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.     

The Borderline Schizophrenic in Group Psychotherapy

SAGE is a group program developed for the community elderly. Groups led by professionals were compared to those led by the elderly, who were supervised SAGE graduates, and both of these groups of participants were compared to a wait-control group of elderly. A series of pre- and postmeasures on goal attainment scales and physical and mental health indices were used to evaluate the impact of the SAGE program. Professionally led groups had greater impact on improvement of mental health indices compared to the peer-led groups. These findings are discussed in the context of a framework used to analyze the differences between professionally conducted therapy, paraprofessionals, and peer-led self-help groups. Implications for the role of professionals in self-help are examined.     

A Worksite smoking cessation intervention involving the media and incentives

This study evaluated an attempt at 38 workplaces to help employees stop or reduce their levels of smoking. In past research, worksite support groups, in combination with a media smoking cessation program and self-help manuals, were found to be effective in helping employees quit smoking. Unfortunately, recidivism was found at the follow-up evaluations. The present study replicated the results of the previous worksite smoking cessation program with support groups, a television intervention, and self-help manuals. At this postpoint, 42% of employees provided groups plus incentives were abstinent compared to only 15% who were only provided self-help materials. An important difference in this study was that there were also monthly follow-up support groups and incentives. Work settings can be a source of stress and conflict, which can precipitate relapse. At a 12-month follow-up, 26% of those participants who were provided support and incentives were abstinent compared to 16% who were only provided the self-help materials.     

Self-help interventions for adjustment disorder problems: a randomized waiting-list controlled study in a sample of burglary victims

Adjustment disorders (AjD) are among the most frequent mental disorders yet often remain untreated. The high prevalence, comparatively mild symptom impairment, and transient nature make AjD a promising target for low-threshold self-help interventions. Bibliotherapy represents a potential treatment for AjD problems. This study investigates the effectiveness of a cognitive behavioral self-help manual specifically directed at alleviating AjD symptoms in a homogenous sample of burglary victims. Participants with clinical or subclinical AjD symptoms following experience of burglary were randomized to an intervention group (n = 30) or waiting-list control group (n = 24). The new explicit stress response syndrome model for diagnosing AjD was applied. Participants received no therapist support and assessments took place at baseline, after the one-month intervention, and at three-month follow-up. Based on completer analyses, group by time interactions indicated that the intervention group showed more improvement in AjD symptoms of preoccupation and in post-traumatic stress symptoms. Post-intervention between-group effect sizes ranged from Cohen’s d = .17 to .67 and the proportion of participants showing reliable change was consistently higher in the intervention group than in the control group. Engagement with the self-help manual was high: 87% of participants had worked through at least half the manual. This is the first published RCT of a bibliotherapeutic self-help intervention for AjD problems. The findings provide evidence that a low-threshold self-help intervention without therapist contact is a feasible and effective treatment for symptoms of AjD.     

Political ideology,helping mechanisms and empowerment of mental health self‐help/mutual aid groups

Self‐help/mutual aid groups share common attributes such as they are peer‐led, address a common problem or condition, have a voluntary character and little or no connection with professionals. However, these groups may vary according to their political ideology and focus on personal or/and societal change. This study examines the role of political ideology of self‐help/mutual aid groups and differences in psychosocial characteristics of group members. Fourteen mental health self‐help/mutual aid groups in England were studied. On the basis of stated aims and principles and following semi‐structured interviews with group leaders (facilitators/chairpersons), these were classified according to Emerick's typology as conservative (eight groups), combined (three groups), and radical (three groups). Group members (n = 67) completed questionnaires to assess personal empowerment, mental wellbeing, social networks and support, group identification and helping processes in the groups. Findings suggested that all self‐help group members experienced a large number of naturally occurring helping process and felt empowered whilst they shared limited social networks and support and marginal mental wellbeing. Different ideological types of self‐help groups may be related to specific helping processes and particular aspects of personal empowerment. Specifically, members of conservative and combined groups reported more expressive group processes like sharing of feelings and self‐disclosure, while radical group members reported more optimism/control over their lives. Furthermore, group identification was associated with specific helping processes and aspects of personal empowerment in the three group categories. Copyright © 2002 John Wiley & Sons, Ltd.     

Factors Determining National Stereotypes

Summary

In order to test various explanations of the fact that perceived competence appears to correlate positively with altruism, Ss were given false feedback as to their competence on a “visual creativity” test and then asked to help with a second task, writing creative color names. Three groups of Ss who were told they were competent were given reduced cost, increased happiness, and increased responsibility as reasons for helping; the other three groups were given no explanations, but were told that their competence was high, or low, or given no information. The three explanation groups helped more than the other three groups, and the reduced cost group helped more than the other five. The three dependent measures of helping (percentage of helpful Ss, duration of help, and magnitude of help) proved differentially sensitive to treatment and sex differences. Only the latter two measures showed greater helping in the reduced cost group; only the magnitude measure showed significantly greater helping for males than females.     

Prelogical Experience by Edward S. Tauber and Maurice R. Green

Working as director of a group psychotherapy training program in a university medical center, the author has observed many groups in periods of decreased group stability. These situations tend to arise frequently in an academic setting where summer breaks and other school-related holidays may result in extended periods of irregular attendance. Such times appear to be quite stressful to group members and leaders and frequently result in a storm of transferential and/or countertransferential acting out. This may carry over into supervision sessions via the mechanism of the parallel process and these, too, may become stressful, unrewarding, and nonproductive. An attempt to understand such situations and to find better ways of helping trainees deal with them constructively has resulted in the following ideas about group instability. Although these times remain uncomfortable and stressful, they can be managed and used to generate valuable information for the participants that can further the therapeutic process.     

Self-help conferences for people who stutter: a qualitative investigation

Self-help activities for people who stutter (PWS) have been gaining in popularity; however, there is a scarcity of evidence to support their utility in stuttering management. The purpose of this investigation was to understand the lived experience of individuals who attended a self-help conference(s) for PWS from the perspective of a PWS to learn its potential utility in stuttering management. The investigator used Interpretive Phenomenological Analysis (IPA) to systematically collect authentic data of this social phenomenon. Twelve participants were recruited from a self-help conference and the self-help community of PWS. Semi-structured interviews were conducted 4–18 months after each participant's last conference. Interviews were transcribed and analyzed. Themes were explained in investigator narratives and illustrated through participants’ quotes. Interpreted themes of the experience of having attended a self-help conference(s) for PWS included: socializing opportunities with other PWS, affiliation, redefining oneself and post-conference disclosures. A conclusion of the study was that the experience of having attended a self-help conference(s) for PWS helped to minimize negative impact that stuttering can have on daily functioning. It appears that self-help conferences were perceived as a safer or “stutter-friendly” environment and promoted social interaction, relationship building, and community building through planned and unplanned activities. Another conclusion was that the experience of having attended self-help conferences for PWS helped participants to communicate more easily. Reported increases in social activity and an “openness” about stuttering, suggest self-help conferences’ utility in stuttering management. These findings are supported by other studies about successful stuttering management and self-help activities for PWS. They have helped attendees who stutter to communicate more easily and suggest a reduction in the negative impact that stuttering has on their lives.Educational objectives: The reader will be able to: (1) describe recurring themes associated with the lived experience having attended a self-help conference(s) for people who stutter (PWS) from the perspective of a group of adults who stutter, and (2) describe the potential benefits of attending self-help conferences for PWS in order to make appropriate evidence-based referrals to self-help conferences for PWS.     

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.     

Treating work inhibition in group psychotherapy

Work Inhibition, defined as an impaired ability to pursue one's career goals, may be treated by combined individual and group therapy. The author presents a method for assessing the degree of work difficulty, a psychodynamic understanding of the problem, and an approach to treatment. He proposes that helping the patient work more actively in group will generalize to the workplace and reduce inhibition. A clinical illustration is provided.