Self Help and Mutual Support

Edited by Greg Townley (gtownley@pdx.edu) and Alicia Lucksted (Aluckste@psych.umaryland.edu)

For this issue’s Self-Help and Mutual Support column, Ruth Hollman, Executive Director of SHARE! in Los Angeles, provides suggestions for best practices for the structure and practice of self-help support groups.  SHARE! is a nonprofit organization founded in 1992 that hosts more than 150 self-help support groups each week in Los Angeles, CA. (www.shareselfhelp.org)

Best Practices for the Structure of Self-Help Support Group

Written by Ruth L. Hollman (ruth@shareselfhelp.org)

SHARE! strongly suggests that the format of the meeting be a written document that different members read at each meeting.  Meetings with shared leadership retain more members, last longer and help more people. If you are starting a new meeting, it makes sense to see if there is already a format for the issue you wish to address.  The American Self-Help Clearinghouse is a place to find out about what already exists (http://www.mentalhelp.net/selfhelp/). If you cannot find what you are looking for, then here is what SHARE! recommends as best practices for the structure of self-help support groups.  Choose what works best for your meeting.  As they say in the groups “Take what you like, and leave the rest!”

Welcome

Welcome everyone and let everyone know what meeting they are attending and what time the meeting ends.  These are the two biggest concerns of newcomers:  (1) Am I in the right place? and (2) How long is this meeting? Answering these up front will allow newcomers to relax and listen.

Why are we here?

Describe in terms that each participant understands and relates to, whatever it is that brings them together.  This section can make or break a meeting.  It is the ice breaker, which make it OK to talk about the meeting’s focus at a trusting, deep and feeling level as soon as the sharing begins.  Make lists or narratives of feelings, characteristics and situations, which the group members can particularly relate to.  This section should deeply affect everyone in the meeting.  This section is often read by someone other than that day’s group leader.

What can we do about it?

Here we give members tools and hope for a better life.  Some meetings list tools, such as attending meetings, calling people in the meeting, writing feelings, etc.  Others talk about goals the group members share, and how reaching those goals will make their lives happier.  Research has shown that meetings that give people hope attract and retain members better. The idea of this section is to provide hope.  This section is often read by someone other than that day’s group leader.

Education

Some groups (a) read from a book, (b) do an exercise from a workbook or one brought in by a member, (c) have a guest speaker or (d) some other form of education.  This can be very helpful, but it can also take away from the community-building aspect of the self-help group, which is the health-enhancing aspect of the group.  It is important that this part of the meeting not inhibit people from sharing their feelings later on.  It is easy for people to think that “education” is more important than me or my feelings and not leave time for the “intimacy” which make groups prolong lives, etc.  We suggest that if meetings want to have an education section that they set 10 to 20 minutes aside for it, and then make sure that any “expert” or “authority” that was brought in, loses that role for the rest of the meeting.  We strongly suggest that the same member or members of the group not do the educational portion at each meeting, as this skews the egalitarianism of the group and takes away from the personal responsibility of each member.  In cases where the expert is someone who could not be a member of the group, it may be appropriate to ask them to leave after their presentation.  Research has shown that many members drop out after six months of groups that focus on speakers or education.

Sharing

This is the most important part of the self-help meeting:  listening to others who feel the same way and speaking to others who know how you feel.  This is where the community building takes place.   Ideally each person should be given three to ten minutes of time to speak uninterrupted about their feelings, experiences, hopes and fears.  No one should ask questions or make any comments during someone else’s share.  Each person sharing should concentrate on their own feelings and experiences, avoidingtalking about others in the group.  Confidentiality of the speakers must be guaranteed.  Speakers are encouraged to speak in the First Person (I, me, mine) and avoid speaking in the Second Person (you, your, yours).  This section is where members learn that they are not alone.  Expression of feelings is greatly encouraged.  It may help to have Kleenex available.

Feedback

Most self-help groups do not have a formal part of the meeting for feedback.  Feedback can undermine the feeling of being completely heard and understood, which is a large part of the healing that takes place in a support group.  After the meeting people stand around and talk informally.  People who want feedback can ask during their share for feedback after the meeting. 

In a very small meeting (less that 5 people) feedback can be used to enrich the learning experience of those in attendance.  But again, we caution that unregulated feedback can cause great harm to the group and to individuals in the group, so we do not recommend it, except in limited circumstance.  Feedback which is structured to include only someone’s own experience in a similar situation, can make a small group have the benefits of a larger one.  Under no circumstances should feedback be judgmental or in the form of advice.  Sticking to “I” statements only, with no “you” statements, is one way of achieving this.  Some meetings have had success with statements of encouragement only, e.g. “You really handled that well,” “You have made a lot of progress,” “I can understand how you felt.”

Collecting money

Everyone should be given the opportunity to contribute to the well-being of the group.  Support groups have expenses such as rent, literature, flyers, refreshments, etc. When members pay their way there is a certain ownership of the group that follows as well as an entitlement and self-esteem.  Many groups pass a basket for donations.  Some have a set fee such as $3 or $5 per meeting.  Most groups do not keep track of who has paid what, etc. so that even those without funds can attend without shame.  Spending money on one’s own well-being is a sign of self-esteem.

Announcements

During this time the group’s business is transacted and newcomers are informed of literature, phone list, and any other resources available.  If someone needs a ride, this is the time to ask for it.  Many meetings prefer to leave major business, such as rewriting the format, decisions about money, problems in the group until after the meeting.  They announce during the meeting that there will be a business meeting or in 12-Step language a “group conscience” at the end of the next meeting.  Then those who are interested can plan for it and be there and those who don’t care don’t have to be.  While this may seem like the most accommodating way, it may hinder the learning of personal responsibility and the skill of working through problems.  We recommend that group decisions be made during the announcement part of the meeting. 

Some meetings set aside ten minutes each meeting to discuss “business.”  This may be too much time for most meetings.  It is OK to try different ways of doing things and then figure out what works best.  We recommend that compromises be sought to problems.  Ideally each decision should be a consensus, not majority rules.  When the meeting is divided, we suggest trying the new way for three meetings.  Often before the third meetings happens, the problem is solved and everyone sees a consensus.

Ending

The ending usually includes reminders about the confidentiality of the group; that what is said in the meeting is not for gossip or outside disclosure.  It gives a word of hope to those who haven’t been in the meeting long and suggests that people try the meeting six times before they decide if it is helping them.  It reminds people to let others who can benefit from the meeting, know about the meeting.

Finally the group does something together such as standing in a circle and reciting a statement of unity or clapping to celebrate themselves.  It is very important that everyone in the meeting feel welcome to participate in the ending. Many 12-Step programs traditionally used the Lord’s Prayer as their ending.  This resulted in many non-Christians and minority Christians (who use a different version of the prayer) feeling left out.  A few years ago, Alcoholics Anonymous World Service began suggesting to their meetings that they choose a different ending because of the people who felt excluded.  The purpose of the self-help group is to bring love and acceptance to everyone who participated.

If you do decide to use a statement, we suggest something like:

Unity*

I put my hand in yours

And together we can do

What we could never do alone.

No longer is there a sense of hopelessness.

No longer must we each depend

Upon our own unsteady willpower.

We are together now

Reaching out our hands for strength

Greater than our own.

And as we join hands

We find love and understanding

Beyond our wildest dreams.

Fellowship

After the meeting, people will often join together socially for conversation and camaraderie to “fellowship.” Fellowship gives people from the meeting a more casual atmosphere to establish closer friendships.  People can get feedback on issues that came up in the meeting, and newcomers have a chance to ask whatever questions they may have about the recovery process. Fellowship gives everyone the essential social relationships and friendships they can use to build a sturdy foundation in their recovery. People get a chance to use and practice the tools learned in the meeting in social situations. Perhaps most importantly, it gives everyone a fun, intimate outlet where they can be themselves with peers.

* Adapted from “I Put My Hand in Yours” by Roxann, copyright Overeaters Anonymous 1969, 1983. Used with permission.

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