Abraham Low Self-Help Systems (ALSHS) is a non-profit organisation formed from the merger of Recovery International and the Abraham Low Institute.
ALSHS facilitates the estimated 600 worldwide Recovery International meetings and all projects formerly run by the Abraham Low Institute including the Power to Change programme. The organisation is named after Abraham Low, founder of the mental health self-help organisation now known as Recovery International.
Recovery, Inc., often referred to simply as Recovery, was officially formed 07 November 1937, by neuropsychiatrist Abraham Low in Chicago, Illinois. Low created the organisation to facilitate peer support self-help groups for former mental patients and later allowed for participation of those who had not been hospitalised, but with a desire to improve their mental health. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. As of 2008 there were over 600 weekly Recovery International meetings held throughout North America, Ireland, the United Kingdom, Israel and India.
The Abraham Low Institute was founded in 1989 to develop programmes, in addition to Recovery, based on Low’s self-help principles. The Institute awarded grants to further scholarly research on Low’s work, provided research resources for people interested in Low’s methods, and developed the Power to Change programme and The Relatives Project.
On 01 January 2008 Recovery International merged with The Abraham Low Institute and provisionally renamed the new organisation Recovery International / The Abraham Low Institute (RI/TALI). Celinda Jungheim, a community volunteer from Los Angeles, was elected as president of the Board of Directors. Abraham Low Self-Help Systems was incorporated on 01 January 2009, completing the merger of Recovery International and The Abraham Low Institute. Abraham Low Self-Help Systems is now the provider of Recovery International community, phone and online meetings and The Power to Change programme, which was a programme of The Abraham Low Institute.
The Relatives Project
The Relatives Project, found in 1993, provides support for family and friends of people who have mental and emotional problems. The Relatives Project teaches coping skills and stress management through meetings similar to those held in Recovery International groups, but using literature written by Abraham Low specifically for the families of his patients. Relatives are taught to maintain empathy and unconditional positive regard for their ill relative, while reframing their domestic environment to provide an empowering atmosphere for all members. The Relatives Project groups are open to adults and teenagers, and allow professionals to observe but only to participate if it is in support of a family member’s mental health. Mental health becomes a shared goal for a family, and all family members share in responsibility to achieve it.
Power to Change
Power to Change is a cognitive-behavioural peer-to-peer programme based on Low’s self-help principles. Power to Change primarily teaches at-risk students and ex-prisoners principles of Low’s Self-Help system in peer-to-peer groups. Power to Change groups generally consist of 8-12 members, meeting weekly, who learn the principles of the Low Self-Help System by describing their personal experience of disturbing events and commenting on each other’s experiences using a highly structured format.
Specifically, Power to Change consists of five components:
A peer-to-peer process intended to provide a safe environment for members to disclose their experiences to a supportive group,
A meeting structure intended to keep discussion on topic,
A four-part format to help members frame their experiences as useful examples, and
Group feedback utilising a set of tools (principles of Abraham Low’s therapeutic technique).
The four-part example consists of an objective description an event; a report of the feelings, sensations, thoughts, and impulses experienced in the members mind and body; how the member used the Power to Change tools to manage the experience; and a self-endorsement to remind the member of the progress made and to reward their effort. The Power to Change groups use much of the language suggested in the Recovery International programme, such as identifying “temper” and avoiding judgment of right and wrong.
The W.K. Kellogg Foundation has provided grants for Power to Change since 2003. The most recent grant was awarded in November 2008, and will provide funding until November 2010.
Chicago Public Schools
In 2007 Urban Networks Associates (UNA) conducted an evaluation of Power to Change as it was implemented in seventeen secondary and middle schools in the Chicago Public School system. In each school 12-24 group sessions were held and facilitated by either staff from the Abraham Low Institute or by a local facilitator trained by the Abraham Low Institute. Participating students showed significant improvement in prosocial behaviour as measured by pre-testing and post-testing of emotional intelligence, specifically increasing self-restraint and decreasing violent behaviours. Although statistically significant, the effect sizes of changes were low or medium.
UNA’s SEM evaluation of the Power to Change logic model, the required steps and conditions for the program to be effective, found it fit the data collected well. To improve the effectiveness of the program UNA recommended improving communication with and training of local facilitators, encouraging students to develop plans to apply programme tools outside of the group, updating the literature used to make it more age appropriate for the young students, adding activities to encourage confidentiality of what was said in group meetings and developing more interactive activities to teach programme concepts. UNA also suggested asking for a commitment from participating schools to guarantee facilities were always available and that students would not be prohibited from attending group sessions.
Low was born 28 February 1891, in Baranów Sandomierski, Poland.
Low attended grade school, high school and medical school in France from 1910 to 1918. He continued his medical education in Austria, serving in the Medical Corps of the Austrian Army. He graduated with a medical degree in 1919, after his military service, from the University of Vienna Medical School. After serving an internship in Vienna, Austria from 1919 to 1920, he immigrated to the United States, obtaining his US citizenship in 1927.
From 1921 to 1925 he practiced medicine in both New York, New York and Chicago, Illinois. In 1925 he was appointed as an instructor of neurology at the University of Illinois College of Medicine and became an associate professor of psychiatry. In 1931 Low was appointed assistant director and in 1940 became acting director of the university’s Neuropsychiatric Institute.
From 1931 to 1941 he supervised the Illinois State Hospitals. During this time he conducted demanding seminars with the staff and interviewed the most severe mental patients in the wards. In 1936, Low’s Studies in Infant Speech and Thought was published by the University of Illinois Press. Some sixty papers are by Low dealing variously with such topics as: Histopathology of brain and spinal cord, studies on speech disturbances (aphasias) in brain lesions, clinical testing of psychiatric and neurological conditions, studies in shock treatment, laboratory investigations of mental diseases; and several articles on group psychotherapy had been published in medical periodicals.
Death and Legacy
Low died in 1954 at the Mayo Clinic in Rochester, Minnesota. His contributions to the psychiatric and mental health communities are often not well known, but his work has and continues to assist numerous individuals in the area of mental health. The psychologist and founder of REBT, Albert Ellis, credits Low as a founder of cognitive behavioural therapy.
In 1937, Low founded Recovery, Inc. where he served as its medical director from 1937 to 1954. During this time he presented lectures to relatives of former patients on his work with these patients and the before and after scenarios. In 1941, Recovery Inc. became an independent organization. Low’s three volumes of The Technique of Self-help in Psychiatric Aftercare (including “Lectures to Relatives of Former Patients”) were published by Recovery, Inc. in 1943. Recovery’s main text, Mental Health Through Will-Training, was originally published in 1950. During the organisation’s annual meeting in June 2007, it was announced that Recovery, Inc. would thereafter be known as Recovery International.
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Recovery International (formerly Recovery, Inc., often referred to simply as Recovery or RI) is a mental health self-help organisation founded in 1937 by neuropsychiatrist Abraham Low in Chicago, Illinois.
Recovery’s programme is based on self-control, self-confidence, and increasing one’s determination to act. Recovery deals with a range of people, all of whom have difficulty coping with everyday problems, whether or not they have a history of psychiatric hospitalisation. It is non-profit, secular, and although it uses methods devised by Low, most groups are currently led by experienced non-professionals.
In 1937, Abraham Low, a neuropsychiatrist, was on the faculty at the University of Illinois at Chicago, and participants in Recovery were limited to those who had been hospitalised in the Psychiatric Institute at the University. At that time, Recovery Inc. was an entity of the Neuropsychiatric Institute at the University of Illinois Research and Education Hospital. The original thirty-seven founding members had recovered their mental health after receiving insulin shock treatments at the Institute.
Low began the groups as part of an attempt to improve the patient’s care following discharge from his hospital. In the early years of the organisation he encouraged members to advocate for improvements in social policies regarding state mental health regulations. Following backlash from the medical community to these efforts, Low disbanded the group in 1941. His patients, however, asked to be trained to teach Recovery’s methods to others and in 1942 Low began to teach members to lead groups in their homes.
The organization separated from the Psychiatric Institute in 1942, operating out of private offices in Chicago. New membership at this time was drawn largely from patients in Low’s private psychiatry practice. During the first years following its separation Low remained in close contact with all Recovery groups and received regular reports from group leaders. As the membership and number of meetings grew, it made this level of cooperation with the groups untenable. In 1952, Low allowed expansion of Recovery outside of Illinois, giving control of local groups to former patients who had become group leaders. Following Low’s death in 1954, Recovery transitioned completely from a professionally run treatment adjunct, to a peer-run self-help group.
Effective 01 January 2007 Recovery, Inc. formally changed its name to Recovery International. On 02 January 2008 Recovery International merged with The Abraham Low Institute and provisionally renamed the new organisation Recovery International / The Abraham Low Institute (RI/TALI). On 01 January 2009, Abraham Low Self-Help Systems was incorporated to umbrella several new programmes, and the group continues operations as Recovery International and Abraham Low Self-Help Systems in various states and internationally.
The causes and classification of mental illnesses are considered irrelevant in the Recovery method. Recovery members are simply viewed as people who have developed disturbing symptom-reactions leading to ill-controlled behaviour. Symptoms are threatening sensations; including feelings, impulses, and obsessive thoughts. The phrase, “symptomatic idiom” describes the mental association of danger with symptoms.
The symptomatic idiom implies that there is an impending catastrophe of physical collapse, mental collapse, or permanent handicap. In the first instance, for example, a person may consider heart palpitations as signalling that sudden death is imminent, or that a painful headache is caused by a brain tumour; phobias, compulsions, and ruminations would eventually cause a mental collapse. The fear of permanent handicap insists that there is no cure or relief for one’s mental illness and that recovery is impossible.
Temper is a combination of a feeling and a judgement about oneself or others. The feeling is related to one of the two types of temper, fear or anger. The judgment is that one has been wronged by another, or that one has done something wrong. “Fearful temper” arises from thoughts that one has made a mistake (has done something wrong) which in turn causes feelings such as fear, shame and inadequacy. “Angry temper” results from the belief that one has been wronged which in turn creates feelings of indignation and impatience. There is a two-way relationship between temper and symptoms. Symptoms induce emotions such as fear and anger, which in turn induce temper, which increases the intensity of the symptoms.
“Temperamental lingo” describes language related to judgments of right and wrong, and the use of defeatist language when discussing symptoms. When discussing symptoms, temperamental lingo includes the use of adjectives such as “intolerable,” “uncontrollable,” “unbearable,” and similar language that places an emphasis on the dangerous and fatalistic implications of feelings, impulses, or thoughts.
Free will is fundamental to Recovery’s method. The subconscious, as it is known in psychoanalysis, as well as viewpoints emphasizing unconscious motivations, drives, and instincts are considered to be self-defeating. Recovery considers adults as capable of behaving based on deliberate plans, settled decisions, reasoned conclusions and firm determinations. Will gives adults the ability to accept or reject thoughts and impulses. Recovery members achieve mental health by training their Wills to reject self-defeating thoughts and impulses, countering them with self-endorsing thoughts and wellness-promoting actions.
External and Internal Environment
Recovery distinguishes between the External Environment, the realities of a situation, and the Internal Environment, one’s own subjective feelings, thoughts, impulses, and sensations. Two components of the Internal Environment, thoughts and impulses, can be directly controlled by Will. Control of thoughts and impulses allows indirect control over sensations and feelings. For instance, thoughts of insecurity and anxiousness can be replaced with thoughts of security. Similarly, a feeling of fear can be disposed by removing the associated belief of danger (symptomatic idiom). While the Internal Environment can be changed with cognitive reframing, changing one’s External Environment may or may not be possible.
Recovery focuses on treating former mental patients, sometimes referred to as post-psychotic persons, as well as psychoneurotic persons. The latter group is most often referred to as “nervous” or “nervous patients”. Recovery members may refer to themselves as “nervous patients” regardless of whether they are being treated by a physician or other professional. Sociologist Edward Sagarin described this as a compromise between the term neurotic and the more colloquial phrase “nervous breakdown”.
Recovery encourages members to cognitively reframe their experiences using several techniques. Spotting, reframing defeatist language, self-endorsement and creating Examples are the most commonly cited in scholarly reviews of Recovery.
Spotting is an introspective relabelling of thoughts and symptoms. When a thought arises related to angry temper, fearful temper, or associating danger with a symptom it must be spotted and reframed. Members practice spotting and reacting appropriately to the distressing thought or symptom.
Recovery developed its own language for labelling psychiatric symptoms and responding to them. This language is centred around two concepts, “authority” and “sabotage.” It is suggested that members rely on the authority of a physician’s diagnosis with respect to their symptoms. For instance, if a member self-diagnoses a headache as being caused by a brain tumour, but a physician has diagnosed it otherwise, then the member is said to be sabotaging the physician’s authority. This is similarly true for the member’s prognosis, if a member despairs that their condition is hopeless, but a physician has found the prognosis to be good, this is also sabotage of the physician’s authority. Using the physician’s perspective to reframe defeatist thoughts is intended to help members recognise that they have not lost control, and their situation can be coped with.
Members practice self-endorsement of every effort made to use a Recovery method, no matter how small and regardless of the outcome. In this way, similar subsequent efforts will require less work and are more likely to be successful. Similarly members are taught to change their behaviour in “part acts” (small steps), to simply “move their muscles” to complete tasks, however small, to eventually complete larger overwhelming tasks.
The Example format was created by Low as a means to allow Recovery to function as a stand-alone lay self-help group that would not require professional supervision. Members create Examples by following a four-part outline, each part requiring a description.
Details of an event that caused distress.
The symptoms and discomfort that the event aroused.
How Recovery principles were utilised to cope with the event.
How the member would have behaved in response to the event before joining Recovery.
Examples are a formalised way to practice the Recovery programme. A successful outcome is not required to create an Example, as all attempts at practicing Recovery methods are endorsed.
1937 to 1952
During the first fifteen years of Recovery, Low required members to attend classes and meetings for at least six months at a cost of ten dollars per month, not including the membership dues of two dollars per year. Members would meet at least three days a week and on Wednesdays take part in panel discussions as panellists or audience members held at a private home. Panel discussions would consist of three to four panellists with considerable experience in Recovery discussing a topic from Low’s literature, focusing on spotting and conquering symptoms. Dr. Low would address the audience at the end of each panel discussion summing up the discussion and correcting any misinformation given about Recovery. Every Thursday Low would conduct a group psychotherapy class for Recovery members.
No meetings were held between Saturday and Wednesday. Commonly, novice members would have a “setback,” a relapse of psychiatric symptoms, during this time. As setbacks were considered unavoidable, the novice members were assigned to a more experienced member to call or visit should they need assistance. If the assistance provided by the experienced member was not helpful, they could contact a chairperson in their area (a member who functioned like the physician’s deputy), and if that was still not satisfactory they could contact the physician, Dr. Low.
1952 to Present
At the meetings, members share examples from their lives that caused nervous symptoms, the thoughts that occurred just beforehand, how they spotted them and reacted to them. Other members offer alternative ways of looking at the situation and suggest how to better handle similar symptoms in the future. Meetings range in size from 6 to 30 members and follow a rigid schedule to ensure adherence to Recovery methods. Each meeting has a leader in a permanent position; leadership duties do not rotate from meeting to meeting. Each meeting is split into five parts. Members introduce themselves by first name only, as is practiced in Alcoholics Anonymous.
Impact of Pandemic (2020-2021)
Due to COVID-19, more than 300 community meetings were closed, and many new telephone and online meetings were added. This gives people access to more meetings at various times during the week, regardless of geography.
Reading of Recovery Literature
The beginning of a meeting is generally reserved for reading from Recovery literature. Members take turns reading sections of a chapter or article. Group leaders will often call on new members during this period, or members who are hesitant to volunteer. After finishing a paragraph a group leader will often ask a member if they experienced any symptoms while reading the literature and will endorse them for the efforts to continue reading despite feelings of discomfort or fear of making mistakes.
Presentation of Examples
Only members who have read Mental Health Through Will Training are allowed to participate in this portion of the meeting. Those participating form a “panel” although they are usually seated face-to-face around a table. The group leader reminds the members that examples should be constructed around day-to-day events as Recovery is a non-professional organisation and cannot help people with major problems. This statement is qualified, however, with Low’s opinion that the majority of a nervous patient’s problems are related to “trivial” incidents. Rather than being a limitation of Recovery’s programme, this is intended to be a novel treatment approach. A day-today trivial event may generalise to other problems experienced by the member. Discussion of trivialities is less threatening than complex problems, making a discussion of coping mechanisms possible.
A survey of groups in Chicago in 1971 and 1977 found that most examples presented were stories of successful application of the Recovery method, less than 10% represented “problem examples” where the application was not successful.
After an Example has been given, the meeting is opened for “group spotting”. During this period other members of the panel are allowed to comment on the Example based on Recovery principles. This group leader usually makes the first comments, and if there are no volunteers to continue, he or she may call on panel members to provide commentary. Comments not based on Recovery’s concepts or not related to the example are stopped by the group leader. Comments are either classed as positive, praise for application of a Recovery method, or negative, related to an instance where a method was not applied. An Example rarely passes without mention of additional Recovery techniques that could be applied to it. This serves as a constant reminder that Recovery’s method can never be practiced perfectly; members can always learn from experience and benefit from group practice.
For example, a person may experience “lowered feelings” (depression) because they are aiming for a perfect performance. Trying to be perfect or trying to appear perfect leads one to feel down if one makes even the slightest mistake. All improvements, no matter how small, are acknowledged and members are encouraged to endorse themselves for their efforts – not for their successes. Longstanding members are encouraged to share their success with the Recovery methods to help newcomers. Low saw the sharing of successes by veteran members as an essential component of meetings, as it demonstrates that distressing sensations can be endured, impulses can be controlled, and obsessions can be checked.
Question and Answer
Following the panel presentation, about fifteen minutes are set aside for a question and answer period. Any member may ask a question of the panel during this time, newcomers are especially encouraged to participate. Discussion, however, must be limited to the Examples given and related Recovery concepts. Discussion questioning Recovery’s method is not allowed. Discussion of psychological theories outside of Recovery is similarly discouraged. In a case where a member brings up a disagreement between his physician and a Recovery concept, he or she is told that the panel is not qualified to provide an answer not related to the Examples presented. Members are expected to follow the advice of their professional; Recovery is not intended as a substitute for psychiatric services, but a self-directed programme that can be used as an adjunct to professional treatment, or alone when professional treatment is not available.
Mutual Aid Meeting
The formal meeting ends with the question and answer period, and an informal “mutual-aid” gathering usually follows. During this time refreshments are usually served. Members may speak freely with one another and discuss problems or ask for advice, although there is an attempt to keep the discussion within the bounds of Recovery concepts. By convention, discussion of problems are limited to five minutes in an attempt to discourage self-pity and complaining.
From 1952 to 2008, Recovery was run from its office in Chicago by a twelve-member Board of Directors, a number of committees, organisation officers, and a full-time paid administrative staff. The Board of Directors was elected at Recovery’s annual meeting and served for a period of three years. Authority from the Board of Directors was passed to Area Leaders then to Assistant Area Leaders, District Leaders, and lastly to Group Leaders. Leaders are trained to run Recovery meetings, but are not considered experts or authorities. Policies and practices of Recovery were made by the Board of Directors.
In the early years of Recovery, an event was held on Saturday afternoons at Recovery’s office in Chicago for Recovery members as well as their relatives and friends. Later, family and friends of members were allowed to attend meetings, although not to participate. In 1943 Low published a book, Lectures to Relatives of Former Patients to help assist them with the recovery effort; this information was later reprinted in Peace Versus Power in the Family: Domestic Discord and Emotional Distress in 1967.
In 1945, Abraham Low found the average member improved considerably after the first or second week in the programme as it existed at that time. However, members were required to lose their major symptoms within two months of membership and class attendance. If they did not, this was taken as an indication that the member was still sabotaging the physician’s efforts.
A 1984 study found that following participation in Recovery, former mental patients reported no more anxiety about their mental health than the general public. Members rated their life satisfaction levels as high, or higher, than the general public. Members who had participated two years or more reported the highest levels of satisfaction with their health. Members who participated for less than two years tended to still be taking medication and living below the poverty level with smaller social networks.
A 1988 study found that participation in Recovery decreased members’ symptoms of mental illness and the amount of psychiatric treatment needed. About half of the members had been hospitalised before joining. Following participation, less than 8% had been hospitalised. Members’ scores of neurotic distress decreased, and scores of psychological well-being for longstanding members were no different from members of a control group in the same community. Long-term members were being treated with less psychiatric medication and psychotherapy than newer members.
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Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing.
This article focuses on groups for which members do not need to share a common diagnosis or aetiology of their mental illness. Improving mental health and wellbeing is also a desired outcome of groups like, for example, Alcoholics Anonymous and Survivors Network of those Abused by Priests. In those cases, for example, members share the trait of alcoholism or traumatic experiences of abuse by priests and those groups focus on improving the mental health and wellbeing of members while acknowledging their shared circumstances.
Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.
Mutual Support and Self-Help
Mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. Mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.
Mutual support may include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. The former is where members seek to improve themselves, where as the latter set encompasses advocacy organisations such as the National Alliance on Mental Illness and Psychiatric Rehabilitation Association.
Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help Organisations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favour of those affected.
Behaviour Control or Stress Coping Groups
Of individual therapy groups, researchers distinguish between Behaviour Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.
Significant differences exist between Behavioural Control groups and Stress Coping groups. Meetings of Behaviour Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behaviour Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behaviour Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.
Member vs Professional Leadership
In Germany, a specific subset of Conversation Circles are categorised as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.
Professionally Led Group Psychotherapy
Self-help groups are not intended to provide “deep” psychotherapy. Nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.
Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.
Professional Affiliation and Group Lifespan
If self-help groups are not affiliated with a national organisation, professional involvement increases their life expectancy. Conversely, if particular groups are affiliated with a national organisation professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group’s effectiveness.
Typology of Self-Help Groups
In 1991 researchers Marsha A. Schubert and Thomasina Borkman created five conceptual categorizations for self-help groups.
Unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. These groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. Leaders serve to help the groups function by collecting donations not through controlling the members. Experiential knowledge is mostly found, and there is a high emphasis on sharing. An example of an unaffiliated group includes Wildflowers’ Movement in Los Angeles.
Federated groups have superordinate levels of their own self-help organisation at state or national levels which makes publicity and literature available. The local unit of the federated self-help group retains full control of its decisions. These groups tend to rely on experiential knowledge, and professionals rarely directly interact. The leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. Leaders do not need to have formal training to gain their title. Examples of a federated self-help group would be Depression and Bipolar Support Alliance (DBSA) and Recovery International.
Affiliated groups are subordinate to another group, a regional or national level of their own organisation. Local groups conform to the guidelines of the regional/national groups. Leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. Examples of an affiliated self-help group would be the National Alliance on Mental Illness (NAMI).
Managed groups are based on a combination of self-help and professional techniques. These groups are populated generally through referrals and group activities are led by group members. Managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. Examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion.
The hybrid group has characteristics of the affiliated and managed groups. Like affiliated groups, hybrid groups are organised by another level of their own organisation. To participate in specialised roles, training is developed by a higher level and enforced through trained leaders or facilitators. Like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge.
No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioural techniques, and complicated cognitive-restructuring methods are not necessary.
Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited to: acceptance, behavioural rehearsal, changing member’s perspectives of themselves, changing member’s perspectives of the world, catharsis, extinction, role modelling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalisation, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or “opening up”), and showing empathy.
Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.
Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
Members obtain specialised information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increases their confidence.
Social Learning Theory
Members with experience become credible role models.
Social Comparison Theory
Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
Those helping each other feel greater interpersonal competence from changing other’s lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive “personalized learning” from working with helpees. The helpers’ self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others.
A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behaviour. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.
Relationship with Mental Health Professionals
A 1978 survey of mental health professionals in the United States found they had a relatively favourable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.
The 1987 Surgeon’s General Workshop marked a publicised call for egalitarian relationships with self-help groups. Surgeon General C. Everett Koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations.
A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.
Surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is “Doctors know better than we do how sickness can be treated. We know better than doctors how sick people can be treated as humans.”
A large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. Professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. While twelve-step groups, such as Alcoholics Anonymous, make an indispensable contribution to the mental and/or substance use (M/SU) professional services system, a vast number of non-twelve-step groups remain underutilised within that system.
Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one-third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals.
Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalisations, and shorter hospitalisations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programmes, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalisation and shorter durations of hospitalisation indicate that self-help groups result in financial savings for the health care system, as hospitalisation is one of the most expensive mental health services. Similarly, reduced utilisation of other mental health services may translate into additional savings for the system.
While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.
Members of self-help groups for mental health rated their perception of the group’s effectiveness on average at 4.3 on a 5-point Likert scale.
Social support, in general, can lead to added benefits in managing stress, a factor that can exacerbate mental illness.
Select List of Organisations
Depressed Anonymous (DA) is based on the model pioneered by Alcoholics Anonymous and open to anyone who wants to stop saddening themselves.
Emotions Anonymous (EA) is a derivative programme of Neurotics Anonymous and open to anyone who wants to achieve emotional well-being. Following the Twelve Traditions, EA groups cannot accept outside contributions.
GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organisation now known as Recovery International, see below) and integrated its processes into their programme. GROW’s original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.
Neurotics Anonymous is a twelve-step programme open to anyone with a desire to become emotionally well. According to the Twelve Traditions followed in the programme, Neurotics Anonymous is unable to accept outside contributions. The term “neurotics” or “neuroses” has since fallen out of favour with mental health professionals, with the movement away from the psychoanalytic principles of a DSM-II. Branches of Neurotics Anonymous have since changed their name to Emotions Anonymous, which is currently the name in favour with the Minnesota Groups. Groups in Mexico, however, called Neuróticos Anónimos still are referred to by the same name, due to the term “neuroticos” having a less pejorative connotation in Spanish. This branch continues to flourish in Mexico City as well as largely Spanish-speaking cities in the United States, such as Los Angeles.
Recovery, Inc. was founded in Chicago, Illinois, in 1937 by psychiatrist Abraham Low using principles in contrast to those popularised by psychoanalysis. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise between the loaded term neurotic and the colloquial phrase “nervous breakdown”); strictly encourages members to follow their physician’s, social worker’s, psychologist’s or psychiatrist’s orders; and does not operate with funding restrictions.
Fundamentally, Low believes “Adult life is not driven by instincts but guided by Will,” using a definition of will opposite of Arthur Schopenhauer’s. Low’s programme is based on increasing determination to act, self-control, and self-confidence. Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encouraged to attend Recovery International meetings in addition to their twelve-step group participation.
There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognise a “newcomer” presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups’ formulaic approach, attrition rates, over-generalisation, and “panacea complex”.
Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticised self-help group structure as being too rigid.
High Attrition Rates
There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.
Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.
There is a risk that self-help group members may come to believe that group participation is a panacea – that the group’s processes can remedy any problem.
Sexual Predation and Opportunism
Often membership of non-associated self-help groups is run by volunteers. Monitoring of relationships and standards of conduct are seldom formalised within a group and are done on a self-regulating basis. This can mean undesirable and unethical initiation of sexual and intimate encounters are facilitated in these settings. Predatory and opportunistic behaviour in these environments which by association involve divulging volatile mental states, medication changes and life circumstances mean opportunities by those willing to leverage information that is often normally guarded and deeply personal, is a risk more-so than in other social meetup settings or professionally governed bodies.
Finding Your Best Self: Recovery from Addiction, Trauma, or Both.
Author(s): Lisa M. Najavits (PhD).
Edition: Second (2nd).
Publisher: Guildford Press.
Type(s): Hardcover, Paperback, and Kindle.
Addiction and trauma are two of the most common and difficult issues that people face. In this motivating book, leading expert Lisa Najavits explains the link between addiction and trauma and presents science-based self-help strategies that you can use no matter where you are in your recovery. Every chapter features inspiring words from people who have “been there,” plus carefully designed reflection questions, exercises, and other practical tools. Learn how you can:
Build coping skills so that the future is better than the past.
Keep yourself safe and find support.
Set your own goals and make a plan to achieve them at your own pace.
Choose compassion over self-blame and shame.
Move toward your best self – the person you want to be.
If you are a family member or friend seeking to support a loved one – or a helping professional – this book is also for you. Now in a convenient large-size format, the revised edition features added materials for professional and peer counsellors. First edition title: Recovery from Trauma, Addiction, or Both.
Mental health professionals, see also the author’s Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, which presents an evidence-based treatment approach developed specifically for PTSD and substance abuse.
An Introduction to Child and Adolescent Mental Health.
Author(s): Maddie Burton, Erica Pavord, and Briony Williams.
Edition: First (1st).
Publisher: SAGE Publications.
Type(s): Hardcover, Paperback, and Kindle.
Anyone who works within children and adolescent mental health services will tell you what a challenging and complex world it is. To help prepare you, the authors have produced a clear introduction to child and adolescent mental health that takes you step-by-step on a journey through the subject. Beginning with the foundations, the book explores the common mental health concepts and influences that you can expect to encounter examining topics like the difference between emotional and mental health issues and how mental health problems develop.
Never Let Go: How to Parent Your Child Through Mental Illness.
Author(s): Suzanne Alderson.
Edition: First (1st).
Type(s): Paperback, Audiobook, and Kindle.
How to help your child with mental illness through partnering, not parenting.
Never Let Go is a supportive and practical guide for parents looking after a child with a mental illness. Suzanne Alderson understands the agonising struggle of bringing a child back from the brink of suicide, having spent three years supporting her own daughter through recovery. Her method of ‘partnering, not parenting’ has now helped thousands of other parents through her charity, Parenting Mental Health.
Combining Suzanne’s honest personal experience with expert input from psychologists, this book provides parents with the methods and knowledge they need to support, shield and strengthen their child as they progress towards recovery. Chapters include a background to the mental health epidemic, why a new method of parenting is crucial, how to change your thinking about mental health and practical advice on solutions to daily problems including accepting the new normal, dealing with others, and looking after yourself as well as your child.
Understanding Mental Illness is the 6th edition of this professionally acclaimed book. This is a comprehensive, jargon-free guide aimed at volunteers, patients, carers, new professionals and students of mental health, as well as the keen general reader.
The book contains a wealth of information, including a history of mental illness from primitive times to the 20th century, with the often-bizarre treatments meted out in earlier times.
There is a selection of case histories on common disorders, together with ‘pen portraits’ illustrating ‘a day in the life of’ medical and non-medical therapists. Illustrated throughout with a glossary, suggested reading and index. The keen student is sure to find topics of interest for further study in this fascinating field.